Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DET NUC ACD NEISSERIA GONORRHO

Facility

$141.00

Service Code	HCPCS 87590
Hospital Charge Code	38477164
Hospital Revenue Code	306
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

DET NUC ACD NOS DIRECT PROBE

Facility

$141.00

Service Code	HCPCS 87797
Hospital Charge Code	38477166
Hospital Revenue Code	306
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

DET NUC ACD NOS DIRECT PROBE

Facility

$141.00

Service Code	HCPCS 87797
Hospital Charge Code	38477166
Hospital Revenue Code	306
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$81.68
Rate for Payer: Aetna Medicare Advantage	$97.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.93
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: Cigna Medicare Advantage	$30.03
Rate for Payer: Clover Medicare Advantage	$28.53
Rate for Payer: EmblemHealth Commercial	$90.09
Rate for Payer: Humana Medicare Advantage	$30.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$24.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.03
Rate for Payer: Wellcare Medicare Advantage	$30.03
Rate for Payer: Wellpoint Medicaid Managed Care	$4.00

DET NUC ACD TRICHOMONAS VAG DR

Facility

$141.00

Service Code	HCPCS 87660
Hospital Charge Code	38477165
Hospital Revenue Code	306
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.73
Rate for Payer: Cigna Commercial	$70.50
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$4.00

DET NUC ACD TRICHOMONAS VAG DR

Facility

$141.00

Service Code	HCPCS 87660
Hospital Charge Code	38477165
Hospital Revenue Code	306
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$21.15
Rate for Payer: Qualcare PPO/HMO/WC	$21.15

DEVICE ANGIO SEAL HEMO 610091

Facility

$1,659.25

Service Code	HCPCS C1760
Hospital Charge Code	270610663
Hospital Revenue Code	278
Min. Negotiated Rate	$47.12
Max. Negotiated Rate	$829.62
Rate for Payer: Aetna Commercial	$630.51
Rate for Payer: Aetna Medicare Advantage	$497.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$423.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$423.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$331.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$423.11
Rate for Payer: Cigna Commercial	$829.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.54
Rate for Payer: Qualcare PPO/HMO/WC	$248.89
Rate for Payer: UnitedHealthcare Community & State	$52.43
Rate for Payer: Wellpoint Medicaid Managed Care	$47.12

DEVICE ANGIO SEAL HEMO 610091

Facility

$1,659.25

Service Code	HCPCS C1760
Hospital Charge Code	270610663
Hospital Revenue Code	278
Min. Negotiated Rate	$248.89
Max. Negotiated Rate	$401.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$331.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$401.54
Rate for Payer: Qualcare PPO/HMO/WC	$248.89

DEVICE CAPIO SLIM SUT CAPTURG

Facility

$2,480.00

Hospital Charge Code	270676958
Hospital Revenue Code	272
Min. Negotiated Rate	$70.43
Max. Negotiated Rate	$1,240.00
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: Aetna Medicare Advantage	$744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$632.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$632.40
Rate for Payer: Cigna Commercial	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$644.80
Rate for Payer: Oxford Commercial	$496.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00
Rate for Payer: UnitedHealthcare Commercial	$496.00
Rate for Payer: UnitedHealthcare Community & State	$78.37
Rate for Payer: Wellpoint Medicaid Managed Care	$70.43

DEVICE CAPIO SLIM SUT CAPTURG

Facility

$2,480.00

Hospital Charge Code	270676958
Hospital Revenue Code	272
Min. Negotiated Rate	$372.00
Max. Negotiated Rate	$372.00
Rate for Payer: Qualcare PPO/HMO/WC	$372.00

DEVICECAPTIVATOR EMR STD

Facility

$1,490.00

Hospital Charge Code	270677012
Hospital Revenue Code	272
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$223.50
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

DEVICECAPTIVATOR EMR STD

Facility

$1,490.00

Hospital Charge Code	270677012
Hospital Revenue Code	272
Min. Negotiated Rate	$42.32
Max. Negotiated Rate	$745.00
Rate for Payer: Aetna Commercial	$566.20
Rate for Payer: Aetna Medicare Advantage	$447.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$379.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$379.95
Rate for Payer: Cigna Commercial	$745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.40
Rate for Payer: Oxford Commercial	$298.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.50
Rate for Payer: UnitedHealthcare Commercial	$298.00
Rate for Payer: UnitedHealthcare Community & State	$47.08
Rate for Payer: Wellpoint Medicaid Managed Care	$42.32

DEVICE EXPRESS FILTRATION P

Facility

$5,725.00

Service Code	HCPCS C1783
Hospital Charge Code	270659750
Hospital Revenue Code	278
Min. Negotiated Rate	$162.59
Max. Negotiated Rate	$2,862.50
Rate for Payer: Aetna Commercial	$2,175.50
Rate for Payer: Aetna Medicare Advantage	$1,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,459.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,459.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,459.88
Rate for Payer: Cigna Commercial	$2,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.45
Rate for Payer: Qualcare PPO/HMO/WC	$858.75
Rate for Payer: UnitedHealthcare Community & State	$180.91
Rate for Payer: Wellpoint Medicaid Managed Care	$162.59

DEVICE EXPRESS FILTRATION P

Facility

$5,725.00

Service Code	HCPCS C1783
Hospital Charge Code	270659750
Hospital Revenue Code	278
Min. Negotiated Rate	$858.75
Max. Negotiated Rate	$1,385.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,385.45
Rate for Payer: Qualcare PPO/HMO/WC	$858.75

DEVICE FIXATION 15 FAST OPTIFI

Facility

$2,375.00

Hospital Charge Code	270685694
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

DEVICE FIXATION 15 FAST OPTIFI

Facility

$2,375.00

Hospital Charge Code	270685694
Hospital Revenue Code	272
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$75.05
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

DEVICE FLIPCUTTER 9.0MM

Facility

$3,375.00

Hospital Charge Code	270675323
Hospital Revenue Code	272
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

DEVICE FLIPCUTTER 9.0MM

Facility

$3,375.00

Hospital Charge Code	270675323
Hospital Revenue Code	272
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.50
Rate for Payer: Oxford Commercial	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Commercial	$675.00
Rate for Payer: UnitedHealthcare Community & State	$106.65
Rate for Payer: Wellpoint Medicaid Managed Care	$95.85

DEVICE FORCE TRIVERSE

Facility

$169.25

Hospital Charge Code	270668208
Hospital Revenue Code	272
Min. Negotiated Rate	$25.39
Max. Negotiated Rate	$25.39
Rate for Payer: Qualcare PPO/HMO/WC	$25.39

DEVICE FORCE TRIVERSE

Facility

$169.25

Hospital Charge Code	270668208
Hospital Revenue Code	272
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$84.62
Rate for Payer: Aetna Commercial	$64.31
Rate for Payer: Aetna Medicare Advantage	$50.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.16
Rate for Payer: Cigna Commercial	$84.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.01
Rate for Payer: Oxford Commercial	$33.85
Rate for Payer: Qualcare PPO/HMO/WC	$25.39
Rate for Payer: UnitedHealthcare Commercial	$33.85
Rate for Payer: UnitedHealthcare Community & State	$5.35
Rate for Payer: Wellpoint Medicaid Managed Care	$4.81

DEVICE GRASPING RAPTOR

Facility

$600.00

Hospital Charge Code	270646647
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

DEVICE GRASPING RAPTOR

Facility

$600.00

Hospital Charge Code	270646647
Hospital Revenue Code	272
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

DEVICE GRASPING TALON

Facility

$680.00

Hospital Charge Code	270647220
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

DEVICE GRASPING TALON

Facility

$680.00

Hospital Charge Code	270647220
Hospital Revenue Code	272
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.80
Rate for Payer: Oxford Commercial	$136.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$136.00
Rate for Payer: UnitedHealthcare Community & State	$21.49
Rate for Payer: Wellpoint Medicaid Managed Care	$19.31

DEVICE HIP DISTRACTION ATHE

Facility

$4,875.00

Hospital Charge Code	270667791
Hospital Revenue Code	272
Min. Negotiated Rate	$138.45
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.50
Rate for Payer: Oxford Commercial	$975.00
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Commercial	$975.00
Rate for Payer: UnitedHealthcare Community & State	$154.05
Rate for Payer: Wellpoint Medicaid Managed Care	$138.45

DEVICE HIP DISTRACTION ATHE

Facility

$4,875.00

Hospital Charge Code	270667791
Hospital Revenue Code	272
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$731.25
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

Know your out-of-pocket cost for care.

All Charges