Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEVICE POLYP REMOVAL MYOSURE

Facility

$3,466.67

Hospital Charge Code	270662591
Hospital Revenue Code	272
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$520.00

DEVICE POWER PORT 8FR

Facility

$1,550.00

Service Code	HCPCS C1788
Hospital Charge Code	270657913
Hospital Revenue Code	278
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$375.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

DEVICE POWER PORT 8FR

Facility

$1,550.00

Service Code	HCPCS C1788
Hospital Charge Code	270657913
Hospital Revenue Code	278
Min. Negotiated Rate	$44.02
Max. Negotiated Rate	$775.00
Rate for Payer: Aetna Commercial	$589.00
Rate for Payer: Aetna Medicare Advantage	$465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$395.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$395.25
Rate for Payer: Cigna Commercial	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.10
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Community & State	$48.98
Rate for Payer: Wellpoint Medicaid Managed Care	$44.02

DEVICE PRESS MONITR K05L1L5A

Facility

$495.00

Hospital Charge Code	270631600
Hospital Revenue Code	272
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$247.50
Rate for Payer: Aetna Commercial	$188.10
Rate for Payer: Aetna Medicare Advantage	$148.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.22
Rate for Payer: Cigna Commercial	$247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.70
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: Wellpoint Medicaid Managed Care	$14.06

DEVICE PRESS MONITR K05L1L5A

Facility

$495.00

Hospital Charge Code	270631600
Hospital Revenue Code	272
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

DEVICE PUSH - PULL REDUCTION

Facility

$1,041.35

Hospital Charge Code	270639429
Hospital Revenue Code	272
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$520.67
Rate for Payer: Aetna Commercial	$395.71
Rate for Payer: Aetna Medicare Advantage	$312.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$265.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$265.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$265.54
Rate for Payer: Cigna Commercial	$520.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$270.75
Rate for Payer: Oxford Commercial	$208.27
Rate for Payer: Qualcare PPO/HMO/WC	$156.20
Rate for Payer: UnitedHealthcare Commercial	$208.27
Rate for Payer: UnitedHealthcare Community & State	$32.91
Rate for Payer: Wellpoint Medicaid Managed Care	$29.57

DEVICE PUSH - PULL REDUCTION

Facility

$1,041.35

Hospital Charge Code	270639429
Hospital Revenue Code	272
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$156.20
Rate for Payer: Qualcare PPO/HMO/WC	$156.20

DEVICE PUSH PULL REDUCTION

Facility

$1,100.05

Hospital Charge Code	270649704
Hospital Revenue Code	272
Min. Negotiated Rate	$165.01
Max. Negotiated Rate	$165.01
Rate for Payer: Qualcare PPO/HMO/WC	$165.01

DEVICE PUSH PULL REDUCTION

Facility

$1,100.05

Hospital Charge Code	270649704
Hospital Revenue Code	272
Min. Negotiated Rate	$31.24
Max. Negotiated Rate	$550.02
Rate for Payer: Aetna Commercial	$418.02
Rate for Payer: Aetna Medicare Advantage	$330.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$280.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$280.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$280.51
Rate for Payer: Cigna Commercial	$550.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.01
Rate for Payer: Oxford Commercial	$220.01
Rate for Payer: Qualcare PPO/HMO/WC	$165.01
Rate for Payer: UnitedHealthcare Commercial	$220.01
Rate for Payer: UnitedHealthcare Community & State	$34.76
Rate for Payer: Wellpoint Medicaid Managed Care	$31.24

DEVICE REVASCULARIZATION 3D

Facility

$24,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968N
Hospital Revenue Code	278
Min. Negotiated Rate	$3,742.50
Max. Negotiated Rate	$6,037.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,037.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,742.50

DEVICE REVASCULARIZATION 3D

Facility

$26,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968
Hospital Revenue Code	278
Min. Negotiated Rate	$4,042.50
Max. Negotiated Rate	$6,521.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,521.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,042.50

DEVICE REVASCULARIZATION 3D

Facility

$26,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968
Hospital Revenue Code	278
Min. Negotiated Rate	$765.38
Max. Negotiated Rate	$13,475.00
Rate for Payer: Aetna Commercial	$10,241.00
Rate for Payer: Aetna Medicare Advantage	$8,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,872.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,872.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,872.25
Rate for Payer: Cigna Commercial	$13,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,521.90
Rate for Payer: Qualcare PPO/HMO/WC	$4,042.50
Rate for Payer: UnitedHealthcare Community & State	$851.62
Rate for Payer: Wellpoint Medicaid Managed Care	$765.38

DEVICE REVASCULARIZATION 3D

Facility

$24,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682968N
Hospital Revenue Code	278
Min. Negotiated Rate	$708.58
Max. Negotiated Rate	$12,475.00
Rate for Payer: Aetna Commercial	$9,481.00
Rate for Payer: Aetna Medicare Advantage	$7,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,362.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,362.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,362.25
Rate for Payer: Cigna Commercial	$12,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,037.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,742.50
Rate for Payer: UnitedHealthcare Community & State	$788.42
Rate for Payer: Wellpoint Medicaid Managed Care	$708.58

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590S
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590S
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590N
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 4 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643590N
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

DEVICE SPIDER FX 5 0X320X190

Facility

$1,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270657526N
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

DEVICE SPIDER FX 5 0X320X190

Facility

$1,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270657526N
Hospital Revenue Code	278
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$41.08
Rate for Payer: Wellpoint Medicaid Managed Care	$36.92

DEVICE SPIDER FX 6 0X320x190

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527
Hospital Revenue Code	278
Min. Negotiated Rate	$1,046.25
Max. Negotiated Rate	$1,687.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25

DEVICE SPIDER FX 6 0X320x190

Facility

$6,975.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527
Hospital Revenue Code	278
Min. Negotiated Rate	$198.09
Max. Negotiated Rate	$3,487.50
Rate for Payer: Aetna Commercial	$2,650.50
Rate for Payer: Aetna Medicare Advantage	$2,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,778.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,778.62
Rate for Payer: Cigna Commercial	$3,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,687.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$220.41
Rate for Payer: Wellpoint Medicaid Managed Care	$198.09

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527S
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527N
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527S
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

DEVICE SPIDER FX 6 0X320X190

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657527N
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

Know your out-of-pocket cost for care.

All Charges