Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEVICE SPIDER FX 7.0XSVG-320-1

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657528N
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 7.0XSVG-320-1

Facility

$6,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270657528N
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 STONE NTRAP 3FR

Facility

$1,127.65

Hospital Charge Code	270658409
Hospital Revenue Code	270
Min. Negotiated Rate	$32.03
Max. Negotiated Rate	$563.83
Rate for Payer: Aetna Commercial	$428.51
Rate for Payer: Aetna Medicare Advantage	$338.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.55
Rate for Payer: Cigna Commercial	$563.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.19
Rate for Payer: Oxford Commercial	$225.53
Rate for Payer: Qualcare PPO/HMO/WC	$169.15
Rate for Payer: UnitedHealthcare Commercial	$225.53
Rate for Payer: UnitedHealthcare Community & State	$35.63
Rate for Payer: Wellpoint Medicaid Managed Care	$32.03

DEVICE STONE NTRAP 3FR

Facility

$1,127.65

Hospital Charge Code	270658409
Hospital Revenue Code	270
Min. Negotiated Rate	$169.15
Max. Negotiated Rate	$169.15
Rate for Payer: Qualcare PPO/HMO/WC	$169.15

DEVICE TORQUE 91400300

Facility

$29.85

Hospital Charge Code	270632533
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$14.93
Rate for Payer: Aetna Commercial	$11.34
Rate for Payer: Aetna Medicare Advantage	$8.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.61
Rate for Payer: Cigna Commercial	$14.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.76
Rate for Payer: Oxford Commercial	$5.97
Rate for Payer: Qualcare PPO/HMO/WC	$4.48
Rate for Payer: UnitedHealthcare Commercial	$5.97
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

DEVICE TORQUE 91400300

Facility

$29.85

Hospital Charge Code	270632533
Hospital Revenue Code	272
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$4.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.48

DEVICE TORQUE ALCOTT

Facility

$80.00

Hospital Charge Code	270660229
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

DEVICE TORQUE ALCOTT

Facility

$80.00

Hospital Charge Code	270660229
Hospital Revenue Code	272
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503
Hospital Revenue Code	272
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.32

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.72
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare Advantage	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.94
Rate for Payer: Cigna Commercial	$7.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.02
Rate for Payer: Oxford Commercial	$3.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.32
Rate for Payer: UnitedHealthcare Commercial	$3.09
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.32

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503N
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.72
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare Advantage	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.94
Rate for Payer: Cigna Commercial	$7.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.02
Rate for Payer: Oxford Commercial	$3.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.32
Rate for Payer: UnitedHealthcare Commercial	$3.09
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503S
Hospital Revenue Code	272
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.32

DEVICE TORQUE FL PINK

Facility

$15.45

Hospital Charge Code	270639503S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.72
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare Advantage	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.94
Rate for Payer: Cigna Commercial	$7.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.02
Rate for Payer: Oxford Commercial	$3.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.32
Rate for Payer: UnitedHealthcare Commercial	$3.09
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

DEVICE WEB17 SL 4X2MM

Facility

$82,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697114S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,371.25
Max. Negotiated Rate	$19,958.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25

DEVICE WEB17 SL 4X2MM

Facility

$82,475.00

Service Code	HCPCS C1884
Hospital Charge Code	270697114S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,342.29
Max. Negotiated Rate	$41,237.50
Rate for Payer: Aetna Commercial	$31,340.50
Rate for Payer: Aetna Medicare Advantage	$24,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,031.12
Rate for Payer: Cigna Commercial	$41,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25
Rate for Payer: UnitedHealthcare Community & State	$2,606.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2,342.29

DEVICE WEB17SL EMBOL COIL 4X2

Facility

$82,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270697714S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,371.25
Max. Negotiated Rate	$19,958.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25

DEVICE WEB17SL EMBOL COIL 4X2

Facility

$82,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270697714S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,342.29
Max. Negotiated Rate	$41,237.50
Rate for Payer: Aetna Commercial	$31,340.50
Rate for Payer: Aetna Medicare Advantage	$24,742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,031.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,031.12
Rate for Payer: Cigna Commercial	$41,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,958.95
Rate for Payer: Qualcare PPO/HMO/WC	$12,371.25
Rate for Payer: UnitedHealthcare Community & State	$2,606.21
Rate for Payer: Wellpoint Medicaid Managed Care	$2,342.29

DEX 5%.3% SOD CHL500ml 7925-03

Facility

$17.50

Hospital Charge Code	270649408
Hospital Revenue Code	258
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

DEX 5%.3% SOD CHL500ml 7925-03

Facility

$17.50

Hospital Charge Code	270649408
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.75
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare Advantage	$5.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.46
Rate for Payer: Cigna Commercial	$8.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.62
Rate for Payer: UnitedHealthcare Commercial	$3.50
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

DEXAMETHASONE 0.1% OPHTH SOLN

Facility

$141.37

Service Code	NDC 61314029405
Hospital Charge Code	6001713
Hospital Revenue Code	251
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$70.69
Rate for Payer: Aetna Commercial	$53.72
Rate for Payer: Aetna Medicare Advantage	$42.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.05
Rate for Payer: Cigna Commercial	$70.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.76
Rate for Payer: Oxford Commercial	$28.27
Rate for Payer: Qualcare PPO/HMO/WC	$21.21
Rate for Payer: UnitedHealthcare Commercial	$28.27
Rate for Payer: UnitedHealthcare Community & State	$4.47
Rate for Payer: Wellpoint Medicaid Managed Care	$4.01

DEXAMETHASONE 0.1% OPHTH SOLN

Facility

$141.37

Service Code	NDC 61314029405
Hospital Charge Code	6001713
Hospital Revenue Code	251
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$21.21
Rate for Payer: Qualcare PPO/HMO/WC	$21.21

DEXAMETHASONE 0.5 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	6023055
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE 0.5 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	6023055
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE 0.75 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60628185
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges