Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DISC MOBI-C MOD 13X17MM HT5MM

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692671
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,185.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,065.00

DISC MOBI-C MOD 13X17MM HT5MM

Facility

$37,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692671
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

DISC MONITOR PROBE 407-290-000

Facility

$2,057.41

Hospital Charge Code	270646547
Hospital Revenue Code	272
Min. Negotiated Rate	$308.61
Max. Negotiated Rate	$308.61
Rate for Payer: Qualcare PPO/HMO/WC	$308.61

DISC MONITOR PROBE 407-290-000

Facility

$2,057.41

Hospital Charge Code	270646547
Hospital Revenue Code	272
Min. Negotiated Rate	$58.43
Max. Negotiated Rate	$1,028.70
Rate for Payer: Aetna Commercial	$781.82
Rate for Payer: Aetna Medicare Advantage	$617.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$524.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$524.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$524.64
Rate for Payer: Cigna Commercial	$1,028.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.93
Rate for Payer: Oxford Commercial	$411.48
Rate for Payer: Qualcare PPO/HMO/WC	$308.61
Rate for Payer: UnitedHealthcare Commercial	$411.48
Rate for Payer: UnitedHealthcare Community & State	$65.01
Rate for Payer: Wellpoint Medicaid Managed Care	$58.43

DISCOGRAPHY SYSTEM

Facility

$187.00

Hospital Charge Code	270332614
Hospital Revenue Code	272
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$28.05
Rate for Payer: Qualcare PPO/HMO/WC	$28.05

DISCOGRAPHY SYSTEM

Facility

$187.00

Hospital Charge Code	270332614
Hospital Revenue Code	272
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$93.50
Rate for Payer: Aetna Commercial	$71.06
Rate for Payer: Aetna Medicare Advantage	$56.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.69
Rate for Payer: Cigna Commercial	$93.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.62
Rate for Payer: Oxford Commercial	$37.40
Rate for Payer: Qualcare PPO/HMO/WC	$28.05
Rate for Payer: UnitedHealthcare Commercial	$37.40
Rate for Payer: UnitedHealthcare Community & State	$5.91
Rate for Payer: Wellpoint Medicaid Managed Care	$5.31

DISC ROI LORDOTIC 7MM X 15.5

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690495
Hospital Revenue Code	278
Min. Negotiated Rate	$1,749.75
Max. Negotiated Rate	$2,822.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75

DISC ROI LORDOTIC 7MM X 15.5

Facility

$11,665.00

Service Code	HCPCS C1889
Hospital Charge Code	270690495
Hospital Revenue Code	278
Min. Negotiated Rate	$331.29
Max. Negotiated Rate	$5,832.50
Rate for Payer: Aetna Commercial	$4,432.70
Rate for Payer: Aetna Medicare Advantage	$3,499.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,974.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,974.57
Rate for Payer: Cigna Commercial	$5,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,822.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,749.75
Rate for Payer: UnitedHealthcare Community & State	$368.61
Rate for Payer: Wellpoint Medicaid Managed Care	$331.29

DISC SZ 2, HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270705514
Hospital Revenue Code	278
Min. Negotiated Rate	$766.55
Max. Negotiated Rate	$13,495.62
Rate for Payer: Aetna Commercial	$10,256.67
Rate for Payer: Aetna Medicare Advantage	$8,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,882.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,882.77
Rate for Payer: Cigna Commercial	$13,495.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69
Rate for Payer: UnitedHealthcare Community & State	$852.92
Rate for Payer: Wellpoint Medicaid Managed Care	$766.55

DISC SZ 2, HT 4

Facility

$26,991.25

Service Code	HCPCS C1713
Hospital Charge Code	270705514
Hospital Revenue Code	278
Min. Negotiated Rate	$4,048.69
Max. Negotiated Rate	$6,531.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,398.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,531.88
Rate for Payer: Qualcare PPO/HMO/WC	$4,048.69

DISK EPIFIX 18MM

Facility

$3,427.50

Service Code	HCPCS Q4186
Hospital Charge Code	270679817
Hospital Revenue Code	278
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$829.46
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.46
Rate for Payer: Qualcare PPO/HMO/WC	$514.12
Rate for Payer: UnitedHealthcare Community & State	$108.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$97.34

DISK EPIFIX 18MM

Facility

$3,427.50

Service Code	HCPCS Q4186
Hospital Charge Code	270679817
Hospital Revenue Code	278
Min. Negotiated Rate	$514.12
Max. Negotiated Rate	$829.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$685.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$829.46
Rate for Payer: Qualcare PPO/HMO/WC	$514.12

DISOPYRAMIDE 100 MG CAP

Facility

$32.03

Service Code	NDC 51862009301
Hospital Charge Code	60627562
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$16.02
Rate for Payer: Aetna Commercial	$12.17
Rate for Payer: Aetna Medicare Advantage	$9.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.17
Rate for Payer: Cigna Commercial	$16.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.33
Rate for Payer: Oxford Commercial	$6.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.41
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

DISOPYRAMIDE 100 MG CAP

Facility

$32.03

Service Code	NDC 51862009301
Hospital Charge Code	60627562
Hospital Revenue Code	250
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

DISOPYRAMIDE 100 MG SR CAP

Facility

$9.58

Service Code	NDC 25273231
Hospital Charge Code	60627559
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.79
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.49
Rate for Payer: Oxford Commercial	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$1.92
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DISOPYRAMIDE 100 MG SR CAP

Facility

$9.58

Service Code	NDC 25273231
Hospital Charge Code	60627559
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

DISOPYRAMIDE 150 MG CAP

Facility

$22.65

Service Code	NDC 93312901
Hospital Charge Code	60627560
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$3.40

DISOPYRAMIDE 150 MG CAP

Facility

$22.65

Service Code	NDC 93312901
Hospital Charge Code	60627560
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.32
Rate for Payer: Aetna Commercial	$8.61
Rate for Payer: Aetna Medicare Advantage	$6.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.78
Rate for Payer: Cigna Commercial	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.89
Rate for Payer: Oxford Commercial	$4.53
Rate for Payer: Qualcare PPO/HMO/WC	$3.40
Rate for Payer: UnitedHealthcare Commercial	$4.53
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DISOPYRAMIDE 150 MG SR CAP

Facility

$11.79

Service Code	NDC 25274231
Hospital Charge Code	60627561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.89
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: Aetna Medicare Advantage	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.01
Rate for Payer: Cigna Commercial	$5.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.07
Rate for Payer: Oxford Commercial	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$2.36
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

DISOPYRAMIDE 150 MG SR CAP

Facility

$11.79

Service Code	NDC 25274231
Hospital Charge Code	60627561
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

DISOPYRAMIDE (NORPACE)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472254
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

DISOPYRAMIDE (NORPACE)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472254
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$11,522.96

Service Code	APR-DRG 2842
Min. Negotiated Rate	$11,297.02
Max. Negotiated Rate	$11,522.96
Rate for Payer: UnitedHealthcare Community & State	$11,297.02
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,522.96
Rate for Payer: Wellpoint Medicaid Managed Care	$11,297.02

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$16,139.17

Service Code	APR-DRG 2843
Min. Negotiated Rate	$15,822.72
Max. Negotiated Rate	$16,139.17
Rate for Payer: UnitedHealthcare Community & State	$15,822.72
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,139.17
Rate for Payer: Wellpoint Medicaid Managed Care	$15,822.72

DISORDERS OF GALLBLADDER AND BILIARY TRACT

Facility

$27,475.34

Service Code	APR-DRG 2844
Min. Negotiated Rate	$26,936.61
Max. Negotiated Rate	$27,475.34
Rate for Payer: UnitedHealthcare Community & State	$26,936.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27,475.34
Rate for Payer: Wellpoint Medicaid Managed Care	$26,936.61

Know your out-of-pocket cost for care.

All Charges