Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$65,901.97

Service Code	APR-DRG 3032
Min. Negotiated Rate	$64,609.77
Max. Negotiated Rate	$65,901.97
Rate for Payer: UnitedHealthcare Community & State	$64,609.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$65,901.97
Rate for Payer: Wellpoint Medicaid Managed Care	$64,609.77

DORZOLAMIDE 2% OPHT SOL

Facility

$616.67

Service Code	NDC 6351936
Hospital Charge Code	60628047
Hospital Revenue Code	250
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$92.50
Rate for Payer: Qualcare PPO/HMO/WC	$92.50

DORZOLAMIDE 2% OPHT SOL

Facility

$616.67

Service Code	NDC 6351936
Hospital Charge Code	60628047
Hospital Revenue Code	250
Min. Negotiated Rate	$17.51
Max. Negotiated Rate	$308.33
Rate for Payer: Aetna Commercial	$234.33
Rate for Payer: Aetna Medicare Advantage	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.25
Rate for Payer: Cigna Commercial	$308.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.33
Rate for Payer: Oxford Commercial	$123.33
Rate for Payer: Qualcare PPO/HMO/WC	$92.50
Rate for Payer: UnitedHealthcare Commercial	$123.33
Rate for Payer: UnitedHealthcare Community & State	$19.49
Rate for Payer: Wellpoint Medicaid Managed Care	$17.51

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367
Hospital Revenue Code	278
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Community & State	$21.01
Rate for Payer: Wellpoint Medicaid Managed Care	$18.89

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367S
Hospital Revenue Code	278
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Community & State	$21.01
Rate for Payer: Wellpoint Medicaid Managed Care	$18.89

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367S
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367N
Hospital Revenue Code	278
Min. Negotiated Rate	$18.89
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$252.70
Rate for Payer: Aetna Medicare Advantage	$199.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$169.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$169.57
Rate for Payer: Cigna Commercial	$332.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75
Rate for Payer: UnitedHealthcare Community & State	$21.01
Rate for Payer: Wellpoint Medicaid Managed Care	$18.89

DOT POWER MIDLINE 4 F SL MAX

Facility

$665.00

Service Code	HCPCS C1751
Hospital Charge Code	270680367N
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$160.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.93
Rate for Payer: Qualcare PPO/HMO/WC	$99.75

DOT/SLOT BLOT PRODUCTION

Facility

$99.00

Service Code	HCPCS 83893
Hospital Charge Code	38472804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

DOT/SLOT BLOT PRODUCTION

Facility

$99.00

Service Code	HCPCS 83893
Hospital Charge Code	38472804
Hospital Revenue Code	301
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

DOUBLE ARM MENISCAL REPAIR NEE

Facility

$128.00

Hospital Charge Code	270665314
Hospital Revenue Code	270
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.28
Rate for Payer: Oxford Commercial	$25.60
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Commercial	$25.60
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

DOUBLE ARM MENISCAL REPAIR NEE

Facility

$128.00

Hospital Charge Code	270665314
Hospital Revenue Code	270
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$19.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

DOUBLE ECCENTER

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686875
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

DOUBLE ECCENTER

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686875
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

DOUBLE JOINT W/END PIECE

Facility

$2,724.00

Hospital Charge Code	270669838
Hospital Revenue Code	278
Min. Negotiated Rate	$408.60
Max. Negotiated Rate	$659.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.21
Rate for Payer: Qualcare PPO/HMO/WC	$408.60

DOUBLE JOINT W/END PIECE

Facility

$2,724.00

Hospital Charge Code	270669838
Hospital Revenue Code	278
Min. Negotiated Rate	$77.36
Max. Negotiated Rate	$1,362.00
Rate for Payer: Aetna Commercial	$1,035.12
Rate for Payer: Aetna Medicare Advantage	$817.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$694.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$694.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$544.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$694.62
Rate for Payer: Cigna Commercial	$1,362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$659.21
Rate for Payer: Qualcare PPO/HMO/WC	$408.60
Rate for Payer: UnitedHealthcare Community & State	$86.08
Rate for Payer: Wellpoint Medicaid Managed Care	$77.36

DOUBLE LOADED KNOTLESS KNEE FI

Facility

$2,703.75

Service Code	HCPCS C1713
Hospital Charge Code	270703166
Hospital Revenue Code	278
Min. Negotiated Rate	$405.56
Max. Negotiated Rate	$654.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.31
Rate for Payer: Qualcare PPO/HMO/WC	$405.56

DOUBLE LOADED KNOTLESS KNEE FI

Facility

$2,703.75

Service Code	HCPCS C1713
Hospital Charge Code	270703166
Hospital Revenue Code	278
Min. Negotiated Rate	$76.79
Max. Negotiated Rate	$1,351.88
Rate for Payer: Aetna Commercial	$1,027.42
Rate for Payer: Aetna Medicare Advantage	$811.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$689.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$689.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$689.46
Rate for Payer: Cigna Commercial	$1,351.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$654.31
Rate for Payer: Qualcare PPO/HMO/WC	$405.56
Rate for Payer: UnitedHealthcare Community & State	$85.44
Rate for Payer: Wellpoint Medicaid Managed Care	$76.79

DOUBLE LOADED TIGHTROPE 10 MM

Facility

$3,475.00

Hospital Charge Code	270679791
Hospital Revenue Code	272
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$903.50
Rate for Payer: Oxford Commercial	$695.00
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Commercial	$695.00
Rate for Payer: UnitedHealthcare Community & State	$109.81
Rate for Payer: Wellpoint Medicaid Managed Care	$98.69

DOUBLE LOADED TIGHTROPE 10 MM

Facility

$3,475.00

Hospital Charge Code	270679791
Hospital Revenue Code	272
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$521.25
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

DOUBLE PIGTAIL STENT 7FR 24CM

Facility

$907.00

Hospital Charge Code	270331901
Hospital Revenue Code	278
Min. Negotiated Rate	$25.76
Max. Negotiated Rate	$453.50
Rate for Payer: Aetna Commercial	$344.66
Rate for Payer: Aetna Medicare Advantage	$272.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.28
Rate for Payer: Cigna Commercial	$453.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.49
Rate for Payer: Qualcare PPO/HMO/WC	$136.05
Rate for Payer: UnitedHealthcare Community & State	$28.66
Rate for Payer: Wellpoint Medicaid Managed Care	$25.76

DOUBLE PIGTAIL STENT 7FR 24CM

Facility

$907.00

Hospital Charge Code	270331901
Hospital Revenue Code	278
Min. Negotiated Rate	$136.05
Max. Negotiated Rate	$219.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.49
Rate for Payer: Qualcare PPO/HMO/WC	$136.05

DOUBLE VELOUR GRAFT BIFURCATED

Facility

$2,911.00

Hospital Charge Code	270335057
Hospital Revenue Code	278
Min. Negotiated Rate	$436.65
Max. Negotiated Rate	$704.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.46
Rate for Payer: Qualcare PPO/HMO/WC	$436.65

DOUBLE VELOUR GRAFT BIFURCATED

Facility

$2,911.00

Hospital Charge Code	270335057
Hospital Revenue Code	278
Min. Negotiated Rate	$82.67
Max. Negotiated Rate	$1,455.50
Rate for Payer: Aetna Commercial	$1,106.18
Rate for Payer: Aetna Medicare Advantage	$873.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$582.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.30
Rate for Payer: Cigna Commercial	$1,455.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$704.46
Rate for Payer: Qualcare PPO/HMO/WC	$436.65
Rate for Payer: UnitedHealthcare Community & State	$91.99
Rate for Payer: Wellpoint Medicaid Managed Care	$82.67

Know your out-of-pocket cost for care.

All Charges