Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DX-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	2692005
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	411075984R
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	2692005
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	411075984R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	366875984R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	366875984R
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-RETROGRAD UROGRAPH-BI

Facility

$5,100.00

Service Code	HCPCS 7442050
Hospital Charge Code	2009155
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-RETROGRAD UROGRAPH-BI

Facility

$5,100.00

Service Code	HCPCS 7442050
Hospital Charge Code	2009155
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-RIBS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009365
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-RIBS 2 VIEWS-LT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009365
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-RIBS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009360
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-RIBS 2 VIEWS-RT

Facility

$5,100.00

Service Code	HCPCS 71100
Hospital Charge Code	2009360
Hospital Revenue Code	320
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-RIBS W/CHEST 3 VIEWS-LT

Facility

$448.00

Service Code	HCPCS 71101LT
Hospital Charge Code	2007010
Hospital Revenue Code	320
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$170.24
Rate for Payer: Aetna Medicare Advantage	$134.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.24
Rate for Payer: Cigna Commercial	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.48
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.20
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$14.16
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

DX-RIBS W/CHEST 3 VIEWS-LT

Facility

$448.00

Service Code	HCPCS 71101LT
Hospital Charge Code	2007010
Hospital Revenue Code	320
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

DX-RIBS W/CHEST 3 VIEWS-RT

Facility

$448.00

Service Code	HCPCS 71101RT
Hospital Charge Code	2007005
Hospital Revenue Code	320
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$170.24
Rate for Payer: Aetna Medicare Advantage	$134.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.24
Rate for Payer: Cigna Commercial	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.48
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.20
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$14.16
Rate for Payer: Wellpoint Medicaid Managed Care	$12.72

DX-RIBS W/CHEST 3 VIEWS-RT

Facility

$448.00

Service Code	HCPCS 71101RT
Hospital Charge Code	2007005
Hospital Revenue Code	320
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Qualcare PPO/HMO/WC	$67.20

DX SHOULDER 1 VW

Facility

$267.00

Service Code	HCPCS 73020
Hospital Charge Code	2011515
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

DX SHOULDER 1 VW

Facility

$267.00

Service Code	HCPCS 73020
Hospital Charge Code	2011515
Hospital Revenue Code	320
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.42
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

DX-SWALLOW FUNCT W/VIDEO FLUOR

Facility

$5,100.00

Service Code	HCPCS 74230
Hospital Charge Code	2007030
Hospital Revenue Code	320
Min. Negotiated Rate	$66.87
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-SWALLOW FUNCT W/VIDEO FLUOR

Facility

$5,100.00

Service Code	HCPCS 74230
Hospital Charge Code	2007030
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-THUMB-LT

Facility

$412.00

Service Code	HCPCS 73140
Hospital Charge Code	2007060
Hospital Revenue Code	320
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.12
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.80
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$13.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.70

DX-THUMB-LT

Facility

$412.00

Service Code	HCPCS 73140
Hospital Charge Code	2007060
Hospital Revenue Code	320
Min. Negotiated Rate	$61.80
Max. Negotiated Rate	$61.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.80

DX-TOE 2ND DIGIT LT

Facility

$267.00

Service Code	HCPCS 7366050
Hospital Charge Code	2007055
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

DX-TOE 2ND DIGIT LT

Facility

$267.00

Service Code	HCPCS 7366050
Hospital Charge Code	2007055
Hospital Revenue Code	320
Min. Negotiated Rate	$7.58
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$101.46
Rate for Payer: Aetna Medicare Advantage	$80.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.08
Rate for Payer: Cigna Commercial	$133.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.42
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

DX-UPPER GI/AIR CONTRAST W/KUB

Facility

$938.00

Service Code	HCPCS 74247
Hospital Charge Code	2007015
Hospital Revenue Code	320
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$356.44
Rate for Payer: Aetna Medicare Advantage	$281.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.19
Rate for Payer: Cigna Commercial	$469.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.88
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$140.70
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$29.64
Rate for Payer: Wellpoint Medicaid Managed Care	$26.64

Know your out-of-pocket cost for care.

All Charges