Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ENDOSCOP APPLICATOR 5MMX41CM

Facility

$282.66

Service Code	HCPCS A4649
Hospital Charge Code	270662368
Hospital Revenue Code	272
Min. Negotiated Rate	$42.40
Max. Negotiated Rate	$42.40
Rate for Payer: Qualcare PPO/HMO/WC	$42.40

ENDOSCOP APPLICATOR 5MMX41CM

Facility

$282.66

Service Code	HCPCS A4649
Hospital Charge Code	270662368
Hospital Revenue Code	272
Min. Negotiated Rate	$8.03
Max. Negotiated Rate	$141.33
Rate for Payer: Aetna Commercial	$107.41
Rate for Payer: Aetna Medicare Advantage	$84.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.08
Rate for Payer: Cigna Commercial	$141.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.49
Rate for Payer: Oxford Commercial	$56.53
Rate for Payer: Qualcare PPO/HMO/WC	$42.40
Rate for Payer: UnitedHealthcare Commercial	$56.53
Rate for Payer: UnitedHealthcare Community & State	$8.93
Rate for Payer: Wellpoint Medicaid Managed Care	$8.03

ENDOSCOPIC GASTROC RELEASE KIT

Facility

$4,672.80

Hospital Charge Code	270667237
Hospital Revenue Code	272
Min. Negotiated Rate	$700.92
Max. Negotiated Rate	$700.92
Rate for Payer: Qualcare PPO/HMO/WC	$700.92

ENDOSCOPIC GASTROC RELEASE KIT

Facility

$4,672.80

Hospital Charge Code	270667237
Hospital Revenue Code	272
Min. Negotiated Rate	$132.71
Max. Negotiated Rate	$2,336.40
Rate for Payer: Aetna Commercial	$1,775.66
Rate for Payer: Aetna Medicare Advantage	$1,401.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,191.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,191.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,191.56
Rate for Payer: Cigna Commercial	$2,336.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,214.93
Rate for Payer: Oxford Commercial	$934.56
Rate for Payer: Qualcare PPO/HMO/WC	$700.92
Rate for Payer: UnitedHealthcare Commercial	$934.56
Rate for Payer: UnitedHealthcare Community & State	$147.66
Rate for Payer: Wellpoint Medicaid Managed Care	$132.71

ENDOSCOPIC INJECTION/IMPLANT

Facility

$15,142.80

Service Code	HCPCS 51715
Hospital Charge Code	1600000470
Hospital Revenue Code	360
Min. Negotiated Rate	$430.06
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,937.13
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.42
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$478.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$430.06

ENDOSCOPIC INJECTION/IMPLANT

Facility

$15,142.80

Service Code	HCPCS 51715
Hospital Charge Code	1600000470
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.42
Max. Negotiated Rate	$2,271.42
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.42

ENDOSCOPIC PLANTAR FASCITMY-LT

Facility

$21,064.35

Service Code	HCPCS 29893
Hospital Charge Code	16000257
Hospital Revenue Code	360
Min. Negotiated Rate	$3,159.65
Max. Negotiated Rate	$3,159.65
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.65

ENDOSCOPIC PLANTAR FASCITMY-LT

Facility

$21,064.35

Service Code	HCPCS 29893
Hospital Charge Code	16000257
Hospital Revenue Code	360
Min. Negotiated Rate	$598.23
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,476.73
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,159.65
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$665.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$598.23

ENDOSCOPIC W/ MIX TIP 5MMX30CM

Facility

$470.00

Hospital Charge Code	270670802
Hospital Revenue Code	272
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

ENDOSCOPIC W/ MIX TIP 5MMX30CM

Facility

$470.00

Hospital Charge Code	270670802
Hospital Revenue Code	272
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$235.00
Rate for Payer: Aetna Commercial	$178.60
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.20
Rate for Payer: Oxford Commercial	$94.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$94.00
Rate for Payer: UnitedHealthcare Community & State	$14.85
Rate for Payer: Wellpoint Medicaid Managed Care	$13.35

ENDOSCOP MULTIBAND LIGAT SET 6

Facility

$360.00

Hospital Charge Code	270700680
Hospital Revenue Code	272
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.60
Rate for Payer: Oxford Commercial	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.22

ENDOSCOP MULTIBAND LIGAT SET 6

Facility

$360.00

Hospital Charge Code	270700680
Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

ENDOSCOPY 1-2 HRS WITH FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300075
Hospital Revenue Code	750
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$1,406.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

ENDOSCOPY 1-2 HRS WITH FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300075
Hospital Revenue Code	750
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,437.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$296.25
Rate for Payer: Wellpoint Medicaid Managed Care	$266.25

ENDOSCOPY 1-2 HRS WITH FOUR BX

Facility

$8,125.00

Hospital Charge Code	2300074
Hospital Revenue Code	750
Min. Negotiated Rate	$230.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,112.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$256.75
Rate for Payer: Wellpoint Medicaid Managed Care	$230.75

ENDOSCOPY 1-2 HRS WITH FOUR BX

Facility

$8,125.00

Hospital Charge Code	2300074
Hospital Revenue Code	750
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,218.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

ENDOSCOPY 1-2 HRS WITH ONE BX

Facility

$4,375.00

Hospital Charge Code	2300071
Hospital Revenue Code	750
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$656.25
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

ENDOSCOPY 1-2 HRS WITH ONE BX

Facility

$4,375.00

Hospital Charge Code	2300071
Hospital Revenue Code	750
Min. Negotiated Rate	$124.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,137.50
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$138.25
Rate for Payer: Wellpoint Medicaid Managed Care	$124.25

ENDOSCOPY 1-2 HRS WITHOUT BX

Facility

$3,125.00

Hospital Charge Code	2300070
Hospital Revenue Code	750
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

ENDOSCOPY 1-2 HRS WITHOUT BX

Facility

$3,125.00

Hospital Charge Code	2300070
Hospital Revenue Code	750
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$812.50
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Community & State	$98.75
Rate for Payer: Wellpoint Medicaid Managed Care	$88.75

ENDOSCOPY 1-2HRS WITH THREE BX

Facility

$6,875.00

Hospital Charge Code	2300073
Hospital Revenue Code	750
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,787.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

ENDOSCOPY 1-2HRS WITH THREE BX

Facility

$6,875.00

Hospital Charge Code	2300073
Hospital Revenue Code	750
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

ENDOSCOPY 1-2 HRS WITH TWO BX

Facility

$5,625.00

Hospital Charge Code	2300072
Hospital Revenue Code	750
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,462.50
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$177.75
Rate for Payer: Wellpoint Medicaid Managed Care	$159.75

ENDOSCOPY 1-2 HRS WITH TWO BX

Facility

$5,625.00

Hospital Charge Code	2300072
Hospital Revenue Code	750
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$843.75
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

ENDOSCOPY < 1 HR W/ > FIVE BX

Facility

$9,375.00

Hospital Charge Code	2300066
Hospital Revenue Code	750
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$1,406.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

Know your out-of-pocket cost for care.

All Charges