Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3043M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$21.37
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.65
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$23.78
Rate for Payer: Wellpoint Medicaid Managed Care	$21.37

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3080M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3050M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3046M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EW FULL THREAD 2.5X 16 MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270701484
Hospital Revenue Code	278
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$481.25
Rate for Payer: Aetna Commercial	$365.75
Rate for Payer: Aetna Medicare Advantage	$288.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.44
Rate for Payer: Cigna Commercial	$481.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: Qualcare PPO/HMO/WC	$144.38
Rate for Payer: UnitedHealthcare Community & State	$30.41
Rate for Payer: Wellpoint Medicaid Managed Care	$27.34

EW FULL THREAD 2.5X 16 MM

Facility

$962.50

Service Code	HCPCS C1713
Hospital Charge Code	270701484
Hospital Revenue Code	278
Min. Negotiated Rate	$144.38
Max. Negotiated Rate	$232.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$232.93
Rate for Payer: Qualcare PPO/HMO/WC	$144.38

EXAM/BIOPSY VAGINA W SCOPE

Facility

$3,267.85

Service Code	HCPCS 57421
Hospital Charge Code	412357421
Hospital Revenue Code	361
Min. Negotiated Rate	$490.18
Max. Negotiated Rate	$490.18
Rate for Payer: Qualcare PPO/HMO/WC	$490.18

EXAM/BIOPSY VAGINA W SCOPE

Facility

$3,267.85

Service Code	HCPCS 57421
Hospital Charge Code	412357421
Hospital Revenue Code	361
Min. Negotiated Rate	$92.81
Max. Negotiated Rate	$3,969.32
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
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	$3,969.32
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$849.64
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$490.18
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$103.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$92.81

EXAM/BIOPSY VAGINA W SCOPE

Facility

$3,267.85

Service Code	HCPCS 57421
Hospital Charge Code	412367421
Hospital Revenue Code	361
Min. Negotiated Rate	$92.81
Max. Negotiated Rate	$3,969.32
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
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	$3,969.32
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$849.64
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$490.18
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$103.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$92.81

EXAM/BIOPSY VAGINA W SCOPE

Facility

$3,267.85

Service Code	HCPCS 57421
Hospital Charge Code	412367421
Hospital Revenue Code	361
Min. Negotiated Rate	$490.18
Max. Negotiated Rate	$490.18
Rate for Payer: Qualcare PPO/HMO/WC	$490.18

EXAM OF VAGINA W/SCOPE

Facility

$1,719.15

Service Code	HCPCS 57420
Hospital Charge Code	1600000594
Hospital Revenue Code	360
Min. Negotiated Rate	$48.82
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
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	$1,313.26
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$446.98
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$257.87
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$54.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$48.82

EXAM OF VAGINA W/SCOPE

Facility

$1,719.15

Service Code	HCPCS 57420
Hospital Charge Code	1600000594
Hospital Revenue Code	360
Min. Negotiated Rate	$257.87
Max. Negotiated Rate	$257.87
Rate for Payer: Qualcare PPO/HMO/WC	$257.87

EXAM/SELECT ARCHIVAL TISSUE

Facility

$66.00

Service Code	HCPCS 88363
Hospital Charge Code	38477059
Hospital Revenue Code	312
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

EXAM/SELECT ARCHIVAL TISSUE

Facility

$66.00

Service Code	HCPCS 88363
Hospital Charge Code	38477059
Hospital Revenue Code	312
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

EX ARM/ELBOW TUM DEEP < 5 CM

Facility

$13,615.50

Service Code	HCPCS 24076
Hospital Charge Code	16000613
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EX ARM/ELBOW TUM DEEP < 5 CM

Facility

$13,615.50

Service Code	HCPCS 24076
Hospital Charge Code	16000613
Hospital Revenue Code	360
Min. Negotiated Rate	$386.68
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,540.03
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$430.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$386.68

EX ARM/ELBOW TUM DEEP 5 CM/>

Facility

$11,141.64

Service Code	HCPCS 24073
Hospital Charge Code	16000391
Hospital Revenue Code	360
Min. Negotiated Rate	$316.42
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,896.83
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$352.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$316.42

EX ARM/ELBOW TUM DEEP 5 CM/>

Facility

$11,141.64

Service Code	HCPCS 24073
Hospital Charge Code	16000391
Hospital Revenue Code	360
Min. Negotiated Rate	$1,671.25
Max. Negotiated Rate	$1,671.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25

EXC 1' WST GANGLION RT

Facility

$23,750.00

Service Code	HCPCS 25111
Hospital Charge Code	16000229
Hospital Revenue Code	360
Min. Negotiated Rate	$674.50
Max. Negotiated Rate	$8,192.00
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,175.00
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$750.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$674.50

EXC 1' WST GANGLION RT

Facility

$23,750.00

Service Code	HCPCS 25111
Hospital Charge Code	16000229
Hospital Revenue Code	360
Min. Negotiated Rate	$3,562.50
Max. Negotiated Rate	$3,562.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,562.50

EXC ABD LES SC < 3 CM

Facility

$13,615.50

Service Code	HCPCS 22902
Hospital Charge Code	16000499
Hospital Revenue Code	360
Min. Negotiated Rate	$2,042.33
Max. Negotiated Rate	$2,042.33
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33

EXC ABD LES SC < 3 CM

Facility

$13,615.50

Service Code	HCPCS 22902
Hospital Charge Code	16000499
Hospital Revenue Code	360
Min. Negotiated Rate	$386.68
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,540.03
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,042.33
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$430.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$386.68

EXC ABD LES SC > 3 CM

Facility

$23,455.00

Service Code	HCPCS 22903
Hospital Charge Code	16000254
Hospital Revenue Code	360
Min. Negotiated Rate	$666.12
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,098.30
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,518.25
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$741.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$666.12

EXC ABD LES SC > 3 CM

Facility

$23,455.00

Service Code	HCPCS 22903
Hospital Charge Code	16000254
Hospital Revenue Code	360
Min. Negotiated Rate	$3,518.25
Max. Negotiated Rate	$3,518.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,518.25

EXC ABDL TUM DEEP < 5 CM

Facility

$20,625.50

Service Code	HCPCS 22900
Hospital Charge Code	16000811
Hospital Revenue Code	360
Min. Negotiated Rate	$3,093.82
Max. Negotiated Rate	$3,093.82
Rate for Payer: Qualcare PPO/HMO/WC	$3,093.82

Know your out-of-pocket cost for care.

All Charges