Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HIP W/O CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2205385
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

HIP W/O CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2205385
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

HIP W/WO PELVIS 2-3V LT

Facility

$6,601.19

Service Code	HCPCS 73502LT
Hospital Charge Code	94061487
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

HIP W/WO PELVIS 2-3V LT

Facility

$358.23

Service Code	HCPCS 73502LT
Hospital Charge Code	94270267
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

HIP W/WO PELVIS 2-3V LT

Facility

$358.23

Service Code	HCPCS 73502LT
Hospital Charge Code	94270267
Hospital Revenue Code	320
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.14
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$11.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.17

HIP W/WO PELVIS 2-3V LT

Facility

$358.23

Service Code	HCPCS 73502LT
Hospital Charge Code	75190640
Hospital Revenue Code	320
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.14
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$11.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.17

HIP W/WO PELVIS 2-3V LT

Facility

$358.23

Service Code	HCPCS 73502LT
Hospital Charge Code	75190640
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

HIP W/WO PELVIS 2-3V LT

Facility

$6,601.19

Service Code	HCPCS 73502LT
Hospital Charge Code	2011546
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

HIP W/WO PELVIS 2-3V LT

Facility

$6,601.19

Service Code	HCPCS 73502LT
Hospital Charge Code	2011546
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

HIP W/WO PELVIS 2-3V LT

Facility

$6,601.19

Service Code	HCPCS 73502LT
Hospital Charge Code	94061487
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

HIP W/WO PELVIS 2-3V RT

Facility

$6,601.19

Service Code	HCPCS 73502RT
Hospital Charge Code	94061489
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

HIP W/WO PELVIS 2-3V RT

Facility

$6,601.19

Service Code	HCPCS 73502RT
Hospital Charge Code	94061489
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

HIP W/WO PELVIS 2-3V RT

Facility

$358.23

Service Code	HCPCS 73502RT
Hospital Charge Code	75190642
Hospital Revenue Code	320
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.14
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$11.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.17

HIP W/WO PELVIS 2-3V RT

Facility

$358.23

Service Code	HCPCS 73502RT
Hospital Charge Code	75190642
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

HIP W/WO PELVIS 2-3V RT

Facility

$358.23

Service Code	HCPCS 73502RT
Hospital Charge Code	94270269
Hospital Revenue Code	320
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$136.13
Rate for Payer: Aetna Medicare Advantage	$107.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.35
Rate for Payer: Cigna Commercial	$179.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.14
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.73
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$11.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.17

HIP W/WO PELVIS 2-3V RT

Facility

$6,601.19

Service Code	HCPCS 73502RT
Hospital Charge Code	2011548
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

HIP W/WO PELVIS 2-3V RT

Facility

$358.23

Service Code	HCPCS 73502RT
Hospital Charge Code	94270269
Hospital Revenue Code	320
Min. Negotiated Rate	$53.73
Max. Negotiated Rate	$53.73
Rate for Payer: Qualcare PPO/HMO/WC	$53.73

HIP W/WO PELVIS 2-3V RT

Facility

$6,601.19

Service Code	HCPCS 73502RT
Hospital Charge Code	2011548
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94061488
Hospital Revenue Code	320
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.25
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$18.75
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94061488
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	75190641
Hospital Revenue Code	320
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.25
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$18.75
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94270268
Hospital Revenue Code	320
Min. Negotiated Rate	$88.99
Max. Negotiated Rate	$88.99
Rate for Payer: Qualcare PPO/HMO/WC	$88.99

HIP W/WO PELVIS MIN 4V LT

Facility

$593.26

Service Code	HCPCS 73503LT
Hospital Charge Code	94270268
Hospital Revenue Code	320
Min. Negotiated Rate	$16.85
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$225.44
Rate for Payer: Aetna Medicare Advantage	$177.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.28
Rate for Payer: Cigna Commercial	$296.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.25
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.99
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$18.75
Rate for Payer: Wellpoint Medicaid Managed Care	$16.85

HIP W/WO PELVIS MIN 4V LT

Facility

$5,100.00

Service Code	HCPCS 73503LT
Hospital Charge Code	2011547
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

HIP W/WO PELVIS MIN 4V LT

Facility

$5,100.00

Service Code	HCPCS 73503LT
Hospital Charge Code	2011547
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges