Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HYSTEROSCOPY DIAGNOSTIC_

Facility

$28,242.08

Service Code	HCPCS 58555
Hospital Charge Code	1600000252
Hospital Revenue Code	360
Min. Negotiated Rate	$4,236.31
Max. Negotiated Rate	$4,236.31
Rate for Payer: Qualcare PPO/HMO/WC	$4,236.31

HYSTEROSCOPY RESECT SEPTUM

Facility

$19,285.59

Service Code	HCPCS 58560
Hospital Charge Code	1600000461
Hospital Revenue Code	360
Min. Negotiated Rate	$547.71
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,014.25
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,892.84
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$609.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$547.71

HYSTEROSCOPY RESECT SEPTUM

Facility

$19,285.59

Service Code	HCPCS 58560
Hospital Charge Code	1600000461
Hospital Revenue Code	360
Min. Negotiated Rate	$2,892.84
Max. Negotiated Rate	$2,892.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,892.84

HYSTEROSCOPY,W ENDOMETAL ABLTN

Facility

$44,931.96

Service Code	HCPCS 58563
Hospital Charge Code	1600000318
Hospital Revenue Code	360
Min. Negotiated Rate	$1,276.07
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,682.31
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,739.79
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,419.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,276.07

HYSTEROSCOPY,W ENDOMETAL ABLTN

Facility

$44,931.96

Service Code	HCPCS 58563
Hospital Charge Code	1600000318
Hospital Revenue Code	360
Min. Negotiated Rate	$6,739.79
Max. Negotiated Rate	$6,739.79
Rate for Payer: Qualcare PPO/HMO/WC	$6,739.79

HYSTEROSCOPY W REM IMPACTED FB

Facility

$20,944.30

Service Code	HCPCS 58562
Hospital Charge Code	1600000301
Hospital Revenue Code	360
Min. Negotiated Rate	$3,141.64
Max. Negotiated Rate	$3,141.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64

HYSTEROSCOPY W REM IMPACTED FB

Facility

$20,944.30

Service Code	HCPCS 58562
Hospital Charge Code	1600000301
Hospital Revenue Code	360
Min. Negotiated Rate	$594.82
Max. Negotiated Rate	$13,950.60
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
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	$13,950.60
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.52
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$661.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$594.82

HYSTEROSCOPY,W REM LEIOMYOMAT

Facility

$35,886.86

Service Code	HCPCS 58561
Hospital Charge Code	16000651
Hospital Revenue Code	360
Min. Negotiated Rate	$1,019.19
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,330.58
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,383.03
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,134.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,019.19

HYSTEROSCOPY,W REM LEIOMYOMAT

Facility

$35,886.86

Service Code	HCPCS 58561
Hospital Charge Code	16000651
Hospital Revenue Code	360
Min. Negotiated Rate	$5,383.03
Max. Negotiated Rate	$5,383.03
Rate for Payer: Qualcare PPO/HMO/WC	$5,383.03

HYSTEROSY,W BX ENDOM /POLYPECT

Facility

$20,944.30

Service Code	HCPCS 58558
Hospital Charge Code	16000762
Hospital Revenue Code	360
Min. Negotiated Rate	$3,141.64
Max. Negotiated Rate	$3,141.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64

HYSTEROSY,W BX ENDOM /POLYPECT

Facility

$20,944.30

Service Code	HCPCS 58558
Hospital Charge Code	16000762
Hospital Revenue Code	360
Min. Negotiated Rate	$594.82
Max. Negotiated Rate	$13,950.60
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
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	$13,950.60
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.52
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$661.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$594.82

HYSTRCPY;W LYSIS INTRAUT ADHSN

Facility

$20,944.30

Service Code	HCPCS 58559
Hospital Charge Code	1600000653
Hospital Revenue Code	360
Min. Negotiated Rate	$3,141.64
Max. Negotiated Rate	$3,141.64
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64

HYSTRCPY;W LYSIS INTRAUT ADHSN

Facility

$20,944.30

Service Code	HCPCS 58559
Hospital Charge Code	1600000653
Hospital Revenue Code	360
Min. Negotiated Rate	$594.82
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,445.52
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,141.64
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$661.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$594.82

HYTRIN/10MG/TAB

Facility

$10.72

Service Code	NDC 781205401
Hospital Charge Code	60634839
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

HYTRIN/10MG/TAB

Facility

$10.72

Service Code	NDC 781205401
Hospital Charge Code	60634839
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$4.07
Rate for Payer: Aetna Medicare Advantage	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.73
Rate for Payer: Cigna Commercial	$5.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$2.14
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

HYTRIN/1MG/UD

Facility

$10.79

Service Code	NDC 51079093720
Hospital Charge Code	60634630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.39
Rate for Payer: Aetna Commercial	$4.10
Rate for Payer: Aetna Medicare Advantage	$3.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.75
Rate for Payer: Cigna Commercial	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.81
Rate for Payer: Oxford Commercial	$2.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.62
Rate for Payer: UnitedHealthcare Commercial	$2.16
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

HYTRIN/1MG/UD

Facility

$10.79

Service Code	NDC 51079093720
Hospital Charge Code	60634630
Hospital Revenue Code	250
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.62

I-123 PER UNIT OF 100UCI

Facility

$193.83

Service Code	HCPCS A9516
Hospital Charge Code	4509075
Hospital Revenue Code	343
Min. Negotiated Rate	$29.07
Max. Negotiated Rate	$29.07
Rate for Payer: Qualcare PPO/HMO/WC	$29.07

I-123 PER UNIT OF 100UCI

Facility

$193.83

Service Code	HCPCS A9516
Hospital Charge Code	4509075
Hospital Revenue Code	343
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$96.92
Rate for Payer: Aetna Commercial	$73.66
Rate for Payer: Aetna Medicare Advantage	$58.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.43
Rate for Payer: Cigna Commercial	$96.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$29.07
Rate for Payer: UnitedHealthcare Community & State	$6.13
Rate for Payer: Wellpoint Medicaid Managed Care	$5.50

I-131 MIBG 0.5MCI CAPSULE

Facility

$395.77

Hospital Charge Code	4509076
Hospital Revenue Code	343
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$197.88
Rate for Payer: Aetna Commercial	$150.39
Rate for Payer: Aetna Medicare Advantage	$118.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.92
Rate for Payer: Cigna Commercial	$197.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.90
Rate for Payer: Qualcare PPO/HMO/WC	$59.37
Rate for Payer: UnitedHealthcare Community & State	$12.51
Rate for Payer: Wellpoint Medicaid Managed Care	$11.24

I-131 MIBG 0.5MCI CAPSULE

Facility

$395.77

Hospital Charge Code	4509076
Hospital Revenue Code	343
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$59.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

I-131 Sodium Iodide Therapy Ca

Facility

$395.77

Hospital Charge Code	4509077
Hospital Revenue Code	344
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$197.88
Rate for Payer: Aetna Commercial	$150.39
Rate for Payer: Aetna Medicare Advantage	$118.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.92
Rate for Payer: Cigna Commercial	$197.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.90
Rate for Payer: Qualcare PPO/HMO/WC	$59.37
Rate for Payer: UnitedHealthcare Community & State	$12.51
Rate for Payer: Wellpoint Medicaid Managed Care	$11.24

I-131 Sodium Iodide Therapy Ca

Facility

$395.77

Hospital Charge Code	4509077
Hospital Revenue Code	344
Min. Negotiated Rate	$59.37
Max. Negotiated Rate	$59.37
Rate for Payer: Qualcare PPO/HMO/WC	$59.37

IA-2 ANTIBODY

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	401186341
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IA-2 ANTIBODY

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	401186341
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.11
Rate for Payer: Aetna Medicare Advantage	$76.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.57
Rate for Payer: Clover Medicare Advantage	$22.39
Rate for Payer: EmblemHealth Commercial	$70.71
Rate for Payer: Humana Medicare Advantage	$24.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.57
Rate for Payer: Wellcare Medicare Advantage	$23.57
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges