Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INJ FORAMEN EPIDURAL L/S

Facility

$7,956.80

Service Code	HCPCS 64483
Hospital Charge Code	1600000393
Hospital Revenue Code	360
Min. Negotiated Rate	$1,193.52
Max. Negotiated Rate	$1,193.52
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52

INJ FORAMEN EPIDURAL L/S

Facility

$7,956.80

Service Code	HCPCS 64483
Hospital Charge Code	1600000393
Hospital Revenue Code	360
Min. Negotiated Rate	$251.43
Max. Negotiated Rate	$3,811.70
Rate for Payer: Aetna Commercial	$2,858.12
Rate for Payer: Aetna Medicare Advantage	$3,404.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,811.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,811.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,050.78
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	$3,811.70
Rate for Payer: Cigna Commercial	$2,106.27
Rate for Payer: Cigna Medicare Advantage	$1,050.78
Rate for Payer: Clover Medicare Advantage	$998.24
Rate for Payer: EmblemHealth Commercial	$3,152.34
Rate for Payer: Humana Medicare Advantage	$1,082.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,050.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,068.77
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,193.52
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$251.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare Medicare Advantage	$1,050.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$2,311.74
Rate for Payer: Wellpoint Medicaid Managed Care	$2,266.41

INJ FOR CYSTOGRAM

Facility

$2,994.91

Service Code	HCPCS 51600
Hospital Charge Code	16000432
Hospital Revenue Code	360
Min. Negotiated Rate	$85.06
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,138.07
Rate for Payer: Aetna Medicare Advantage	$898.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$763.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$763.70
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	$763.70
Rate for Payer: Cigna Commercial	$1,497.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.68
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$449.24
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$94.64
Rate for Payer: Wellpoint Medicaid Managed Care	$85.06

INJ FOR CYSTOGRAM

Facility

$2,994.91

Service Code	HCPCS 51600
Hospital Charge Code	16000432
Hospital Revenue Code	360
Min. Negotiated Rate	$449.24
Max. Negotiated Rate	$449.24
Rate for Payer: Qualcare PPO/HMO/WC	$449.24

INJ.GANDOLINIUM MRI CONT AGNT

Facility

$405.00

Service Code	HCPCS A9579
Hospital Charge Code	2008070
Hospital Revenue Code	255
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

INJ.GANDOLINIUM MRI CONT AGNT

Facility

$405.00

Service Code	HCPCS A9579
Hospital Charge Code	2008070
Hospital Revenue Code	255
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

INJ HIP XRAY

Facility

$1,152.44

Service Code	HCPCS 27095
Hospital Charge Code	16000378
Hospital Revenue Code	360
Min. Negotiated Rate	$172.87
Max. Negotiated Rate	$172.87
Rate for Payer: Qualcare PPO/HMO/WC	$172.87

INJ HIP XRAY

Facility

$1,152.44

Service Code	HCPCS 27095
Hospital Charge Code	16000378
Hospital Revenue Code	360
Min. Negotiated Rate	$36.42
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$437.93
Rate for Payer: Aetna Medicare Advantage	$345.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.87
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	$293.87
Rate for Payer: Cigna Commercial	$576.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.63
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.87
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$36.42

INJ ION INTO SKIN LESIONS =<7

Facility

$994.50

Service Code	HCPCS 11900
Hospital Charge Code	16000781
Hospital Revenue Code	360
Min. Negotiated Rate	$28.24
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.57
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$149.18
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$31.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$28.24

INJ ION INTO SKIN LESIONS =<7

Facility

$994.50

Service Code	HCPCS 11900
Hospital Charge Code	16000781
Hospital Revenue Code	360
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$149.18
Rate for Payer: Qualcare PPO/HMO/WC	$149.18

INJ MYELOGRAPHY (EPIDUROGRAM)

Facility

$498.00

Service Code	HCPCS 62284
Hospital Charge Code	84506020
Hospital Revenue Code	361
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

INJ MYELOGRAPHY (EPIDUROGRAM)

Facility

$498.00

Service Code	HCPCS 62284
Hospital Charge Code	84506020
Hospital Revenue Code	361
Min. Negotiated Rate	$15.74
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$189.24
Rate for Payer: Aetna Medicare Advantage	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.99
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	$126.99
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.48
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.70
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$15.74

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,292.50

Service Code	HCPCS 50431
Hospital Charge Code	321050431
Hospital Revenue Code	361
Min. Negotiated Rate	$93.51
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$856.05
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$493.88
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$104.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$93.51

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,292.50

Service Code	HCPCS 50431
Hospital Charge Code	321050431
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	7411607
Hospital Revenue Code	361
Min. Negotiated Rate	$87.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$803.45
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$97.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$87.76

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	7411607
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	366850431
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	366850431
Hospital Revenue Code	361
Min. Negotiated Rate	$87.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$803.45
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$97.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$87.76

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	411050431
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,090.18

Service Code	HCPCS 50431
Hospital Charge Code	411050431
Hospital Revenue Code	361
Min. Negotiated Rate	$87.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$803.45
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$97.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$87.76

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,292.50

Service Code	HCPCS 50431
Hospital Charge Code	2600239
Hospital Revenue Code	361
Min. Negotiated Rate	$493.88
Max. Negotiated Rate	$493.88
Rate for Payer: Qualcare PPO/HMO/WC	$493.88

INJ NEPH/URETEROGRAM EXISTING

Facility

$3,292.50

Service Code	HCPCS 50431
Hospital Charge Code	2600239
Hospital Revenue Code	361
Min. Negotiated Rate	$93.51
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$856.05
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$493.88
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$104.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$93.51

INJ NEPH/URETEROGRAM NEW

Facility

$3,090.18

Service Code	HCPCS 50430
Hospital Charge Code	2600238
Hospital Revenue Code	361
Min. Negotiated Rate	$87.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,253.28
Rate for Payer: Aetna Medicare Advantage	$2,684.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,005.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$828.41
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	$3,005.06
Rate for Payer: Cigna Commercial	$1,660.53
Rate for Payer: Cigna Medicare Advantage	$828.41
Rate for Payer: Clover Medicare Advantage	$786.99
Rate for Payer: EmblemHealth Commercial	$2,485.23
Rate for Payer: Humana Medicare Advantage	$853.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$828.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$803.45
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$463.53
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$97.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$828.41
Rate for Payer: Wellcare Medicare Advantage	$828.41
Rate for Payer: Wellpoint Medicaid Managed Care	$87.76

INJ NEPH/URETEROGRAM NEW

Facility

$3,090.18

Service Code	HCPCS 50430
Hospital Charge Code	2600238
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

INJ NEPH/URETEROGRAM NEW

Facility

$3,090.18

Service Code	HCPCS 50430
Hospital Charge Code	7411606
Hospital Revenue Code	361
Min. Negotiated Rate	$463.53
Max. Negotiated Rate	$463.53
Rate for Payer: Qualcare PPO/HMO/WC	$463.53

Know your out-of-pocket cost for care.

All Charges