Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958N
Hospital Revenue Code	278
Min. Negotiated Rate	$335.12
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$372.88
Rate for Payer: Wellpoint Medicaid Managed Care	$335.12

IN.PACT Admiral 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958
Hospital Revenue Code	278
Min. Negotiated Rate	$335.12
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$372.88
Rate for Payer: Wellpoint Medicaid Managed Care	$335.12

IN.PACT ADMIRAL 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958S
Hospital Revenue Code	278
Min. Negotiated Rate	$335.12
Max. Negotiated Rate	$5,900.00
Rate for Payer: Aetna Commercial	$4,484.00
Rate for Payer: Aetna Medicare Advantage	$3,540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,009.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,009.00
Rate for Payer: Cigna Commercial	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$372.88
Rate for Payer: Wellpoint Medicaid Managed Care	$335.12

IN.PACT ADMIRAL 6x250

Facility

$11,800.00

Service Code	HCPCS C2623
Hospital Charge Code	270684958S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,770.00
Max. Negotiated Rate	$2,855.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,855.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,770.00

IN.PACT Admiral DCB 40mm

Facility

$7,050.00

Service Code	HCPCS C2623
Hospital Charge Code	270686203
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

IN.PACT Admiral DCB 40mm

Facility

$7,050.00

Service Code	HCPCS C2623
Hospital Charge Code	270686203
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

INR STRIP

Facility

$390.00

Service Code	HCPCS 85610
Hospital Charge Code	87502750
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INR STRIP

Facility

$390.00

Service Code	HCPCS 85610
Hospital Charge Code	87502750
Hospital Revenue Code	305
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.67
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.56
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.29
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.29
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	$3.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Medicare Advantage	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

INS CATH ABD/L-EXT ART 1ST

Facility

$364.00

Service Code	HCPCS 36245
Hospital Charge Code	366836245
Hospital Revenue Code	361
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

INS CATH ABD/L-EXT ART 1ST

Facility

$364.00

Service Code	HCPCS 36245
Hospital Charge Code	366836245
Hospital Revenue Code	361
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
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	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$11.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

INS CATH ABD/L-EXT ART 1ST

Facility

$3,632.92

Service Code	HCPCS 36245
Hospital Charge Code	16000580
Hospital Revenue Code	360
Min. Negotiated Rate	$103.17
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,380.51
Rate for Payer: Aetna Medicare Advantage	$1,089.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$926.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$926.39
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	$926.39
Rate for Payer: Cigna Commercial	$1,816.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$944.56
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$544.94
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$114.80
Rate for Payer: Wellpoint Medicaid Managed Care	$103.17

INS CATH ABD/L-EXT ART 1ST

Facility

$3,632.92

Service Code	HCPCS 36245
Hospital Charge Code	16000580
Hospital Revenue Code	360
Min. Negotiated Rate	$544.94
Max. Negotiated Rate	$544.94
Rate for Payer: Qualcare PPO/HMO/WC	$544.94

INS CATH ABD/L-EXT ART ADDL

Facility

$2,620.78

Service Code	HCPCS 36248
Hospital Charge Code	16000733
Hospital Revenue Code	360
Min. Negotiated Rate	$393.12
Max. Negotiated Rate	$393.12
Rate for Payer: Qualcare PPO/HMO/WC	$393.12

INS CATH ABD/L-EXT ART ADDL

Facility

$2,620.78

Service Code	HCPCS 36248
Hospital Charge Code	16000733
Hospital Revenue Code	360
Min. Negotiated Rate	$74.43
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$995.90
Rate for Payer: Aetna Medicare Advantage	$786.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$668.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$668.30
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	$668.30
Rate for Payer: Cigna Commercial	$1,310.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$681.40
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.12
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$82.82
Rate for Payer: Wellpoint Medicaid Managed Care	$74.43

INS CATH ABD/L-EXT ART ADDL

Facility

$484.00

Service Code	HCPCS 36248
Hospital Charge Code	366836248
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

INS CATH ABD/L-EXT ART ADDL

Facility

$484.00

Service Code	HCPCS 36248
Hospital Charge Code	366836248
Hospital Revenue Code	361
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

INS CATH REN ART 1ST BILAT

Facility

$12,462.85

Service Code	HCPCS 36252
Hospital Charge Code	366836252
Hospital Revenue Code	361
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

INS CATH REN ART 1ST BILAT

Facility

$12,462.85

Service Code	HCPCS 36252
Hospital Charge Code	411036252
Hospital Revenue Code	361
Min. Negotiated Rate	$393.83
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.34
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$393.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

INS CATH REN ART 1ST BILAT

Facility

$12,462.85

Service Code	HCPCS 36252
Hospital Charge Code	411036252
Hospital Revenue Code	361
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

INS CATH REN ART 1ST BILAT

Facility

$12,462.85

Service Code	HCPCS 36252
Hospital Charge Code	366836252
Hospital Revenue Code	361
Min. Negotiated Rate	$393.83
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.34
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$393.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

INS CATH REN ART 1ST UNILAT

Facility

$12,462.85

Service Code	HCPCS 36251
Hospital Charge Code	411036251
Hospital Revenue Code	361
Min. Negotiated Rate	$393.83
Max. Negotiated Rate	$13,607.37
Rate for Payer: Aetna Commercial	$10,203.18
Rate for Payer: Aetna Medicare Advantage	$12,153.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,607.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,751.17
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	$13,607.37
Rate for Payer: Cigna Commercial	$7,519.21
Rate for Payer: Cigna Medicare Advantage	$3,751.17
Rate for Payer: Clover Medicare Advantage	$3,563.61
Rate for Payer: EmblemHealth Commercial	$11,253.51
Rate for Payer: Humana Medicare Advantage	$3,863.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,751.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,240.34
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$393.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare Medicare Advantage	$3,751.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,216.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7,075.29

INS CATH REN ART 1ST UNILAT

Facility

$12,462.85

Service Code	HCPCS 36251
Hospital Charge Code	411036251
Hospital Revenue Code	361
Min. Negotiated Rate	$1,869.43
Max. Negotiated Rate	$1,869.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,869.43

INSERT 12x63/67 183722

Facility

$5,370.00

Hospital Charge Code	270639168
Hospital Revenue Code	272
Min. Negotiated Rate	$805.50
Max. Negotiated Rate	$805.50
Rate for Payer: Qualcare PPO/HMO/WC	$805.50

INSERT 12x63/67 183722

Facility

$5,370.00

Hospital Charge Code	270639168
Hospital Revenue Code	272
Min. Negotiated Rate	$152.51
Max. Negotiated Rate	$2,685.00
Rate for Payer: Aetna Commercial	$2,040.60
Rate for Payer: Aetna Medicare Advantage	$1,611.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,369.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,369.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,369.35
Rate for Payer: Cigna Commercial	$2,685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,396.20
Rate for Payer: Oxford Commercial	$1,074.00
Rate for Payer: Qualcare PPO/HMO/WC	$805.50
Rate for Payer: UnitedHealthcare Commercial	$1,074.00
Rate for Payer: UnitedHealthcare Community & State	$169.69
Rate for Payer: Wellpoint Medicaid Managed Care	$152.51

Know your out-of-pocket cost for care.

All Charges