Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INTERSTIM I CON PROGRAMMER

Facility

$9,750.00

Service Code	HCPCS C1787
Hospital Charge Code	270685083
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

INTERSTIM X SSMRI 97800

Facility

$58,400.00

Service Code	HCPCS L8679
Hospital Charge Code	270695516
Hospital Revenue Code	278
Min. Negotiated Rate	$8,760.00
Max. Negotiated Rate	$14,132.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,680.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,132.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,760.00

INTERSTIM X SSMRI 97800

Facility

$58,400.00

Service Code	HCPCS L8679
Hospital Charge Code	270695516
Hospital Revenue Code	278
Min. Negotiated Rate	$1,658.56
Max. Negotiated Rate	$29,200.00
Rate for Payer: Aetna Commercial	$22,192.00
Rate for Payer: Aetna Medicare Advantage	$17,520.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,892.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,892.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,892.00
Rate for Payer: Cigna Commercial	$29,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,132.80
Rate for Payer: Qualcare PPO/HMO/WC	$8,760.00
Rate for Payer: UnitedHealthcare Community & State	$1,845.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1,658.56

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$9,875.58

Service Code	APR-DRG 1422
Min. Negotiated Rate	$9,681.94
Max. Negotiated Rate	$9,875.58
Rate for Payer: UnitedHealthcare Community & State	$9,681.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,875.58
Rate for Payer: Wellpoint Medicaid Managed Care	$9,681.94

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$24,641.24

Service Code	APR-DRG 1424
Min. Negotiated Rate	$24,158.08
Max. Negotiated Rate	$24,641.24
Rate for Payer: UnitedHealthcare Community & State	$24,158.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,641.24
Rate for Payer: Wellpoint Medicaid Managed Care	$24,158.08

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$14,347.16

Service Code	APR-DRG 1423
Min. Negotiated Rate	$14,065.84
Max. Negotiated Rate	$14,347.16
Rate for Payer: UnitedHealthcare Community & State	$14,065.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,347.16
Rate for Payer: Wellpoint Medicaid Managed Care	$14,065.84

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$8,391.20

Service Code	APR-DRG 1421
Min. Negotiated Rate	$8,226.67
Max. Negotiated Rate	$8,391.20
Rate for Payer: UnitedHealthcare Community & State	$8,226.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,391.20
Rate for Payer: Wellpoint Medicaid Managed Care	$8,226.67

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$49,450.07

Service Code	MSDRG 197
Min. Negotiated Rate	$15,056.91
Max. Negotiated Rate	$49,450.07
Rate for Payer: Aetna Commercial	$37,077.42
Rate for Payer: Aetna Medicare Advantage	$49,450.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,849.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,705.00
Rate for Payer: Cigna Commercial	$21,158.29
Rate for Payer: Cigna Medicare Advantage	$15,849.38
Rate for Payer: Clover Medicare Advantage	$15,056.91
Rate for Payer: EmblemHealth Commercial	$47,548.14
Rate for Payer: Humana Medicare Advantage	$16,324.86
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,849.38
Rate for Payer: Oxford Commercial	$16,723.14
Rate for Payer: UnitedHealthcare Commercial	$22,384.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,849.38
Rate for Payer: Wellcare Medicare Advantage	$15,849.38

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$79,088.01

Service Code	MSDRG 196
Min. Negotiated Rate	$24,081.28
Max. Negotiated Rate	$79,088.01
Rate for Payer: Aetna Commercial	$58,185.89
Rate for Payer: Aetna Medicare Advantage	$79,088.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52,639.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52,639.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25,348.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52,639.50
Rate for Payer: Cigna Commercial	$42,071.35
Rate for Payer: Cigna Medicare Advantage	$25,348.72
Rate for Payer: Clover Medicare Advantage	$24,081.28
Rate for Payer: EmblemHealth Commercial	$76,046.16
Rate for Payer: Humana Medicare Advantage	$26,109.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25,348.72
Rate for Payer: Oxford Commercial	$33,252.46
Rate for Payer: UnitedHealthcare Commercial	$44,509.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$25,348.72
Rate for Payer: Wellcare Medicare Advantage	$25,348.72

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$42,091.92

Service Code	MSDRG 198
Min. Negotiated Rate	$12,619.44
Max. Negotiated Rate	$42,091.92
Rate for Payer: Aetna Commercial	$31,836.85
Rate for Payer: Aetna Medicare Advantage	$42,091.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,609.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,609.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,491.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,609.90
Rate for Payer: Cigna Commercial	$15,966.25
Rate for Payer: Cigna Medicare Advantage	$13,491.00
Rate for Payer: Clover Medicare Advantage	$12,816.45
Rate for Payer: EmblemHealth Commercial	$40,473.00
Rate for Payer: Humana Medicare Advantage	$13,895.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,491.00
Rate for Payer: Oxford Commercial	$12,619.44
Rate for Payer: UnitedHealthcare Commercial	$16,891.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,491.00
Rate for Payer: Wellcare Medicare Advantage	$13,491.00

INTERVERT BODY FUSION DEV 15X1

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705401
Hospital Revenue Code	278
Min. Negotiated Rate	$553.80
Max. Negotiated Rate	$9,750.00
Rate for Payer: Aetna Commercial	$7,410.00
Rate for Payer: Aetna Medicare Advantage	$5,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,972.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,972.50
Rate for Payer: Cigna Commercial	$9,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00
Rate for Payer: UnitedHealthcare Community & State	$616.20
Rate for Payer: Wellpoint Medicaid Managed Care	$553.80

INTERVERT BODY FUSION DEV 15X1

Facility

$19,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705401
Hospital Revenue Code	278
Min. Negotiated Rate	$2,925.00
Max. Negotiated Rate	$4,719.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,719.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.00

INTERVERTEBRAL BODY FUSION DEV

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704543
Hospital Revenue Code	278
Min. Negotiated Rate	$2,325.00
Max. Negotiated Rate	$3,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00

INTERVERTEBRAL BODY FUSION DEV

Facility

$15,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704543
Hospital Revenue Code	278
Min. Negotiated Rate	$440.20
Max. Negotiated Rate	$7,750.00
Rate for Payer: Aetna Commercial	$5,890.00
Rate for Payer: Aetna Medicare Advantage	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,952.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,952.50
Rate for Payer: Cigna Commercial	$7,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,751.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,325.00
Rate for Payer: UnitedHealthcare Community & State	$489.80
Rate for Payer: Wellpoint Medicaid Managed Care	$440.20

INTESTINAL OBSTRUCTION

Facility

$12,431.60

Service Code	APR-DRG 2473
Min. Negotiated Rate	$12,187.84
Max. Negotiated Rate	$12,431.60
Rate for Payer: UnitedHealthcare Community & State	$12,187.84
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,431.60
Rate for Payer: Wellpoint Medicaid Managed Care	$12,187.84

INTESTINAL OBSTRUCTION

Facility

$22,781.88

Service Code	APR-DRG 2474
Min. Negotiated Rate	$22,335.18
Max. Negotiated Rate	$22,781.88
Rate for Payer: UnitedHealthcare Community & State	$22,335.18
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,781.88
Rate for Payer: Wellpoint Medicaid Managed Care	$22,335.18

INTESTINAL OBSTRUCTION

Facility

$6,450.31

Service Code	APR-DRG 2471
Min. Negotiated Rate	$6,323.83
Max. Negotiated Rate	$6,450.31
Rate for Payer: UnitedHealthcare Community & State	$6,323.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,450.31
Rate for Payer: Wellpoint Medicaid Managed Care	$6,323.83

INTESTINAL OBSTRUCTION

Facility

$8,291.47

Service Code	APR-DRG 2472
Min. Negotiated Rate	$8,128.89
Max. Negotiated Rate	$8,291.47
Rate for Payer: UnitedHealthcare Community & State	$8,128.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,291.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8,128.89

INTL HOSP OR BIRTH CARE E&M NB

Facility

$478.30

Service Code	HCPCS 99460
Hospital Charge Code	93950215
Hospital Revenue Code	510
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$573.76
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.76
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.36
Rate for Payer: Qualcare PPO/HMO/WC	$71.75
Rate for Payer: UnitedHealthcare Community & State	$15.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.58

INTL HOSP OR BIRTH CARE E&M NB

Facility

$478.30

Service Code	HCPCS 99460
Hospital Charge Code	93950215
Hospital Revenue Code	510
Min. Negotiated Rate	$71.75
Max. Negotiated Rate	$71.75
Rate for Payer: Qualcare PPO/HMO/WC	$71.75

INTL PREVENTIVE PHYSICAL EXAM

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	87502675
Hospital Revenue Code	770
Min. Negotiated Rate	$75.07
Max. Negotiated Rate	$75.07
Rate for Payer: Qualcare PPO/HMO/WC	$75.07

INTL PREVENTIVE PHYSICAL EXAM

Facility

$500.45

Service Code	HCPCS G0402
Hospital Charge Code	87502675
Hospital Revenue Code	770
Min. Negotiated Rate	$14.21
Max. Negotiated Rate	$573.76
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.76
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.12
Rate for Payer: Oxford Commercial	$100.09
Rate for Payer: Qualcare PPO/HMO/WC	$75.07
Rate for Payer: UnitedHealthcare Commercial	$100.09
Rate for Payer: UnitedHealthcare Community & State	$15.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$14.21

INTL PREVENTIVE PHYSICAL EXAM

Facility

$495.00

Service Code	HCPCS G0402
Hospital Charge Code	83652529
Hospital Revenue Code	770
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$573.76
Rate for Payer: Aetna Commercial	$430.22
Rate for Payer: Aetna Medicare Advantage	$512.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.76
Rate for Payer: Cigna Commercial	$317.04
Rate for Payer: Cigna Medicare Advantage	$158.17
Rate for Payer: Clover Medicare Advantage	$150.26
Rate for Payer: EmblemHealth Commercial	$474.51
Rate for Payer: Humana Medicare Advantage	$162.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.70
Rate for Payer: Oxford Commercial	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.25
Rate for Payer: UnitedHealthcare Commercial	$99.00
Rate for Payer: UnitedHealthcare Community & State	$15.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.17
Rate for Payer: Wellcare Medicare Advantage	$158.17
Rate for Payer: Wellpoint Medicaid Managed Care	$14.06

INTL PREVENTIVE PHYSICAL EXAM

Facility

$495.00

Service Code	HCPCS G0402
Hospital Charge Code	83652529
Hospital Revenue Code	770
Min. Negotiated Rate	$74.25
Max. Negotiated Rate	$74.25
Rate for Payer: Qualcare PPO/HMO/WC	$74.25

INTMD RPR N-HF/GENIT 2.5cm/<

Facility

$1,457.75

Service Code	HCPCS 12041
Hospital Charge Code	16000357
Hospital Revenue Code	360
Min. Negotiated Rate	$218.66
Max. Negotiated Rate	$218.66
Rate for Payer: Qualcare PPO/HMO/WC	$218.66

Know your out-of-pocket cost for care.

All Charges