Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INTRAFIX PEEK TP SCR 8-10x30MM

Facility

$1,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270673367
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$343.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.64
Rate for Payer: Qualcare PPO/HMO/WC	$213.00

INTRALIPID 20% 250ML EMULSION

Facility

$278.59

Service Code	NDC 338051902
Hospital Charge Code	60630044
Hospital Revenue Code	250
Min. Negotiated Rate	$41.79
Max. Negotiated Rate	$41.79
Rate for Payer: Qualcare PPO/HMO/WC	$41.79

INTRALIPID 20% 250ML EMULSION

Facility

$278.59

Service Code	NDC 338051902
Hospital Charge Code	60630044
Hospital Revenue Code	250
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$139.29
Rate for Payer: Aetna Commercial	$105.86
Rate for Payer: Aetna Medicare Advantage	$83.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.04
Rate for Payer: Cigna Commercial	$139.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.43
Rate for Payer: Oxford Commercial	$55.72
Rate for Payer: Qualcare PPO/HMO/WC	$41.79
Rate for Payer: UnitedHealthcare Commercial	$55.72
Rate for Payer: UnitedHealthcare Community & State	$8.80
Rate for Payer: Wellpoint Medicaid Managed Care	$7.91

INTRALIPID 20% 500ML EMULSION

Facility

$292.52

Service Code	NDC 338051903
Hospital Charge Code	60630045
Hospital Revenue Code	250
Min. Negotiated Rate	$43.88
Max. Negotiated Rate	$43.88
Rate for Payer: Qualcare PPO/HMO/WC	$43.88

INTRALIPID 20% 500ML EMULSION

Facility

$292.52

Service Code	NDC 338051903
Hospital Charge Code	60630045
Hospital Revenue Code	250
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$146.26
Rate for Payer: Aetna Commercial	$111.16
Rate for Payer: Aetna Medicare Advantage	$87.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.59
Rate for Payer: Cigna Commercial	$146.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.06
Rate for Payer: Oxford Commercial	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.88
Rate for Payer: UnitedHealthcare Commercial	$58.50
Rate for Payer: UnitedHealthcare Community & State	$9.24
Rate for Payer: Wellpoint Medicaid Managed Care	$8.31

INTRAOCULAR PROCEDURES WITH CC/MCC

Facility

$76,588.95

Service Code	MSDRG 116
Min. Negotiated Rate	$23,320.35
Max. Negotiated Rate	$76,588.95
Rate for Payer: Aetna Commercial	$56,406.02
Rate for Payer: Aetna Medicare Advantage	$76,588.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50,700.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50,700.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,547.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50,700.15
Rate for Payer: Cigna Commercial	$40,307.97
Rate for Payer: Cigna Medicare Advantage	$24,547.74
Rate for Payer: Clover Medicare Advantage	$23,320.35
Rate for Payer: EmblemHealth Commercial	$73,643.22
Rate for Payer: Humana Medicare Advantage	$25,284.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,547.74
Rate for Payer: Oxford Commercial	$31,858.72
Rate for Payer: UnitedHealthcare Commercial	$42,644.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,547.74
Rate for Payer: Wellcare Medicare Advantage	$24,547.74

INTRAOCULAR PROCEDURES WITHOUT CC/MCC

Facility

$53,740.53

Service Code	MSDRG 117
Min. Negotiated Rate	$16,363.30
Max. Negotiated Rate	$53,740.53
Rate for Payer: Aetna Commercial	$40,133.14
Rate for Payer: Aetna Medicare Advantage	$53,740.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,224.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,246.00
Rate for Payer: Cigna Commercial	$24,185.68
Rate for Payer: Cigna Medicare Advantage	$17,224.53
Rate for Payer: Clover Medicare Advantage	$16,363.30
Rate for Payer: EmblemHealth Commercial	$51,673.59
Rate for Payer: Humana Medicare Advantage	$17,741.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,224.53
Rate for Payer: Oxford Commercial	$19,115.94
Rate for Payer: UnitedHealthcare Commercial	$25,587.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,224.53
Rate for Payer: Wellcare Medicare Advantage	$17,224.53

INTRAPLEU.AEROSOL SUR.TALC(BRY

Facility

$668.00

Hospital Charge Code	270335411
Hospital Revenue Code	272
Min. Negotiated Rate	$100.20
Max. Negotiated Rate	$100.20
Rate for Payer: Qualcare PPO/HMO/WC	$100.20

INTRAPLEU.AEROSOL SUR.TALC(BRY

Facility

$668.00

Hospital Charge Code	270335411
Hospital Revenue Code	272
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$334.00
Rate for Payer: Aetna Commercial	$253.84
Rate for Payer: Aetna Medicare Advantage	$200.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.34
Rate for Payer: Cigna Commercial	$334.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.68
Rate for Payer: Oxford Commercial	$133.60
Rate for Payer: Qualcare PPO/HMO/WC	$100.20
Rate for Payer: UnitedHealthcare Commercial	$133.60
Rate for Payer: UnitedHealthcare Community & State	$21.11
Rate for Payer: Wellpoint Medicaid Managed Care	$18.97

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	74110061
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	74110061
Hospital Revenue Code	480
Min. Negotiated Rate	$172.39
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.20
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$191.81
Rate for Payer: Wellpoint Medicaid Managed Care	$172.39

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	5100651
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

INTRAVASC US COR VESS/GFT ADD

Facility

$6,070.00

Service Code	HCPCS 92979
Hospital Charge Code	5100651
Hospital Revenue Code	480
Min. Negotiated Rate	$172.39
Max. Negotiated Rate	$3,035.00
Rate for Payer: Aetna Commercial	$2,306.60
Rate for Payer: Aetna Medicare Advantage	$1,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,547.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,547.85
Rate for Payer: Cigna Commercial	$3,035.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.20
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$191.81
Rate for Payer: Wellpoint Medicaid Managed Care	$172.39

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	74110060
Hospital Revenue Code	481
Min. Negotiated Rate	$660.56
Max. Negotiated Rate	$660.56
Rate for Payer: Qualcare PPO/HMO/WC	$660.56

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	74110060
Hospital Revenue Code	481
Min. Negotiated Rate	$125.07
Max. Negotiated Rate	$4,213.00
Rate for Payer: Aetna Commercial	$1,673.42
Rate for Payer: Aetna Medicare Advantage	$1,321.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.96
Rate for Payer: Cigna Commercial	$2,201.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.97
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.56
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$139.16
Rate for Payer: Wellpoint Medicaid Managed Care	$125.07

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	5100650
Hospital Revenue Code	481
Min. Negotiated Rate	$660.56
Max. Negotiated Rate	$660.56
Rate for Payer: Qualcare PPO/HMO/WC	$660.56

INTRAVASC US COR VESS/GFT INIT

Facility

$4,403.75

Service Code	HCPCS 92978
Hospital Charge Code	5100650
Hospital Revenue Code	481
Min. Negotiated Rate	$125.07
Max. Negotiated Rate	$4,213.00
Rate for Payer: Aetna Commercial	$1,673.42
Rate for Payer: Aetna Medicare Advantage	$1,321.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.96
Rate for Payer: Cigna Commercial	$2,201.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.97
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.56
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$139.16
Rate for Payer: Wellpoint Medicaid Managed Care	$125.07

INTRAVU NEEDLE SCOPE SUPERIOR

Facility

$3,000.00

Hospital Charge Code	270691835
Hospital Revenue Code	272
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

INTRAVU NEEDLE SCOPE SUPERIOR

Facility

$3,000.00

Hospital Charge Code	270691835
Hospital Revenue Code	272
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.00
Rate for Payer: Oxford Commercial	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$600.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.57
Rate for Payer: Aetna Commercial	$226.16
Rate for Payer: Aetna Medicare Advantage	$178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.76
Rate for Payer: Cigna Commercial	$297.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.03
Rate for Payer: Qualcare PPO/HMO/WC	$89.27
Rate for Payer: UnitedHealthcare Community & State	$18.81
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441N
Hospital Revenue Code	278
Min. Negotiated Rate	$89.27
Max. Negotiated Rate	$144.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.03
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441C
Hospital Revenue Code	278
Min. Negotiated Rate	$89.27
Max. Negotiated Rate	$144.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.03
Rate for Payer: Qualcare PPO/HMO/WC	$89.27

INTRDCR CHCKFLO GUIDSHEATH16FR

Facility

$595.15

Service Code	HCPCS C1893
Hospital Charge Code	270622441C
Hospital Revenue Code	278
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$297.57
Rate for Payer: Aetna Commercial	$226.16
Rate for Payer: Aetna Medicare Advantage	$178.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.76
Rate for Payer: Cigna Commercial	$297.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.03
Rate for Payer: Qualcare PPO/HMO/WC	$89.27
Rate for Payer: UnitedHealthcare Community & State	$18.81
Rate for Payer: Wellpoint Medicaid Managed Care	$16.90

INT REP FACE 2.5-5.0

Facility

$687.50

Service Code	HCPCS 12052
Hospital Charge Code	1600000730
Hospital Revenue Code	360
Min. Negotiated Rate	$103.12
Max. Negotiated Rate	$103.12
Rate for Payer: Qualcare PPO/HMO/WC	$103.12

INT REP FACE 2.5-5.0

Facility

$687.50

Service Code	HCPCS 12052
Hospital Charge Code	1600000730
Hospital Revenue Code	360
Min. Negotiated Rate	$21.73
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.75
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.12
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$21.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95

Know your out-of-pocket cost for care.

All Charges