Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	321053899R
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	411053899
Hospital Revenue Code	361
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.34
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$42.82
Rate for Payer: Wellpoint Medicaid Managed Care	$38.49

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	321053899R
Hospital Revenue Code	361
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.34
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$42.82
Rate for Payer: Wellpoint Medicaid Managed Care	$38.49

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	411053899
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	2691715
Hospital Revenue Code	361
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.34
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$42.82
Rate for Payer: Wellpoint Medicaid Managed Care	$38.49

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	366853899R
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	2691715
Hospital Revenue Code	361
Min. Negotiated Rate	$203.27
Max. Negotiated Rate	$203.27
Rate for Payer: Qualcare PPO/HMO/WC	$203.27

IR-DIL OF URETER-RT

Facility

$1,355.15

Service Code	HCPCS 53899RT
Hospital Charge Code	366853899R
Hospital Revenue Code	361
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$514.96
Rate for Payer: Aetna Medicare Advantage	$406.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.56
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	$345.56
Rate for Payer: Cigna Commercial	$677.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.34
Rate for Payer: Qualcare PPO/HMO/WC	$203.27
Rate for Payer: UnitedHealthcare Community & State	$42.82
Rate for Payer: Wellpoint Medicaid Managed Care	$38.49

IR DIR-ARTERGRM CAROT CERE UNI

Facility

$12,031.00

Service Code	HCPCS 75665
Hospital Charge Code	2680325
Hospital Revenue Code	323
Min. Negotiated Rate	$341.68
Max. Negotiated Rate	$6,015.50
Rate for Payer: Aetna Commercial	$4,571.78
Rate for Payer: Aetna Medicare Advantage	$3,609.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,067.91
Rate for Payer: Cigna Commercial	$6,015.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,128.06
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$380.18
Rate for Payer: Wellpoint Medicaid Managed Care	$341.68

IR DIR-ARTERGRM CAROT CERE UNI

Facility

$12,031.00

Service Code	HCPCS 75665
Hospital Charge Code	2680325
Hospital Revenue Code	323
Min. Negotiated Rate	$1,804.65
Max. Negotiated Rate	$1,804.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65

IR DIR-ARTERGRM CAROTID,EXT,UN

Facility

$19,530.00

Service Code	HCPCS 75660
Hospital Charge Code	2680320
Hospital Revenue Code	323
Min. Negotiated Rate	$554.65
Max. Negotiated Rate	$9,765.00
Rate for Payer: Aetna Commercial	$7,421.40
Rate for Payer: Aetna Medicare Advantage	$5,859.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,980.15
Rate for Payer: Cigna Commercial	$9,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,077.80
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$617.15
Rate for Payer: Wellpoint Medicaid Managed Care	$554.65

IR DIR-ARTERGRM CAROTID,EXT,UN

Facility

$19,530.00

Service Code	HCPCS 75660
Hospital Charge Code	2680320
Hospital Revenue Code	323
Min. Negotiated Rate	$2,929.50
Max. Negotiated Rate	$2,929.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50

IR DIR-ARTERIGRAM VERT CERV UN

Facility

$12,031.00

Service Code	HCPCS 75685
Hospital Charge Code	2670070
Hospital Revenue Code	323
Min. Negotiated Rate	$1,804.65
Max. Negotiated Rate	$1,804.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65

IR DIR-ARTERIGRAM VERT CERV UN

Facility

$12,031.00

Service Code	HCPCS 75685
Hospital Charge Code	2670070
Hospital Revenue Code	323
Min. Negotiated Rate	$341.68
Max. Negotiated Rate	$6,015.50
Rate for Payer: Aetna Commercial	$4,571.78
Rate for Payer: Aetna Medicare Advantage	$3,609.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,067.91
Rate for Payer: Cigna Commercial	$6,015.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,128.06
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$380.18
Rate for Payer: Wellpoint Medicaid Managed Care	$341.68

IR DIR-ARTGRM CAROT CEREB-BILA

Facility

$19,530.00

Service Code	HCPCS 75671
Hospital Charge Code	2670080
Hospital Revenue Code	323
Min. Negotiated Rate	$2,929.50
Max. Negotiated Rate	$2,929.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50

IR DIR-ARTGRM CAROT CEREB-BILA

Facility

$19,530.00

Service Code	HCPCS 75671
Hospital Charge Code	2670080
Hospital Revenue Code	323
Min. Negotiated Rate	$554.65
Max. Negotiated Rate	$9,765.00
Rate for Payer: Aetna Commercial	$7,421.40
Rate for Payer: Aetna Medicare Advantage	$5,859.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,980.15
Rate for Payer: Cigna Commercial	$9,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,077.80
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$617.15
Rate for Payer: Wellpoint Medicaid Managed Care	$554.65

IR DIR-ARTGRM CAROT CERV BILAT

Facility

$12,031.00

Service Code	HCPCS 75680
Hospital Charge Code	2670075
Hospital Revenue Code	323
Min. Negotiated Rate	$341.68
Max. Negotiated Rate	$6,015.50
Rate for Payer: Aetna Commercial	$4,571.78
Rate for Payer: Aetna Medicare Advantage	$3,609.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,067.91
Rate for Payer: Cigna Commercial	$6,015.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,128.06
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$380.18
Rate for Payer: Wellpoint Medicaid Managed Care	$341.68

IR DIR-ARTGRM CAROT CERV BILAT

Facility

$12,031.00

Service Code	HCPCS 75680
Hospital Charge Code	2670075
Hospital Revenue Code	323
Min. Negotiated Rate	$1,804.65
Max. Negotiated Rate	$1,804.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65

IR DIR-ARTGRM CERV-CERE ARCH

Facility

$19,530.00

Service Code	HCPCS 75650
Hospital Charge Code	2670090
Hospital Revenue Code	323
Min. Negotiated Rate	$2,929.50
Max. Negotiated Rate	$2,929.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50

IR DIR-ARTGRM CERV-CERE ARCH

Facility

$19,530.00

Service Code	HCPCS 75650
Hospital Charge Code	2670090
Hospital Revenue Code	323
Min. Negotiated Rate	$554.65
Max. Negotiated Rate	$9,765.00
Rate for Payer: Aetna Commercial	$7,421.40
Rate for Payer: Aetna Medicare Advantage	$5,859.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,980.15
Rate for Payer: Cigna Commercial	$9,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,077.80
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$617.15
Rate for Payer: Wellpoint Medicaid Managed Care	$554.65

IR DIR-ARTRGRM CAROT EXTERN-BI

Facility

$19,530.00

Service Code	HCPCS 75662
Hospital Charge Code	2670085
Hospital Revenue Code	323
Min. Negotiated Rate	$2,929.50
Max. Negotiated Rate	$2,929.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50

IR DIR-ARTRGRM CAROT EXTERN-BI

Facility

$19,530.00

Service Code	HCPCS 75662
Hospital Charge Code	2670085
Hospital Revenue Code	323
Min. Negotiated Rate	$554.65
Max. Negotiated Rate	$9,765.00
Rate for Payer: Aetna Commercial	$7,421.40
Rate for Payer: Aetna Medicare Advantage	$5,859.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,980.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,980.15
Rate for Payer: Cigna Commercial	$9,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,077.80
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,929.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$617.15
Rate for Payer: Wellpoint Medicaid Managed Care	$554.65

IR DIR FLOUR GUIDANCE,SPINE/IN

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	366877003
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR DIR FLOUR GUIDANCE,SPINE/IN

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	366877003
Hospital Revenue Code	320
Min. Negotiated Rate	$33.36
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

IR DIR FLOUR GUIDANCE,SPINE/IN

Facility

$5,100.00

Service Code	HCPCS 77003
Hospital Charge Code	2670015
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges