Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR INJ PROC KNEE ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 27370
Hospital Charge Code	2680095
Hospital Revenue Code	361
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Community & State	$13.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.76

IR INJ PROC PTC

Facility

$414.00

Hospital Charge Code	2004737
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC PTC

Facility

$414.00

Hospital Charge Code	2004737
Hospital Revenue Code	361
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Community & State	$13.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.76

IR INJ PROC PYELO THRU TUBE

Facility

$414.00

Hospital Charge Code	2004810
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC PYELO THRU TUBE

Facility

$414.00

Hospital Charge Code	2004810
Hospital Revenue Code	361
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Community & State	$13.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.76

IR INJ PROC SACROILIAC ARTHROG

Facility

$414.00

Service Code	HCPCS 27096
Hospital Charge Code	2680085
Hospital Revenue Code	361
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.76

IR INJ PROC SACROILIAC ARTHROG

Facility

$414.00

Service Code	HCPCS 27096
Hospital Charge Code	7411368
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC SACROILIAC ARTHROG

Facility

$414.00

Service Code	HCPCS 27096
Hospital Charge Code	7411368
Hospital Revenue Code	361
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.76

IR INJ PROC SACROILIAC ARTHROG

Facility

$414.00

Service Code	HCPCS 27096
Hospital Charge Code	2680085
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC VENOGRAPHY

Facility

$414.45

Service Code	HCPCS 36005
Hospital Charge Code	2004679
Hospital Revenue Code	361
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.76
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.10

IR INJ PROC VENOGRAPHY

Facility

$414.45

Service Code	HCPCS 36005
Hospital Charge Code	321036005
Hospital Revenue Code	361
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.76
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.10

IR INJ PROC VENOGRAPHY

Facility

$414.45

Service Code	HCPCS 36005
Hospital Charge Code	366836005
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ PROC VENOGRAPHY

Facility

$414.45

Service Code	HCPCS 36005
Hospital Charge Code	366836005
Hospital Revenue Code	361
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.49
Rate for Payer: Aetna Medicare Advantage	$124.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.68
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	$105.68
Rate for Payer: Cigna Commercial	$207.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.76
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.17
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.10

IR INJ PROC VENOGRAPHY

Facility

$792.00

Service Code	HCPCS 36005
Hospital Charge Code	7411413
Hospital Revenue Code	361
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$118.80
Rate for Payer: Qualcare PPO/HMO/WC	$118.80

IR INJ PROC VENOGRAPHY

Facility

$792.00

Service Code	HCPCS 36005
Hospital Charge Code	7411413
Hospital Revenue Code	361
Min. Negotiated Rate	$25.03
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$300.96
Rate for Payer: Aetna Medicare Advantage	$237.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.96
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	$201.96
Rate for Payer: Cigna Commercial	$396.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.92
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.80
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$25.03

IR INJ PROC VENOGRAPHY

Facility

$414.45

Service Code	HCPCS 36005
Hospital Charge Code	2004679
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ PROC VENOGRAPHY

Facility

$414.45

Service Code	HCPCS 36005
Hospital Charge Code	321036005
Hospital Revenue Code	361
Min. Negotiated Rate	$62.17
Max. Negotiated Rate	$62.17
Rate for Payer: Qualcare PPO/HMO/WC	$62.17

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	2680075
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	2680075
Hospital Revenue Code	361
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.08

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	7411364
Hospital Revenue Code	361
Min. Negotiated Rate	$13.08
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.08

IR INJ PROC WRIST ARTHROGRAPHY

Facility

$414.00

Service Code	HCPCS 25246
Hospital Charge Code	7411364
Hospital Revenue Code	361
Min. Negotiated Rate	$62.10
Max. Negotiated Rate	$62.10
Rate for Payer: Qualcare PPO/HMO/WC	$62.10

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	2670230
Hospital Revenue Code	361
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$182.02
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
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	$122.14
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.54
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$15.14
Rate for Payer: Wellpoint Medicaid Managed Care	$13.60

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	2670230
Hospital Revenue Code	361
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	7411625
Hospital Revenue Code	361
Min. Negotiated Rate	$71.85
Max. Negotiated Rate	$71.85
Rate for Payer: Qualcare PPO/HMO/WC	$71.85

IR-INJ RETROGRADE URETHROGRAM

Facility

$479.00

Service Code	HCPCS 51610
Hospital Charge Code	7411625
Hospital Revenue Code	361
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$182.02
Rate for Payer: Aetna Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.14
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	$122.14
Rate for Payer: Cigna Commercial	$239.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.54
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.85
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$15.14
Rate for Payer: Wellpoint Medicaid Managed Care	$13.60

Know your out-of-pocket cost for care.

All Charges