Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR-PERC INJ RENAL CYST-LT

Facility

$4,709.90

Service Code	HCPCS 50390LT
Hospital Charge Code	2691590
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2691595
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	2691595
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	366850390R
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	366850390R
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	321050390R
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	321050390R
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	411050390R
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

IR-PERC INJ RENAL CYST-RT

Facility

$4,709.90

Service Code	HCPCS 50390RT
Hospital Charge Code	411050390R
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,789.76
Rate for Payer: Aetna Medicare Advantage	$1,412.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,201.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,201.02
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	$1,201.02
Rate for Payer: Cigna Commercial	$2,354.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

IR PERC NEEDLE CORE BX BREAST

Facility

$1,874.00

Service Code	HCPCS 19100
Hospital Charge Code	7411339
Hospital Revenue Code	361
Min. Negotiated Rate	$281.10
Max. Negotiated Rate	$281.10
Rate for Payer: Qualcare PPO/HMO/WC	$281.10

IR PERC NEEDLE CORE BX BREAST

Facility

$1,874.00

Service Code	HCPCS 19100
Hospital Charge Code	7411339
Hospital Revenue Code	361
Min. Negotiated Rate	$53.22
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.24
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$281.10
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$59.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$53.22

IR PERC NEEDLE CORE BX BREAST

Facility

$1,874.00

Service Code	HCPCS 19100
Hospital Charge Code	2670240
Hospital Revenue Code	361
Min. Negotiated Rate	$53.22
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$487.24
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$281.10
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$59.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$53.22

IR PERC NEEDLE CORE BX BREAST

Facility

$1,874.00

Service Code	HCPCS 19100
Hospital Charge Code	2670240
Hospital Revenue Code	361
Min. Negotiated Rate	$281.10
Max. Negotiated Rate	$281.10
Rate for Payer: Qualcare PPO/HMO/WC	$281.10

IR PERC PCMT OF DRAIN CATH

Facility

$2,687.00

Hospital Charge Code	2008025
Hospital Revenue Code	320
Min. Negotiated Rate	$76.31
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,021.06
Rate for Payer: Aetna Medicare Advantage	$806.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$685.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$685.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$685.18
Rate for Payer: Cigna Commercial	$1,343.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$698.62
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$403.05
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$84.91
Rate for Payer: Wellpoint Medicaid Managed Care	$76.31

IR PERC PCMT OF DRAIN CATH

Facility

$2,687.00

Hospital Charge Code	2008025
Hospital Revenue Code	320
Min. Negotiated Rate	$403.05
Max. Negotiated Rate	$403.05
Rate for Payer: Qualcare PPO/HMO/WC	$403.05

IR PERC PLACE OF METALLIC CLIP

Facility

$270.60

Hospital Charge Code	26702046
Hospital Revenue Code	361
Min. Negotiated Rate	$40.59
Max. Negotiated Rate	$40.59
Rate for Payer: Qualcare PPO/HMO/WC	$40.59

IR PERC PLACE OF METALLIC CLIP

Facility

$270.60

Hospital Charge Code	26702046
Hospital Revenue Code	361
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$102.83
Rate for Payer: Aetna Medicare Advantage	$81.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.00
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	$69.00
Rate for Payer: Cigna Commercial	$135.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.36
Rate for Payer: Qualcare PPO/HMO/WC	$40.59
Rate for Payer: UnitedHealthcare Community & State	$8.55
Rate for Payer: Wellpoint Medicaid Managed Care	$7.69

IR PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	321074363
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
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	$294.03
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 PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	411074363
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	411074363
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
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	$294.03
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 PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	321074363
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	2000935
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

IR PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	2000935
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
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	$294.03
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 PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	366874363
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
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	$294.03
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 PERC TRAN DIL BILIARY DUCTS

Facility

$5,100.00

Service Code	HCPCS 74363
Hospital Charge Code	366874363
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