Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ANNUAL WELLNESS VISIT - SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502685
Hospital Revenue Code	770
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.64
Rate for Payer: Oxford Commercial	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$72.80
Rate for Payer: UnitedHealthcare Community & State	$11.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANNUAL WELLNESS VISIT - SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502685
Hospital Revenue Code	770
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

ANNUAL WELLNESS VISIT-SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	83652535
Hospital Revenue Code	770
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

ANNUAL WELLNESS VISIT-SUBSQ

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	83652535
Hospital Revenue Code	770
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.64
Rate for Payer: Oxford Commercial	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$72.80
Rate for Payer: UnitedHealthcare Community & State	$11.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANNUAL WELLNESS VST FIRST GE

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502825
Hospital Revenue Code	770
Min. Negotiated Rate	$81.45
Max. Negotiated Rate	$81.45
Rate for Payer: Qualcare PPO/HMO/WC	$81.45

ANNUAL WELLNESS VST FIRST GE

Facility

$543.00

Service Code	HCPCS G0438
Hospital Charge Code	87502825
Hospital Revenue Code	770
Min. Negotiated Rate	$15.42
Max. Negotiated Rate	$271.50
Rate for Payer: Aetna Commercial	$206.34
Rate for Payer: Aetna Medicare Advantage	$162.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$138.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$138.47
Rate for Payer: Cigna Commercial	$271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.18
Rate for Payer: Oxford Commercial	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$81.45
Rate for Payer: UnitedHealthcare Commercial	$108.60
Rate for Payer: UnitedHealthcare Community & State	$17.16
Rate for Payer: Wellpoint Medicaid Managed Care	$15.42

ANNUAL WELLNESS VST SUBSQ GE

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502830
Hospital Revenue Code	770
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$182.00
Rate for Payer: Aetna Commercial	$138.32
Rate for Payer: Aetna Medicare Advantage	$109.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.82
Rate for Payer: Cigna Commercial	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.64
Rate for Payer: Oxford Commercial	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$54.60
Rate for Payer: UnitedHealthcare Commercial	$72.80
Rate for Payer: UnitedHealthcare Community & State	$11.50
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

ANNUAL WELLNESS VST SUBSQ GE

Facility

$364.00

Service Code	HCPCS G0439
Hospital Charge Code	87502830
Hospital Revenue Code	770
Min. Negotiated Rate	$54.60
Max. Negotiated Rate	$54.60
Rate for Payer: Qualcare PPO/HMO/WC	$54.60

ANNULOTOMY KNIFE

Facility

$7,420.00

Hospital Charge Code	270696761
Hospital Revenue Code	272
Min. Negotiated Rate	$210.73
Max. Negotiated Rate	$3,710.00
Rate for Payer: Aetna Commercial	$2,819.60
Rate for Payer: Aetna Medicare Advantage	$2,226.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,892.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,892.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,892.10
Rate for Payer: Cigna Commercial	$3,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.20
Rate for Payer: Oxford Commercial	$1,484.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.00
Rate for Payer: UnitedHealthcare Commercial	$1,484.00
Rate for Payer: UnitedHealthcare Community & State	$234.47
Rate for Payer: Wellpoint Medicaid Managed Care	$210.73

ANNULOTOMY KNIFE

Facility

$7,420.00

Hospital Charge Code	270696761
Hospital Revenue Code	272
Min. Negotiated Rate	$1,113.00
Max. Negotiated Rate	$1,113.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,113.00

ANOGENITAL EXAM CHILD

Facility

$59.00

Service Code	HCPCS 99170
Hospital Charge Code	5780315
Hospital Revenue Code	450
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

ANOGENITAL EXAM CHILD

Facility

$59.00

Service Code	HCPCS 99170
Hospital Charge Code	5780315
Hospital Revenue Code	450
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$871.25
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

ANOSCOPY & BIOPSY

Facility

$9,798.35

Service Code	HCPCS 46606
Hospital Charge Code	87502930
Hospital Revenue Code	761
Min. Negotiated Rate	$24.64
Max. Negotiated Rate	$5,157.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,157.00
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,547.57
Rate for Payer: Oxford Commercial	$1,959.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,469.75
Rate for Payer: UnitedHealthcare Commercial	$1,959.67
Rate for Payer: UnitedHealthcare Community & State	$309.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$278.27

ANOSCOPY & BIOPSY

Facility

$9,798.35

Service Code	HCPCS 46606
Hospital Charge Code	87502930
Hospital Revenue Code	761
Min. Negotiated Rate	$1,469.75
Max. Negotiated Rate	$1,469.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,469.75

ANOSCOPY DIAGNOSTIC

Facility

$696.50

Service Code	HCPCS 46600
Hospital Charge Code	87502816
Hospital Revenue Code	761
Min. Negotiated Rate	$104.47
Max. Negotiated Rate	$104.47
Rate for Payer: Qualcare PPO/HMO/WC	$104.47

ANOSCOPY DIAGNOSTIC

Facility

$696.50

Service Code	HCPCS 46600
Hospital Charge Code	87502816
Hospital Revenue Code	761
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.09
Rate for Payer: Oxford Commercial	$139.30
Rate for Payer: Qualcare PPO/HMO/WC	$104.47
Rate for Payer: UnitedHealthcare Commercial	$139.30
Rate for Payer: UnitedHealthcare Community & State	$22.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$19.78

ANOSCOPY DX

Facility

$1,167.00

Service Code	HCPCS 46600
Hospital Charge Code	1600000703
Hospital Revenue Code	360
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.42
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.05
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$36.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$33.14

ANOSCOPY DX

Facility

$1,167.00

Service Code	HCPCS 46600
Hospital Charge Code	1600000703
Hospital Revenue Code	360
Min. Negotiated Rate	$175.05
Max. Negotiated Rate	$175.05
Rate for Payer: Qualcare PPO/HMO/WC	$175.05

ANOSCOPY WITH BIOPSY

Facility

$5,458.64

Service Code	HCPCS 46606
Hospital Charge Code	160000173
Hospital Revenue Code	360
Min. Negotiated Rate	$155.03
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
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	$5,157.00
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,419.25
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$818.80
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$172.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$155.03

ANOSCOPY WITH BIOPSY

Facility

$5,458.64

Service Code	HCPCS 46606
Hospital Charge Code	160000173
Hospital Revenue Code	360
Min. Negotiated Rate	$818.80
Max. Negotiated Rate	$818.80
Rate for Payer: Qualcare PPO/HMO/WC	$818.80

ANOSCOPY W REM FB

Facility

$9,719.54

Service Code	HCPCS 46608
Hospital Charge Code	1600000422
Hospital Revenue Code	360
Min. Negotiated Rate	$1,457.93
Max. Negotiated Rate	$1,457.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,457.93

ANOSCOPY W REM FB

Facility

$9,719.54

Service Code	HCPCS 46608
Hospital Charge Code	1600000422
Hospital Revenue Code	360
Min. Negotiated Rate	$276.03
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$3,005.08
Rate for Payer: Aetna Medicare Advantage	$3,579.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,104.81
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	$4,007.70
Rate for Payer: Cigna Commercial	$2,214.60
Rate for Payer: Cigna Medicare Advantage	$1,104.81
Rate for Payer: Clover Medicare Advantage	$1,049.57
Rate for Payer: EmblemHealth Commercial	$3,314.43
Rate for Payer: Humana Medicare Advantage	$1,137.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,104.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,527.08
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,457.93
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$307.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.81
Rate for Payer: Wellcare Medicare Advantage	$1,104.81
Rate for Payer: Wellpoint Medicaid Managed Care	$276.03

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$11,617.00

Service Code	APR-DRG 0592
Min. Negotiated Rate	$11,389.22
Max. Negotiated Rate	$11,617.00
Rate for Payer: UnitedHealthcare Community & State	$11,389.22
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,617.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11,389.22

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$7,277.50

Service Code	APR-DRG 0591
Min. Negotiated Rate	$7,134.80
Max. Negotiated Rate	$7,277.50
Rate for Payer: UnitedHealthcare Community & State	$7,134.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,277.50
Rate for Payer: Wellpoint Medicaid Managed Care	$7,134.80

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$16,644.75

Service Code	APR-DRG 0593
Min. Negotiated Rate	$16,318.38
Max. Negotiated Rate	$16,644.75
Rate for Payer: UnitedHealthcare Community & State	$16,318.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,644.75
Rate for Payer: Wellpoint Medicaid Managed Care	$16,318.38

Know your out-of-pocket cost for care.

All Charges