Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR SEL VEN CATH 2ND ORD

Facility

$2,919.00

Service Code	HCPCS 36012
Hospital Charge Code	2680175
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

IR SEL VEN CATH 2ND ORD

Facility

$2,919.00

Service Code	HCPCS 36012
Hospital Charge Code	2680175
Hospital Revenue Code	361
Min. Negotiated Rate	$82.90
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,109.22
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.94
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.85
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$92.24
Rate for Payer: Wellpoint Medicaid Managed Care	$82.90

IR SEL VEN CATH 2ND ORD

Facility

$2,919.00

Service Code	HCPCS 36012
Hospital Charge Code	7411416
Hospital Revenue Code	361
Min. Negotiated Rate	$82.90
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,109.22
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.94
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.85
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$92.24
Rate for Payer: Wellpoint Medicaid Managed Care	$82.90

IRSM JT ARTHROCENTESIS

Facility

$1,091.00

Service Code	HCPCS 20600
Hospital Charge Code	7411344
Hospital Revenue Code	361
Min. Negotiated Rate	$30.98
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.66
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$34.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$30.98

IRSM JT ARTHROCENTESIS

Facility

$1,091.00

Service Code	HCPCS 20600
Hospital Charge Code	7411344
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

IRSM JT ARTHROCENTESIS

Facility

$1,091.00

Service Code	HCPCS 20600
Hospital Charge Code	2680025
Hospital Revenue Code	361
Min. Negotiated Rate	$163.65
Max. Negotiated Rate	$163.65
Rate for Payer: Qualcare PPO/HMO/WC	$163.65

IRSM JT ARTHROCENTESIS

Facility

$1,091.00

Service Code	HCPCS 20600
Hospital Charge Code	2680025
Hospital Revenue Code	361
Min. Negotiated Rate	$30.98
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.66
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$163.65
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$34.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$30.98

IR STENT INT VASC TCATH EA VES

Facility

$3,173.00

Hospital Charge Code	2011155
Hospital Revenue Code	320
Min. Negotiated Rate	$475.95
Max. Negotiated Rate	$475.95
Rate for Payer: Qualcare PPO/HMO/WC	$475.95

IR STENT INT VASC TCATH EA VES

Facility

$3,173.00

Hospital Charge Code	2011155
Hospital Revenue Code	320
Min. Negotiated Rate	$90.11
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,205.74
Rate for Payer: Aetna Medicare Advantage	$951.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$809.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$809.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$809.12
Rate for Payer: Cigna Commercial	$1,586.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$824.98
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.95
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$100.27
Rate for Payer: Wellpoint Medicaid Managed Care	$90.11

IR STENT TRANSCATH PERC INIT

Facility

$56,620.95

Service Code	HCPCS 37236
Hospital Charge Code	321037236
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

IR STENT TRANSCATH PERC INIT

Facility

$56,620.95

Service Code	HCPCS 37236
Hospital Charge Code	321037236
Hospital Revenue Code	361
Min. Negotiated Rate	$1,608.03
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
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	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,721.45
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,789.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,608.03

IR STENT TRANSCATH PERC INIT

Facility

$56,620.95

Service Code	HCPCS 37236
Hospital Charge Code	2011160
Hospital Revenue Code	361
Min. Negotiated Rate	$1,608.03
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
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	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,721.45
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,789.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,608.03

IR STENT TRANSCATH PERC INIT

Facility

$56,620.95

Service Code	HCPCS 37236
Hospital Charge Code	2011160
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

IR STENT TRANSCTH PER EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	2011165
Hospital Revenue Code	361
Min. Negotiated Rate	$2,342.25
Max. Negotiated Rate	$2,342.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25

IR STENT TRANSCTH PER EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	2011165
Hospital Revenue Code	361
Min. Negotiated Rate	$443.47
Max. Negotiated Rate	$14,869.00
Rate for Payer: Aetna Commercial	$5,933.70
Rate for Payer: Aetna Medicare Advantage	$4,684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,981.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,981.82
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	$3,981.82
Rate for Payer: Cigna Commercial	$7,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,059.90
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$493.43
Rate for Payer: Wellpoint Medicaid Managed Care	$443.47

IR STENT TRANSCTH PER EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	321037237
Hospital Revenue Code	361
Min. Negotiated Rate	$2,342.25
Max. Negotiated Rate	$2,342.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25

IR STENT TRANSCTH PER EA ADD

Facility

$15,615.00

Service Code	HCPCS 37237
Hospital Charge Code	321037237
Hospital Revenue Code	361
Min. Negotiated Rate	$443.47
Max. Negotiated Rate	$14,869.00
Rate for Payer: Aetna Commercial	$5,933.70
Rate for Payer: Aetna Medicare Advantage	$4,684.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,981.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,981.82
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	$3,981.82
Rate for Payer: Cigna Commercial	$7,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,059.90
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,342.25
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$493.43
Rate for Payer: Wellpoint Medicaid Managed Care	$443.47

IR SUTURE DRESSING TRAY/SUPPLI

Facility

$15.00

Hospital Charge Code	4800970
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

IR SUTURE DRESSING TRAY/SUPPLI

Facility

$15.00

Hospital Charge Code	4800970
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

IR TEMPOROMANDIBULAR JNT ARTHR

Facility

$1,633.00

Service Code	HCPCS 70332
Hospital Charge Code	2680245
Hospital Revenue Code	320
Min. Negotiated Rate	$244.95
Max. Negotiated Rate	$244.95
Rate for Payer: Qualcare PPO/HMO/WC	$244.95

IR TEMPOROMANDIBULAR JNT ARTHR

Facility

$1,633.00

Service Code	HCPCS 70332
Hospital Charge Code	7411660
Hospital Revenue Code	320
Min. Negotiated Rate	$244.95
Max. Negotiated Rate	$244.95
Rate for Payer: Qualcare PPO/HMO/WC	$244.95

IR TEMPOROMANDIBULAR JNT ARTHR

Facility

$1,633.00

Service Code	HCPCS 70332
Hospital Charge Code	7411660
Hospital Revenue Code	320
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.58
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.95
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$51.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

IR TEMPOROMANDIBULAR JNT ARTHR

Facility

$1,633.00

Service Code	HCPCS 70332
Hospital Charge Code	2680245
Hospital Revenue Code	320
Min. Negotiated Rate	$46.38
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.58
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.95
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$51.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$46.38

IR-THORACENTESIS-BI

Facility

$5,466.05

Service Code	HCPCS 3255550
Hospital Charge Code	2690375
Hospital Revenue Code	361
Min. Negotiated Rate	$155.24
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,077.10
Rate for Payer: Aetna Medicare Advantage	$1,639.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,393.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,393.84
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	$1,393.84
Rate for Payer: Cigna Commercial	$2,733.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.17
Rate for Payer: Qualcare PPO/HMO/WC	$819.91
Rate for Payer: UnitedHealthcare Community & State	$172.73
Rate for Payer: Wellpoint Medicaid Managed Care	$155.24

IR-THORACENTESIS-BI

Facility

$5,466.05

Service Code	HCPCS 3255550
Hospital Charge Code	321032555B
Hospital Revenue Code	361
Min. Negotiated Rate	$819.91
Max. Negotiated Rate	$819.91
Rate for Payer: Qualcare PPO/HMO/WC	$819.91

Know your out-of-pocket cost for care.

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