Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IV PUSH FIRST DRUG

Facility

$339.24

Service Code	HCPCS 96374
Hospital Charge Code	2301092
Hospital Revenue Code	260
Min. Negotiated Rate	$9.63
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.20
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.89
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$10.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$9.63

IV PUSH FIRST DRUG

Facility

$339.24

Service Code	HCPCS 96374
Hospital Charge Code	74115057
Hospital Revenue Code	260
Min. Negotiated Rate	$50.89
Max. Negotiated Rate	$50.89
Rate for Payer: Qualcare PPO/HMO/WC	$50.89

IV PUSH FIRST DRUG

Facility

$2,800.00

Service Code	HCPCS 96374
Hospital Charge Code	73092070
Hospital Revenue Code	260
Min. Negotiated Rate	$34.92
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

IV PUSH FIRST DRUG

Facility

$2,800.00

Service Code	HCPCS 96374
Hospital Charge Code	100113
Hospital Revenue Code	260
Min. Negotiated Rate	$34.92
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

IV SET PUSH BUTTON W/LUER 25GX

Facility

$321.90

Hospital Charge Code	270664447
Hospital Revenue Code	270
Min. Negotiated Rate	$48.28
Max. Negotiated Rate	$48.28
Rate for Payer: Qualcare PPO/HMO/WC	$48.28

IV SET PUSH BUTTON W/LUER 25GX

Facility

$321.90

Hospital Charge Code	270664447
Hospital Revenue Code	270
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$122.32
Rate for Payer: Aetna Medicare Advantage	$96.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.08
Rate for Payer: Cigna Commercial	$160.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.69
Rate for Payer: Oxford Commercial	$64.38
Rate for Payer: Qualcare PPO/HMO/WC	$48.28
Rate for Payer: UnitedHealthcare Commercial	$64.38
Rate for Payer: UnitedHealthcare Community & State	$10.17
Rate for Payer: Wellpoint Medicaid Managed Care	$9.14

IVUS NON-CORONARY 1ST

Facility

$5,170.30

Service Code	HCPCS 37252
Hospital Charge Code	7411535
Hospital Revenue Code	361
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$775.54
Rate for Payer: Qualcare PPO/HMO/WC	$775.54

IVUS NON-CORONARY 1ST

Facility

$5,170.30

Service Code	HCPCS 37252
Hospital Charge Code	7411535
Hospital Revenue Code	361
Min. Negotiated Rate	$146.84
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.28
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$163.38
Rate for Payer: Wellpoint Medicaid Managed Care	$146.84

IVUS NON-CORONARY 1ST

Facility

$5,170.30

Service Code	HCPCS 37252
Hospital Charge Code	2600243
Hospital Revenue Code	361
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$775.54
Rate for Payer: Qualcare PPO/HMO/WC	$775.54

IVUS NON-CORONARY 1ST

Facility

$5,170.30

Service Code	HCPCS 37252
Hospital Charge Code	2600243
Hospital Revenue Code	361
Min. Negotiated Rate	$146.84
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.28
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$163.38
Rate for Payer: Wellpoint Medicaid Managed Care	$146.84

IVUS NON-CORONARY 1ST

Facility

$5,170.30

Service Code	HCPCS 37252
Hospital Charge Code	321037252
Hospital Revenue Code	361
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$775.54
Rate for Payer: Qualcare PPO/HMO/WC	$775.54

IVUS NON-CORONARY 1ST

Facility

$5,170.30

Service Code	HCPCS 37252
Hospital Charge Code	321037252
Hospital Revenue Code	361
Min. Negotiated Rate	$146.84
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.28
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$163.38
Rate for Payer: Wellpoint Medicaid Managed Care	$146.84

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	2600244
Hospital Revenue Code	361
Min. Negotiated Rate	$146.84
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.28
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$163.38
Rate for Payer: Wellpoint Medicaid Managed Care	$146.84

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	321037253
Hospital Revenue Code	361
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$775.54
Rate for Payer: Qualcare PPO/HMO/WC	$775.54

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	7411536
Hospital Revenue Code	361
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$775.54
Rate for Payer: Qualcare PPO/HMO/WC	$775.54

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	2600244
Hospital Revenue Code	361
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$775.54
Rate for Payer: Qualcare PPO/HMO/WC	$775.54

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	7411536
Hospital Revenue Code	361
Min. Negotiated Rate	$146.84
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.28
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$163.38
Rate for Payer: Wellpoint Medicaid Managed Care	$146.84

IVUS NON-CORONARY EA ADDL

Facility

$5,170.30

Service Code	HCPCS 37253
Hospital Charge Code	321037253
Hospital Revenue Code	361
Min. Negotiated Rate	$146.84
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,964.71
Rate for Payer: Aetna Medicare Advantage	$1,551.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,318.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,318.43
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	$1,318.43
Rate for Payer: Cigna Commercial	$2,585.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,344.28
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$775.54
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$163.38
Rate for Payer: Wellpoint Medicaid Managed Care	$146.84

JACKSON-PRATT T-TUBE DRAIN

Facility

$124.00

Hospital Charge Code	270330872
Hospital Revenue Code	272
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$62.00
Rate for Payer: Aetna Commercial	$47.12
Rate for Payer: Aetna Medicare Advantage	$37.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.62
Rate for Payer: Cigna Commercial	$62.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.24
Rate for Payer: Oxford Commercial	$24.80
Rate for Payer: Qualcare PPO/HMO/WC	$18.60
Rate for Payer: UnitedHealthcare Commercial	$24.80
Rate for Payer: UnitedHealthcare Community & State	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.52

JACKSON-PRATT T-TUBE DRAIN

Facility

$124.00

Hospital Charge Code	270330872
Hospital Revenue Code	272
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$18.60
Rate for Payer: Qualcare PPO/HMO/WC	$18.60

JACKSON SPINAL TOP PATIENT KIT

Facility

$160.55

Hospital Charge Code	270339537
Hospital Revenue Code	272
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$80.28
Rate for Payer: Aetna Commercial	$61.01
Rate for Payer: Aetna Medicare Advantage	$48.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.94
Rate for Payer: Cigna Commercial	$80.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.74
Rate for Payer: Oxford Commercial	$32.11
Rate for Payer: Qualcare PPO/HMO/WC	$24.08
Rate for Payer: UnitedHealthcare Commercial	$32.11
Rate for Payer: UnitedHealthcare Community & State	$5.07
Rate for Payer: Wellpoint Medicaid Managed Care	$4.56

JACKSON SPINAL TOP PATIENT KIT

Facility

$160.55

Hospital Charge Code	270339537
Hospital Revenue Code	272
Min. Negotiated Rate	$24.08
Max. Negotiated Rate	$24.08
Rate for Payer: Qualcare PPO/HMO/WC	$24.08

JAG REVOLUTION WIRE 260 CM

Facility

$1,719.95

Service Code	HCPCS C1769
Hospital Charge Code	270690162
Hospital Revenue Code	278
Min. Negotiated Rate	$257.99
Max. Negotiated Rate	$416.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.23
Rate for Payer: Qualcare PPO/HMO/WC	$257.99

JAG REVOLUTION WIRE 260 CM

Facility

$1,719.95

Service Code	HCPCS C1769
Hospital Charge Code	270690162
Hospital Revenue Code	278
Min. Negotiated Rate	$48.85
Max. Negotiated Rate	$859.98
Rate for Payer: Aetna Commercial	$653.58
Rate for Payer: Aetna Medicare Advantage	$515.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$438.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$438.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$343.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$438.59
Rate for Payer: Cigna Commercial	$859.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$416.23
Rate for Payer: Qualcare PPO/HMO/WC	$257.99
Rate for Payer: UnitedHealthcare Community & State	$54.35
Rate for Payer: Wellpoint Medicaid Managed Care	$48.85

JAGTOME RX

Facility

$1,510.95

Hospital Charge Code	270680466
Hospital Revenue Code	272
Min. Negotiated Rate	$226.64
Max. Negotiated Rate	$226.64
Rate for Payer: Qualcare PPO/HMO/WC	$226.64

Know your out-of-pocket cost for care.

All Charges