Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LITHOPLASTY BDC 7MM X 40CM

Facility

$16,500.00

Hospital Charge Code	270690506
Hospital Revenue Code	272
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,290.00
Rate for Payer: Oxford Commercial	$3,300.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Commercial	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$521.40
Rate for Payer: Wellpoint Medicaid Managed Care	$468.60

LITHOTRIPTER BASKET

Facility

$458.00

Hospital Charge Code	270325613
Hospital Revenue Code	272
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$229.00
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna Medicare Advantage	$137.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.79
Rate for Payer: Cigna Commercial	$229.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.08
Rate for Payer: Oxford Commercial	$91.60
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$91.60
Rate for Payer: UnitedHealthcare Community & State	$14.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.01

LITHOTRIPTER BASKET

Facility

$458.00

Hospital Charge Code	270325613
Hospital Revenue Code	272
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

LIVER ACCESS AND BIOPSY SET

Facility

$2,215.00

Hospital Charge Code	270689191
Hospital Revenue Code	272
Min. Negotiated Rate	$62.91
Max. Negotiated Rate	$1,107.50
Rate for Payer: Aetna Commercial	$841.70
Rate for Payer: Aetna Medicare Advantage	$664.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$564.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$564.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$564.83
Rate for Payer: Cigna Commercial	$1,107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$575.90
Rate for Payer: Oxford Commercial	$443.00
Rate for Payer: Qualcare PPO/HMO/WC	$332.25
Rate for Payer: UnitedHealthcare Commercial	$443.00
Rate for Payer: UnitedHealthcare Community & State	$69.99
Rate for Payer: Wellpoint Medicaid Managed Care	$62.91

LIVER ACCESS AND BIOPSY SET

Facility

$2,215.00

Hospital Charge Code	270689191
Hospital Revenue Code	272
Min. Negotiated Rate	$332.25
Max. Negotiated Rate	$332.25
Rate for Payer: Qualcare PPO/HMO/WC	$332.25

LIVER CYTOSOL (LC-1) ABS

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	38479747
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER CYTOSOL (LC-1) ABS

Facility

$390.00

Service Code	HCPCS 86376
Hospital Charge Code	38479747
Hospital Revenue Code	302
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.78
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.55
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Medicare Advantage	$14.55
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LIVER FIBRO,HEPSCORE (TM) I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990096A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.29
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Medicare Advantage	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LIVER FIBRO,HEPSCORE (TM) I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990096A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) II

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER FIBRO,HEPSCORE (TM) II

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.80
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LIVER FIBRO,HEPSCORE (TM) III

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.80
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LIVER FIBRO,HEPSCORE (TM) III

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39990096C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LIVER KIDNEY MICROSOMAL AB

Facility

$667.59

Service Code	HCPCS 86376
Hospital Charge Code	39900441
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LIVER KIDNEY MICROSOMAL AB

Facility

$667.59

Service Code	HCPCS 86376
Hospital Charge Code	39900441
Hospital Revenue Code	302
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$39.58
Rate for Payer: Aetna Medicare Advantage	$47.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.78
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.55
Rate for Payer: Clover Medicare Advantage	$13.82
Rate for Payer: EmblemHealth Commercial	$43.65
Rate for Payer: Humana Medicare Advantage	$14.99
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.55
Rate for Payer: Wellcare Medicare Advantage	$14.55
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

LIVER/SPLEEN IMAGE W/VASC FLOW

Facility

$12,000.00

Service Code	HCPCS 78216
Hospital Charge Code	4500105
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

LIVER/SPLEEN IMAGE W/VASC FLOW

Facility

$12,000.00

Service Code	HCPCS 78216
Hospital Charge Code	4500105
Hospital Revenue Code	341
Min. Negotiated Rate	$126.77
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,722.84
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$203,918.96

Service Code	APR-DRG 0014
Min. Negotiated Rate	$199,920.55
Max. Negotiated Rate	$203,918.96
Rate for Payer: UnitedHealthcare Community & State	$199,920.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$203,918.96
Rate for Payer: Wellpoint Medicaid Managed Care	$199,920.55

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$96,805.42

Service Code	APR-DRG 0012
Min. Negotiated Rate	$94,907.27
Max. Negotiated Rate	$96,805.42
Rate for Payer: UnitedHealthcare Community & State	$94,907.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$96,805.42
Rate for Payer: Wellpoint Medicaid Managed Care	$94,907.27

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$116,028.59

Service Code	APR-DRG 0013
Min. Negotiated Rate	$113,753.52
Max. Negotiated Rate	$116,028.59
Rate for Payer: UnitedHealthcare Community & State	$113,753.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$116,028.59
Rate for Payer: Wellpoint Medicaid Managed Care	$113,753.52

LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT

Facility

$86,282.38

Service Code	APR-DRG 0011
Min. Negotiated Rate	$84,590.57
Max. Negotiated Rate	$86,282.38
Rate for Payer: UnitedHealthcare Community & State	$84,590.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$86,282.38
Rate for Payer: Wellpoint Medicaid Managed Care	$84,590.57

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$345,210.03

Service Code	MSDRG 005
Min. Negotiated Rate	$105,112.03
Max. Negotiated Rate	$345,210.03
Rate for Payer: Aetna Medicare Advantage	$345,210.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286,746.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$110,644.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286,746.75
Rate for Payer: Cigna Commercial	$229,851.98
Rate for Payer: Cigna Medicare Advantage	$110,644.24
Rate for Payer: Clover Medicare Advantage	$105,112.03
Rate for Payer: EmblemHealth Commercial	$331,932.72
Rate for Payer: Humana Medicare Advantage	$113,963.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$110,644.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$110,644.24
Rate for Payer: Wellcare Medicare Advantage	$110,644.24

LIVER TRANSPLANT WITHOUT MCC

Facility

$165,963.97

Service Code	MSDRG 006
Min. Negotiated Rate	$50,533.90
Max. Negotiated Rate	$165,963.97
Rate for Payer: Aetna Medicare Advantage	$165,963.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134,092.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134,092.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$53,193.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134,092.20
Rate for Payer: Cigna Commercial	$103,372.64
Rate for Payer: Cigna Medicare Advantage	$53,193.58
Rate for Payer: Clover Medicare Advantage	$50,533.90
Rate for Payer: EmblemHealth Commercial	$159,580.74
Rate for Payer: Humana Medicare Advantage	$54,789.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$53,193.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$53,193.58
Rate for Payer: Wellcare Medicare Advantage	$53,193.58

LLIF PEAK CAGE 18X55X12H

Facility

$29,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705445
Hospital Revenue Code	278
Min. Negotiated Rate	$837.80
Max. Negotiated Rate	$14,750.00
Rate for Payer: Aetna Commercial	$11,210.00
Rate for Payer: Aetna Medicare Advantage	$8,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,522.50
Rate for Payer: Cigna Commercial	$14,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00
Rate for Payer: UnitedHealthcare Community & State	$932.20
Rate for Payer: Wellpoint Medicaid Managed Care	$837.80

LLIF PEAK CAGE 18X55X12H

Facility

$29,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705445
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$7,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

Know your out-of-pocket cost for care.

All Charges