Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LOSARTAN POTASSIUM 50 MG TAB

Facility

$15.14

Service Code	NDC 93736556
Hospital Charge Code	60627576
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$2.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.27

L-O-SLIDE REVIEW NO TECH

Facility

$390.00

Service Code	HCPCS 88329
Hospital Charge Code	3035064B
Hospital Revenue Code	319
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$254.22
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
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	$12.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

L-O-SLIDE REVIEW NO TECH

Facility

$390.00

Service Code	HCPCS 88329
Hospital Charge Code	3035064B
Hospital Revenue Code	319
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LOVAZA CAP

Facility

$79.93

Service Code	NDC 80725042012
Hospital Charge Code	60632240
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$39.97
Rate for Payer: Aetna Commercial	$30.37
Rate for Payer: Aetna Medicare Advantage	$23.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.38
Rate for Payer: Cigna Commercial	$39.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.78
Rate for Payer: Oxford Commercial	$15.99
Rate for Payer: Qualcare PPO/HMO/WC	$11.99
Rate for Payer: UnitedHealthcare Commercial	$15.99
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

LOVAZA CAP

Facility

$79.93

Service Code	NDC 80725042012
Hospital Charge Code	60632240
Hospital Revenue Code	250
Min. Negotiated Rate	$11.99
Max. Negotiated Rate	$11.99
Rate for Payer: Qualcare PPO/HMO/WC	$11.99

LOW BACK,DISK SURGERY

Facility

$47,548.90

Service Code	HCPCS 63030
Hospital Charge Code	16000289
Hospital Revenue Code	360
Min. Negotiated Rate	$1,350.39
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,362.71
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,502.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,350.39

LOW BACK,DISK SURGERY

Facility

$47,548.90

Service Code	HCPCS 63030
Hospital Charge Code	16000289
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

LOW DENSITY LIPOPROTEIN (LDL)

Facility

$85.00

Service Code	HCPCS 83721
Hospital Charge Code	38472464
Hospital Revenue Code	301
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: Aetna Medicare Advantage	$34.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.09
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: Cigna Medicare Advantage	$10.50
Rate for Payer: Clover Medicare Advantage	$9.97
Rate for Payer: EmblemHealth Commercial	$31.50
Rate for Payer: Humana Medicare Advantage	$10.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.50
Rate for Payer: Wellcare Medicare Advantage	$10.50
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

LOW DENSITY LIPOPROTEIN (LDL)

Facility

$85.00

Service Code	HCPCS 83721
Hospital Charge Code	38472464
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$99,589.03

Service Code	MSDRG 493
Min. Negotiated Rate	$30,323.58
Max. Negotiated Rate	$99,589.03
Rate for Payer: Aetna Commercial	$72,786.97
Rate for Payer: Aetna Medicare Advantage	$99,589.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66,492.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66,492.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31,919.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66,492.00
Rate for Payer: Cigna Commercial	$56,537.28
Rate for Payer: Cigna Medicare Advantage	$31,919.56
Rate for Payer: Clover Medicare Advantage	$30,323.58
Rate for Payer: EmblemHealth Commercial	$95,758.68
Rate for Payer: Humana Medicare Advantage	$32,877.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31,919.56
Rate for Payer: Oxford Commercial	$44,686.08
Rate for Payer: UnitedHealthcare Commercial	$59,813.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$31,919.56
Rate for Payer: Wellcare Medicare Advantage	$31,919.56

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$135,463.54

Service Code	MSDRG 492
Min. Negotiated Rate	$41,246.91
Max. Negotiated Rate	$135,463.54
Rate for Payer: Aetna Commercial	$98,337.20
Rate for Payer: Aetna Medicare Advantage	$135,463.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95,859.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95,859.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$43,417.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95,859.30
Rate for Payer: Cigna Commercial	$81,850.98
Rate for Payer: Cigna Medicare Advantage	$43,417.80
Rate for Payer: Clover Medicare Advantage	$41,246.91
Rate for Payer: EmblemHealth Commercial	$130,253.40
Rate for Payer: Humana Medicare Advantage	$44,720.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$43,417.80
Rate for Payer: Oxford Commercial	$64,693.59
Rate for Payer: UnitedHealthcare Commercial	$86,594.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$43,417.80
Rate for Payer: Wellcare Medicare Advantage	$43,417.80

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility

$82,857.15

Service Code	MSDRG 494
Min. Negotiated Rate	$25,228.94
Max. Negotiated Rate	$82,857.15
Rate for Payer: Aetna Commercial	$60,870.32
Rate for Payer: Aetna Medicare Advantage	$82,857.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51,808.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51,808.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,556.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51,808.35
Rate for Payer: Cigna Commercial	$44,730.90
Rate for Payer: Cigna Medicare Advantage	$26,556.78
Rate for Payer: Clover Medicare Advantage	$25,228.94
Rate for Payer: EmblemHealth Commercial	$79,670.34
Rate for Payer: Humana Medicare Advantage	$27,353.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,556.78
Rate for Payer: Oxford Commercial	$35,354.53
Rate for Payer: UnitedHealthcare Commercial	$47,323.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,556.78
Rate for Payer: Wellcare Medicare Advantage	$26,556.78

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$21,193.55

Service Code	APR-DRG 1811
Min. Negotiated Rate	$20,777.99
Max. Negotiated Rate	$21,193.55
Rate for Payer: UnitedHealthcare Community & State	$20,777.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,193.55
Rate for Payer: Wellpoint Medicaid Managed Care	$20,777.99

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$29,230.81

Service Code	APR-DRG 1812
Min. Negotiated Rate	$28,657.66
Max. Negotiated Rate	$29,230.81
Rate for Payer: UnitedHealthcare Community & State	$28,657.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$29,230.81
Rate for Payer: Wellpoint Medicaid Managed Care	$28,657.66

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$44,304.04

Service Code	APR-DRG 1813
Min. Negotiated Rate	$43,435.33
Max. Negotiated Rate	$44,304.04
Rate for Payer: UnitedHealthcare Community & State	$43,435.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$44,304.04
Rate for Payer: Wellpoint Medicaid Managed Care	$43,435.33

LOWER EXTREMITY VASCULAR PROCEDURES

Facility

$68,231.88

Service Code	APR-DRG 1814
Min. Negotiated Rate	$66,894.00
Max. Negotiated Rate	$68,231.88
Rate for Payer: UnitedHealthcare Community & State	$66,894.00
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$68,231.88
Rate for Payer: Wellpoint Medicaid Managed Care	$66,894.00

LOWER MINOR PROCEDURE KIT

Facility

$146.00

Hospital Charge Code	270338742
Hospital Revenue Code	272
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

LOWER MINOR PROCEDURE KIT

Facility

$146.00

Hospital Charge Code	270338742
Hospital Revenue Code	272
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$73.00
Rate for Payer: Aetna Commercial	$55.48
Rate for Payer: Aetna Medicare Advantage	$43.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.23
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.96
Rate for Payer: Oxford Commercial	$29.20
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$29.20
Rate for Payer: UnitedHealthcare Community & State	$4.61
Rate for Payer: Wellpoint Medicaid Managed Care	$4.15

LOW EXT INFANT 2VW-BIL

Facility

$5,100.00

Service Code	HCPCS 7359250
Hospital Charge Code	94061245
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) 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

LOW EXT INFANT 2VW-BIL

Facility

$5,100.00

Service Code	HCPCS 7359250
Hospital Charge Code	94061245
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

LOW EXTR INFANT 2VW-RT

Facility

$5,100.00

Service Code	HCPCS 73592RT
Hospital Charge Code	94061383
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) 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

LOW EXTR INFANT 2VW-RT

Facility

$5,100.00

Service Code	HCPCS 73592RT
Hospital Charge Code	94061383
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

LOW PROFILE NEURO ADAPTION PL

Facility

$1,655.00

Hospital Charge Code	270664778
Hospital Revenue Code	270
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$827.50
Rate for Payer: Aetna Commercial	$628.90
Rate for Payer: Aetna Medicare Advantage	$496.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.02
Rate for Payer: Cigna Commercial	$827.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$430.30
Rate for Payer: Oxford Commercial	$331.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.25
Rate for Payer: UnitedHealthcare Commercial	$331.00
Rate for Payer: UnitedHealthcare Community & State	$52.30
Rate for Payer: Wellpoint Medicaid Managed Care	$47.00

LOW PROFILE NEURO ADAPTION PL

Facility

$1,655.00

Hospital Charge Code	270664778
Hospital Revenue Code	270
Min. Negotiated Rate	$248.25
Max. Negotiated Rate	$248.25
Rate for Payer: Qualcare PPO/HMO/WC	$248.25

LOW PROFILE NEURO X PLATE 4 HO

Facility

$1,475.00

Hospital Charge Code	270664779
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

Know your out-of-pocket cost for care.

All Charges