Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MAG SULFATE 1GM/2ML INJ 10 ML

Facility

$13.94

Service Code	HCPCS J3475
Hospital Charge Code	60627751
Hospital Revenue Code	636
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$6.97
Rate for Payer: Aetna Commercial	$5.30
Rate for Payer: Aetna Medicare Advantage	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.55
Rate for Payer: Cigna Commercial	$6.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

MAG SULFATE 8.12 MEQ/2 ML INJ

Facility

$9.65

Service Code	HCPCS J3475
Hospital Charge Code	6022669
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

MAG SULFATE 8.12 MEQ/2 ML INJ

Facility

$9.65

Service Code	HCPCS J3475
Hospital Charge Code	6022669
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

MAG,WESTERN BLOT W/RFX

Facility

$390.00

Service Code	HCPCS 84181
Hospital Charge Code	39900526
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.32
Rate for Payer: Aetna Medicare Advantage	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.78
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.03
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.03
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	$13.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Medicare Advantage	$17.03
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MAG,WESTERN BLOT W/RFX

Facility

$390.00

Service Code	HCPCS 84181
Hospital Charge Code	39900526
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MAIN BODY AFX2 28 16 X 40 MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270684793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

MAIN BODY AFX2 28 16 X 40 MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270684793
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

MAIN PUMP TUBING

Facility

$305.00

Hospital Charge Code	270688454
Hospital Revenue Code	272
Min. Negotiated Rate	$45.75
Max. Negotiated Rate	$45.75
Rate for Payer: Qualcare PPO/HMO/WC	$45.75

MAIN PUMP TUBING

Facility

$305.00

Hospital Charge Code	270688454
Hospital Revenue Code	272
Min. Negotiated Rate	$8.66
Max. Negotiated Rate	$152.50
Rate for Payer: Aetna Commercial	$115.90
Rate for Payer: Aetna Medicare Advantage	$91.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.78
Rate for Payer: Cigna Commercial	$152.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.30
Rate for Payer: Oxford Commercial	$61.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.75
Rate for Payer: UnitedHealthcare Commercial	$61.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.66

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$80,864.24

Service Code	APR-DRG 1694
Min. Negotiated Rate	$79,278.67
Max. Negotiated Rate	$80,864.24
Rate for Payer: UnitedHealthcare Community & State	$79,278.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$80,864.24
Rate for Payer: Wellpoint Medicaid Managed Care	$79,278.67

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$39,989.77

Service Code	APR-DRG 1692
Min. Negotiated Rate	$39,205.66
Max. Negotiated Rate	$39,989.77
Rate for Payer: UnitedHealthcare Community & State	$39,205.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$39,989.77
Rate for Payer: Wellpoint Medicaid Managed Care	$39,205.66

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$39,255.26

Service Code	APR-DRG 1691
Min. Negotiated Rate	$38,485.55
Max. Negotiated Rate	$39,255.26
Rate for Payer: UnitedHealthcare Community & State	$38,485.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$39,255.26
Rate for Payer: Wellpoint Medicaid Managed Care	$38,485.55

MAJOR ABDOMINAL VASCULAR PROCEDURES

Facility

$51,507.05

Service Code	APR-DRG 1693
Min. Negotiated Rate	$50,497.11
Max. Negotiated Rate	$51,507.05
Rate for Payer: UnitedHealthcare Community & State	$50,497.11
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,507.05
Rate for Payer: Wellpoint Medicaid Managed Care	$50,497.11

MAJOR BILIARY TRACT PROCEDURES

Facility

$20,082.68

Service Code	APR-DRG 2611
Min. Negotiated Rate	$19,688.90
Max. Negotiated Rate	$20,082.68
Rate for Payer: UnitedHealthcare Community & State	$19,688.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,082.68
Rate for Payer: Wellpoint Medicaid Managed Care	$19,688.90

MAJOR BILIARY TRACT PROCEDURES

Facility

$25,666.50

Service Code	APR-DRG 2612
Min. Negotiated Rate	$25,163.24
Max. Negotiated Rate	$25,666.50
Rate for Payer: UnitedHealthcare Community & State	$25,163.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,666.50
Rate for Payer: Wellpoint Medicaid Managed Care	$25,163.24

MAJOR BILIARY TRACT PROCEDURES

Facility

$35,349.68

Service Code	APR-DRG 2613
Min. Negotiated Rate	$34,656.55
Max. Negotiated Rate	$35,349.68
Rate for Payer: UnitedHealthcare Community & State	$34,656.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,349.68
Rate for Payer: Wellpoint Medicaid Managed Care	$34,656.55

MAJOR BILIARY TRACT PROCEDURES

Facility

$68,851.22

Service Code	APR-DRG 2614
Min. Negotiated Rate	$67,501.20
Max. Negotiated Rate	$68,851.22
Rate for Payer: UnitedHealthcare Community & State	$67,501.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$68,851.22
Rate for Payer: Wellpoint Medicaid Managed Care	$67,501.20

MAJOR BLADDER PROCEDURES

Facility

$19,390.32

Service Code	APR-DRG 4411
Min. Negotiated Rate	$19,010.12
Max. Negotiated Rate	$19,390.32
Rate for Payer: UnitedHealthcare Community & State	$19,010.12
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,390.32
Rate for Payer: Wellpoint Medicaid Managed Care	$19,010.12

MAJOR BLADDER PROCEDURES

Facility

$31,150.60

Service Code	APR-DRG 4412
Min. Negotiated Rate	$30,539.80
Max. Negotiated Rate	$31,150.60
Rate for Payer: UnitedHealthcare Community & State	$30,539.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,150.60
Rate for Payer: Wellpoint Medicaid Managed Care	$30,539.80

MAJOR BLADDER PROCEDURES

Facility

$40,550.09

Service Code	APR-DRG 4413
Min. Negotiated Rate	$39,754.99
Max. Negotiated Rate	$40,550.09
Rate for Payer: UnitedHealthcare Community & State	$39,754.99
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$40,550.09
Rate for Payer: Wellpoint Medicaid Managed Care	$39,754.99

MAJOR BLADDER PROCEDURES

Facility

$73,225.83

Service Code	APR-DRG 4414
Min. Negotiated Rate	$71,790.03
Max. Negotiated Rate	$73,225.83
Rate for Payer: UnitedHealthcare Community & State	$71,790.03
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$73,225.83
Rate for Payer: Wellpoint Medicaid Managed Care	$71,790.03

MAJOR BLADDER PROCEDURES WITH CC

Facility

$107,904.54

Service Code	MSDRG 654
Min. Negotiated Rate	$32,855.55
Max. Negotiated Rate	$107,904.54
Rate for Payer: Aetna Commercial	$78,709.35
Rate for Payer: Aetna Medicare Advantage	$107,904.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75,911.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75,911.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34,584.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75,911.70
Rate for Payer: Cigna Commercial	$62,404.79
Rate for Payer: Cigna Medicare Advantage	$34,584.79
Rate for Payer: Clover Medicare Advantage	$32,855.55
Rate for Payer: EmblemHealth Commercial	$103,754.37
Rate for Payer: Humana Medicare Advantage	$35,622.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34,584.79
Rate for Payer: Oxford Commercial	$49,323.67
Rate for Payer: UnitedHealthcare Commercial	$66,021.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$34,584.79
Rate for Payer: Wellcare Medicare Advantage	$34,584.79

MAJOR BLADDER PROCEDURES WITH MCC

Facility

$183,637.40

Service Code	MSDRG 653
Min. Negotiated Rate	$55,915.23
Max. Negotiated Rate	$183,637.40
Rate for Payer: Aetna Commercial	$132,647.18
Rate for Payer: Aetna Medicare Advantage	$183,637.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$58,858.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149,884.05
Rate for Payer: Cigna Commercial	$115,843.35
Rate for Payer: Cigna Medicare Advantage	$58,858.14
Rate for Payer: Clover Medicare Advantage	$55,915.23
Rate for Payer: EmblemHealth Commercial	$176,574.42
Rate for Payer: Humana Medicare Advantage	$60,623.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$58,858.14
Rate for Payer: Oxford Commercial	$91,560.57
Rate for Payer: UnitedHealthcare Commercial	$122,557.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$58,858.14
Rate for Payer: Wellcare Medicare Advantage	$58,858.14

MAJOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$86,335.55

Service Code	MSDRG 655
Min. Negotiated Rate	$26,288.07
Max. Negotiated Rate	$86,335.55
Rate for Payer: Aetna Commercial	$63,347.66
Rate for Payer: Aetna Medicare Advantage	$86,335.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,457.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,457.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,671.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,457.55
Rate for Payer: Cigna Commercial	$47,185.36
Rate for Payer: Cigna Medicare Advantage	$27,671.65
Rate for Payer: Clover Medicare Advantage	$26,288.07
Rate for Payer: EmblemHealth Commercial	$83,014.95
Rate for Payer: Humana Medicare Advantage	$28,501.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,671.65
Rate for Payer: Oxford Commercial	$37,294.49
Rate for Payer: UnitedHealthcare Commercial	$49,920.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,671.65
Rate for Payer: Wellcare Medicare Advantage	$27,671.65

MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY

Facility

$39,367.58

Service Code	APR-DRG 1601
Min. Negotiated Rate	$38,595.67
Max. Negotiated Rate	$39,367.58
Rate for Payer: UnitedHealthcare Community & State	$38,595.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$39,367.58
Rate for Payer: Wellpoint Medicaid Managed Care	$38,595.67

Know your out-of-pocket cost for care.

All Charges