Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MRA/MRV PELVIS WO CONTRAST

Facility

$13,500.00

Service Code	HCPCS 72198
Hospital Charge Code	2400231
Hospital Revenue Code	618
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA/MRV PELVIS WO CONTRAST

Facility

$13,500.00

Service Code	HCPCS 72198
Hospital Charge Code	2400231
Hospital Revenue Code	618
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$418.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

MRA/MRV UPPER EXT W/WO CONT LT

Facility

$13,500.00

Service Code	HCPCS 73225LT
Hospital Charge Code	2400265
Hospital Revenue Code	618
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA/MRV UPPER EXT W/WO CONT LT

Facility

$13,500.00

Service Code	HCPCS 73225LT
Hospital Charge Code	2400265
Hospital Revenue Code	618
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

MRA NECK W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70547
Hospital Charge Code	94061029
Hospital Revenue Code	615
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$6,130.00
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	$499.95
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	$283.47
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	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

MRA NECK W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70547
Hospital Charge Code	94061029
Hospital Revenue Code	615
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA PELVIS W & W/O CONT

Facility

$2,431.00

Service Code	HCPCS 72198
Hospital Charge Code	2400232
Hospital Revenue Code	618
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$364.65
Rate for Payer: Qualcare PPO/HMO/WC	$364.65

MRA PELVIS W & W/O CONT

Facility

$2,431.00

Service Code	HCPCS 72198
Hospital Charge Code	2400232
Hospital Revenue Code	618
Min. Negotiated Rate	$69.04
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$923.78
Rate for Payer: Aetna Medicare Advantage	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$619.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$619.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$418.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$619.90
Rate for Payer: Cigna Commercial	$1,215.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.06
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$364.65
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$76.82
Rate for Payer: Wellpoint Medicaid Managed Care	$69.04

MRA SPINAL CANAL W/OR W/O CONT

Facility

$1,354.00

Service Code	HCPCS 72159
Hospital Charge Code	2400216
Hospital Revenue Code	618
Min. Negotiated Rate	$38.45
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$514.52
Rate for Payer: Aetna Medicare Advantage	$406.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$345.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$345.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$453.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$345.27
Rate for Payer: Cigna Commercial	$677.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$352.04
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$203.10
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$42.79
Rate for Payer: Wellpoint Medicaid Managed Care	$38.45

MRA SPINAL CANAL W/OR W/O CONT

Facility

$1,354.00

Service Code	HCPCS 72159
Hospital Charge Code	2400216
Hospital Revenue Code	618
Min. Negotiated Rate	$203.10
Max. Negotiated Rate	$203.10
Rate for Payer: Qualcare PPO/HMO/WC	$203.10

MRA UPPER EXT W CONTRAST

Facility

$2,043.00

Service Code	HCPCS 73225
Hospital Charge Code	2408005
Hospital Revenue Code	618
Min. Negotiated Rate	$58.02
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$776.34
Rate for Payer: Aetna Medicare Advantage	$612.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$520.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$520.97
Rate for Payer: Cigna Commercial	$1,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$531.18
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$64.56
Rate for Payer: Wellpoint Medicaid Managed Care	$58.02

MRA UPPER EXT W CONTRAST

Facility

$2,043.00

Service Code	HCPCS 73225
Hospital Charge Code	2408005
Hospital Revenue Code	618
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

MR BREAST BI W/ C

Facility

$13,500.00

Service Code	HCPCS C8906
Hospital Charge Code	2400381
Hospital Revenue Code	614
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MR BREAST BI W/ C

Facility

$13,500.00

Service Code	HCPCS C8906
Hospital Charge Code	2400381
Hospital Revenue Code	614
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$414.47
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

MR BREAST BI W/O C

Facility

$1,706.45

Service Code	HCPCS C8907
Hospital Charge Code	2400382
Hospital Revenue Code	614
Min. Negotiated Rate	$48.46
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$648.45
Rate for Payer: Aetna Medicare Advantage	$511.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.14
Rate for Payer: Cigna Commercial	$853.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$443.68
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.97
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: Wellpoint Medicaid Managed Care	$48.46

MR BREAST BI W/O C

Facility

$1,706.45

Service Code	HCPCS C8907
Hospital Charge Code	2400382
Hospital Revenue Code	614
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

MR BREAST BI W/O FOL W/ C

Facility

$4,615.00

Service Code	HCPCS 77059
Hospital Charge Code	2400383
Hospital Revenue Code	614
Min. Negotiated Rate	$692.25
Max. Negotiated Rate	$692.25
Rate for Payer: Qualcare PPO/HMO/WC	$692.25

MR BREAST BI W/O FOL W/ C

Facility

$4,615.00

Service Code	HCPCS 77059
Hospital Charge Code	2400383
Hospital Revenue Code	614
Min. Negotiated Rate	$131.07
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,753.70
Rate for Payer: Aetna Medicare Advantage	$1,384.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,176.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,176.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,176.83
Rate for Payer: Cigna Commercial	$2,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,199.90
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$692.25
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$145.83
Rate for Payer: Wellpoint Medicaid Managed Care	$131.07

MR BREAST UNI W/ C

Facility

$13,500.00

Service Code	HCPCS C8903
Hospital Charge Code	2400373
Hospital Revenue Code	614
Min. Negotiated Rate	$197.96
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$208.38
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

MR BREAST UNI W/ C

Facility

$13,500.00

Service Code	HCPCS C8903
Hospital Charge Code	2400373
Hospital Revenue Code	614
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MR BREAST UNI W/O C

Facility

$1,706.45

Service Code	HCPCS C8904
Hospital Charge Code	2400374
Hospital Revenue Code	614
Min. Negotiated Rate	$48.46
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$648.45
Rate for Payer: Aetna Medicare Advantage	$511.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.14
Rate for Payer: Cigna Commercial	$853.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$443.68
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$255.97
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: Wellpoint Medicaid Managed Care	$48.46

MR BREAST UNI W/O C

Facility

$1,706.45

Service Code	HCPCS C8904
Hospital Charge Code	2400374
Hospital Revenue Code	614
Min. Negotiated Rate	$255.97
Max. Negotiated Rate	$255.97
Rate for Payer: Qualcare PPO/HMO/WC	$255.97

MR BREAST UNI W/WO C

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400375
Hospital Revenue Code	614
Min. Negotiated Rate	$144.20
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,929.45
Rate for Payer: Aetna Medicare Advantage	$1,523.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.76
Rate for Payer: Cigna Commercial	$2,538.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.15
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.62
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$160.45
Rate for Payer: Wellpoint Medicaid Managed Care	$144.20

MR BREAST UNI W/WO C

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	2400375
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MR CHEST LYMPHADEN H/M W/ C

Facility

$2,594.00

Service Code	HCPCS 71551
Hospital Charge Code	2400110
Hospital Revenue Code	614
Min. Negotiated Rate	$389.10
Max. Negotiated Rate	$389.10
Rate for Payer: Qualcare PPO/HMO/WC	$389.10

Know your out-of-pocket cost for care.

All Charges