Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MRI BREAST UNILATERAL

Facility

$5,077.50

Service Code	HCPCS 77058
Hospital Charge Code	94061461
Hospital Revenue Code	614
Min. Negotiated Rate	$761.62
Max. Negotiated Rate	$761.62
Rate for Payer: Qualcare PPO/HMO/WC	$761.62

MRI BREAST UNILATERAL

Facility

$5,078.00

Service Code	HCPCS 77058
Hospital Charge Code	2400372
Hospital Revenue Code	614
Min. Negotiated Rate	$144.22
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,929.64
Rate for Payer: Aetna Medicare Advantage	$1,523.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,294.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,294.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,294.89
Rate for Payer: Cigna Commercial	$2,539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,320.28
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$761.70
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$160.46
Rate for Payer: Wellpoint Medicaid Managed Care	$144.22

MRI BREAST UNILATERAL

Facility

$5,078.00

Service Code	HCPCS 77058
Hospital Charge Code	2400372
Hospital Revenue Code	614
Min. Negotiated Rate	$761.70
Max. Negotiated Rate	$761.70
Rate for Payer: Qualcare PPO/HMO/WC	$761.70

MRI BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	404577047
Hospital Revenue Code	614
Min. Negotiated Rate	$188.38
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	$188.38
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

MRI BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	406177047
Hospital Revenue Code	614
Min. Negotiated Rate	$188.38
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	$188.38
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

MRI BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	406177047
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

MRI BREAST WO CONTRAST BILAT

Facility

$13,500.00

Service Code	HCPCS 77047
Hospital Charge Code	404577047
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

MRI BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	404577046
Hospital Revenue Code	614
Min. Negotiated Rate	$183.71
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	$183.71
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

MRI BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	406177046
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

MRI BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	406177046
Hospital Revenue Code	614
Min. Negotiated Rate	$183.71
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	$183.71
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

MRI BREAST WO CONTRAST UNI

Facility

$13,500.00

Service Code	HCPCS 77046
Hospital Charge Code	404577046
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

MRI BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406144049
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

MRI BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406144049
Hospital Revenue Code	614
Min. Negotiated Rate	$298.17
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	$298.17
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

MRI BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	404577049
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

MRI BREAST W&WO CONT CAD BILAT

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	404577049
Hospital Revenue Code	614
Min. Negotiated Rate	$298.17
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	$298.17
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

MRI BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406177048
Hospital Revenue Code	614
Min. Negotiated Rate	$298.17
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	$298.17
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

MRI BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77048
Hospital Charge Code	404577048
Hospital Revenue Code	614
Min. Negotiated Rate	$292.28
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	$292.28
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

MRI BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77049
Hospital Charge Code	406177048
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

MRI BREAST W&WO CONT CAD UNI

Facility

$13,500.00

Service Code	HCPCS 77048
Hospital Charge Code	404577048
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

MRI BRIAN NEURO QUART WITH D

Facility

$1,145.00

Service Code	HCPCS 0866T
Hospital Charge Code	40450866T
Hospital Revenue Code	614
Min. Negotiated Rate	$32.52
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) 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	$297.70
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$36.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$32.52

MRI BRIAN NEURO QUART WITH D

Facility

$1,145.00

Service Code	HCPCS 0866T
Hospital Charge Code	40450866T
Hospital Revenue Code	614
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

MRI CARD CARD MORPH WO/WITH FL

Facility

$1,762.00

Service Code	HCPCS 75565
Hospital Charge Code	2408025
Hospital Revenue Code	614
Min. Negotiated Rate	$264.30
Max. Negotiated Rate	$264.30
Rate for Payer: Qualcare PPO/HMO/WC	$264.30

MRI CARD CARD MORPH WO/WITH FL

Facility

$1,762.00

Service Code	HCPCS 75565
Hospital Charge Code	2408025
Hospital Revenue Code	614
Min. Negotiated Rate	$50.04
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$669.56
Rate for Payer: Aetna Medicare Advantage	$528.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$449.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$449.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$73.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$449.31
Rate for Payer: Cigna Commercial	$881.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$458.12
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.30
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$55.68
Rate for Payer: Wellpoint Medicaid Managed Care	$50.04

MRI-CARDC MORPH WO-FOLLWD WITH

Facility

$3,168.00

Service Code	HCPCS 75561
Hospital Charge Code	2408020
Hospital Revenue Code	614
Min. Negotiated Rate	$89.97
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) NJ Health	$495.00
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	$823.68
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$475.20
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$100.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$89.97

MRI-CARDC MORPH WO-FOLLWD WITH

Facility

$3,168.00

Service Code	HCPCS 75561
Hospital Charge Code	2408020
Hospital Revenue Code	614
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$475.20
Rate for Payer: Qualcare PPO/HMO/WC	$475.20

Know your out-of-pocket cost for care.

All Charges