Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MRI LE JOINT W/CONTRAST BILTRL

Facility

$2,617.00

Service Code	HCPCS 7372250
Hospital Charge Code	2400509
Hospital Revenue Code	614
Min. Negotiated Rate	$392.55
Max. Negotiated Rate	$392.55
Rate for Payer: Qualcare PPO/HMO/WC	$392.55

MRI LE JOINT W/O CONTRST BLTRL

Facility

$3,410.40

Service Code	HCPCS 7372150
Hospital Charge Code	2400510
Hospital Revenue Code	614
Min. Negotiated Rate	$96.86
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,295.95
Rate for Payer: Aetna Medicare Advantage	$1,023.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$869.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$869.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$869.65
Rate for Payer: Cigna Commercial	$1,705.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$886.70
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$511.56
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$107.77
Rate for Payer: Wellpoint Medicaid Managed Care	$96.86

MRI LE JOINT W/O CONTRST BLTRL

Facility

$3,410.40

Service Code	HCPCS 7372150
Hospital Charge Code	2400510
Hospital Revenue Code	614
Min. Negotiated Rate	$511.56
Max. Negotiated Rate	$511.56
Rate for Payer: Qualcare PPO/HMO/WC	$511.56

MRI LE NON JNT W/CONTRST BILTL

Facility

$2,617.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400512
Hospital Revenue Code	614
Min. Negotiated Rate	$74.32
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$994.46
Rate for Payer: Aetna Medicare Advantage	$785.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$667.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$667.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$667.34
Rate for Payer: Cigna Commercial	$1,308.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$680.42
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.55
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$82.70
Rate for Payer: Wellpoint Medicaid Managed Care	$74.32

MRI LE NON JNT W/CONTRST BILTL

Facility

$2,617.00

Service Code	HCPCS 7371950
Hospital Charge Code	2400512
Hospital Revenue Code	614
Min. Negotiated Rate	$392.55
Max. Negotiated Rate	$392.55
Rate for Payer: Qualcare PPO/HMO/WC	$392.55

MRI LE NON JNT W/O CNTRST BLTL

Facility

$2,436.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400513
Hospital Revenue Code	614
Min. Negotiated Rate	$365.40
Max. Negotiated Rate	$365.40
Rate for Payer: Qualcare PPO/HMO/WC	$365.40

MRI LE NON JNT W/O CNTRST BLTL

Facility

$2,436.00

Service Code	HCPCS 7371850
Hospital Charge Code	2400513
Hospital Revenue Code	614
Min. Negotiated Rate	$69.18
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$925.68
Rate for Payer: Aetna Medicare Advantage	$730.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$621.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$621.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$621.18
Rate for Payer: Cigna Commercial	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$633.36
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$365.40
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$76.98
Rate for Payer: Wellpoint Medicaid Managed Care	$69.18

MRI LE NON JNT W/&W/O CTRST BL

Facility

$3,538.00

Service Code	HCPCS 7372050
Hospital Charge Code	2400511
Hospital Revenue Code	614
Min. Negotiated Rate	$100.48
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,344.44
Rate for Payer: Aetna Medicare Advantage	$1,061.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$902.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$902.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$902.19
Rate for Payer: Cigna Commercial	$1,769.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.88
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$530.70
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$111.80
Rate for Payer: Wellpoint Medicaid Managed Care	$100.48

MRI LE NON JNT W/&W/O CTRST BL

Facility

$3,538.00

Service Code	HCPCS 7372050
Hospital Charge Code	2400511
Hospital Revenue Code	614
Min. Negotiated Rate	$530.70
Max. Negotiated Rate	$530.70
Rate for Payer: Qualcare PPO/HMO/WC	$530.70

MRI LE NONJOINT W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 73719
Hospital Charge Code	406173719
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 LE NONJOINT W CONTRAST

Facility

$13,500.00

Service Code	HCPCS 73719
Hospital Charge Code	406173719
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) NJ Health	$562.65
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

MRI LOWER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73720
Hospital Charge Code	94061117
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) 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	$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

MRI LOWER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73720
Hospital Charge Code	94061117
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 LOWER EXTREMITY NONJ

Facility

$13,500.00

Service Code	HCPCS 73718
Hospital Charge Code	94061115
Hospital Revenue Code	614
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

MRI LOWER EXTREMITY NONJ

Facility

$13,500.00

Service Code	HCPCS 73718
Hospital Charge Code	94061115
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 LOWER EXTREM W/WOCON

Facility

$13,500.00

Service Code	HCPCS 73723
Hospital Charge Code	94061121
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 LOWER EXTREM W/WOCON

Facility

$13,500.00

Service Code	HCPCS 73723
Hospital Charge Code	94061121
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) NJ Health	$807.53
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

MRI LOW EXT OTH THN JT W/WO LT

Facility

$13,500.00

Service Code	HCPCS 73720LT
Hospital Charge Code	2400273
Hospital Revenue Code	614
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

MRI LOW EXT OTH THN JT W/WO LT

Facility

$13,500.00

Service Code	HCPCS 73720LT
Hospital Charge Code	2400273
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 LOW EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73720RT
Hospital Charge Code	2400274
Hospital Revenue Code	614
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

MRI LOW EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73720RT
Hospital Charge Code	2400274
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 LOWR EXTR ANY JT LOWER LT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400281
Hospital Revenue Code	614
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

MRI LOWR EXTR ANY JT LOWER LT

Facility

$13,500.00

Service Code	HCPCS 73721LT
Hospital Charge Code	2400281
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 LOWR EXTR ANY JT LOW RT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400282
Hospital Revenue Code	614
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

MRI LOWR EXTR ANY JT LOW RT

Facility

$13,500.00

Service Code	HCPCS 73721RT
Hospital Charge Code	2400282
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

Know your out-of-pocket cost for care.

All Charges