Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MRI TM JOINTS

Facility

$13,500.00

Service Code	HCPCS 70336
Hospital Charge Code	94061019
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	$495.00
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 TM JOINTS

Facility

$13,500.00

Service Code	HCPCS 70336
Hospital Charge Code	94061019
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 UE JNT W/&W/O CNTRST BLTRL

Facility

$3,538.00

Service Code	HCPCS 7322350
Hospital Charge Code	2400533
Hospital Revenue Code	614
Min. Negotiated Rate	$530.70
Max. Negotiated Rate	$530.70
Rate for Payer: Qualcare PPO/HMO/WC	$530.70

MRI UE JNT W/&W/O CNTRST BLTRL

Facility

$3,538.00

Service Code	HCPCS 7322350
Hospital Charge Code	2400533
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 UE JOINT W/CONTRAST BILTRL

Facility

$2,617.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400534
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 UE JOINT W/CONTRAST BILTRL

Facility

$2,617.00

Service Code	HCPCS 7322250
Hospital Charge Code	2400534
Hospital Revenue Code	614
Min. Negotiated Rate	$392.55
Max. Negotiated Rate	$392.55
Rate for Payer: Qualcare PPO/HMO/WC	$392.55

MRI UE JOINT W/O CNTRST BLTRL

Facility

$13,500.00

Service Code	HCPCS 7322150
Hospital Charge Code	2400535
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 UE JOINT W/O CNTRST BLTRL

Facility

$13,500.00

Service Code	HCPCS 7322150
Hospital Charge Code	2400535
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 UE NON JNT W/CONTRST BLTRL

Facility

$2,617.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400537
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 UE NON JNT W/CONTRST BLTRL

Facility

$2,617.00

Service Code	HCPCS 7321950
Hospital Charge Code	2400537
Hospital Revenue Code	614
Min. Negotiated Rate	$392.55
Max. Negotiated Rate	$392.55
Rate for Payer: Qualcare PPO/HMO/WC	$392.55

MRI UE NON JNT W/O CNTRST BLTL

Facility

$2,436.00

Service Code	HCPCS 7321850
Hospital Charge Code	2400538
Hospital Revenue Code	614
Min. Negotiated Rate	$365.40
Max. Negotiated Rate	$365.40
Rate for Payer: Qualcare PPO/HMO/WC	$365.40

MRI UE NON JNT W/O CNTRST BLTL

Facility

$2,436.00

Service Code	HCPCS 7321850
Hospital Charge Code	2400538
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 UE NON JNT W/&W/O CNTST BL

Facility

$3,538.00

Service Code	HCPCS 7322050
Hospital Charge Code	2400536
Hospital Revenue Code	614
Min. Negotiated Rate	$530.70
Max. Negotiated Rate	$530.70
Rate for Payer: Qualcare PPO/HMO/WC	$530.70

MRI UE NON JNT W/&W/O CNTST BL

Facility

$3,538.00

Service Code	HCPCS 7322050
Hospital Charge Code	2400536
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 UPPER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73221
Hospital Charge Code	94061109
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	$544.50
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 UPPER EXTREMITY

Facility

$13,500.00

Service Code	HCPCS 73221
Hospital Charge Code	94061109
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 UPPER EXTREMITY NON

Facility

$13,500.00

Service Code	HCPCS 73218
Hospital Charge Code	94061107
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 UPPER EXTREMITY NON

Facility

$13,500.00

Service Code	HCPCS 73218
Hospital Charge Code	94061107
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 UPPER EXTREM-LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	94061349
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 UPPER EXTREM-LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	94061349
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 UPPER EXTREM-RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	94061351
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 UPPER EXTREM-RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	94061351
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 UPPER EXTREM W/WO CO

Facility

$13,500.00

Service Code	HCPCS 73223
Hospital Charge Code	94061111
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 UPPER EXTREM W/WO CO

Facility

$13,500.00

Service Code	HCPCS 73223
Hospital Charge Code	94061111
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 UPP EXT OTH THN JT W/WO LT

Facility

$13,500.00

Service Code	HCPCS 73220LT
Hospital Charge Code	2400240
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

Know your out-of-pocket cost for care.

All Charges