Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRI UPP EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73220RT
Hospital Charge Code	2400241
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 UPP EXT OTH THN JT W/WO RT

Facility

$13,500.00

Service Code	HCPCS 73220RT
Hospital Charge Code	2400241
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 UPP EXTR ANY JOINT UPPR LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	2400257
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 UPP EXTR ANY JOINT UPPR LT

Facility

$13,500.00

Service Code	HCPCS 73221LT
Hospital Charge Code	2400257
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 UPP EXTR ANY JT UPPR RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	2400258
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 UPP EXTR ANY JT UPPR RT

Facility

$13,500.00

Service Code	HCPCS 73221RT
Hospital Charge Code	2400258
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

MR LWR EX ANY JT LOW LT W/ C

Facility

$13,500.00

Service Code	HCPCS 73722LT
Hospital Charge Code	2400271
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 LWR EX ANY JT LOW LT W/ C

Facility

$13,500.00

Service Code	HCPCS 73722LT
Hospital Charge Code	2400271
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

MR LWR EX ANY JT LOW LT W/WO C

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400280
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 LWR EX ANY JT LOW LT W/WO C

Facility

$13,500.00

Service Code	HCPCS 73723LT
Hospital Charge Code	2400280
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

MR LWR EX ANY JT LOW RT W/ C

Facility

$13,500.00

Service Code	HCPCS 73722RT
Hospital Charge Code	2400283
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

MR LWR EX ANY JT LOW RT W/ C

Facility

$13,500.00

Service Code	HCPCS 73722RT
Hospital Charge Code	2400283
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 LWR EX ANY JT LOW RT W/WO C

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400284
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

MR LWR EX ANY JT LOW RT W/WO C

Facility

$13,500.00

Service Code	HCPCS 73723RT
Hospital Charge Code	2400284
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 LWR EX OTH THN JT LT W/O C

Facility

$13,500.00

Service Code	HCPCS 73718LT
Hospital Charge Code	2400270
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 LWR EX OTH THN JT LT W/O C

Facility

$13,500.00

Service Code	HCPCS 73718LT
Hospital Charge Code	2400270
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

MR LWR EX OTH THN JT RT W/O C

Facility

$13,500.00

Service Code	HCPCS 73718RT
Hospital Charge Code	2400275
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

MR LWR EX OTH THN JT RT W/O C

Facility

$13,500.00

Service Code	HCPCS 73718RT
Hospital Charge Code	2400275
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 LWR EXT OTH THN JT LT W/ C

Facility

$13,500.00

Service Code	HCPCS 73719LT
Hospital Charge Code	2400272
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 LWR EXT OTH THN JT LT W/ C

Facility

$13,500.00

Service Code	HCPCS 73719LT
Hospital Charge Code	2400272
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

MR LWR EXT OTH THN LT RT W/ C

Facility

$13,500.00

Service Code	HCPCS 73719RT
Hospital Charge Code	2400276
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

MR LWR EXT OTH THN LT RT W/ C

Facility

$13,500.00

Service Code	HCPCS 73719RT
Hospital Charge Code	2400276
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 PELVIS W/O C

Facility

$13,500.00

Service Code	HCPCS 72195
Hospital Charge Code	2400233
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	$453.75
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

MR PELVIS W/O C

Facility

$13,500.00

Service Code	HCPCS 72195
Hospital Charge Code	2400233
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