Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC

Facility

$67,012.92

Service Code	MSDRG 830
Min. Negotiated Rate	$20,404.58
Max. Negotiated Rate	$67,012.92
Rate for Payer: Aetna Commercial	$49,585.89
Rate for Payer: Aetna Medicare Advantage	$67,012.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43,773.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43,773.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,478.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43,773.90
Rate for Payer: Cigna Commercial	$33,550.96
Rate for Payer: Cigna Medicare Advantage	$21,478.50
Rate for Payer: Clover Medicare Advantage	$20,404.58
Rate for Payer: EmblemHealth Commercial	$64,435.50
Rate for Payer: Humana Medicare Advantage	$22,122.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,478.50
Rate for Payer: Oxford Commercial	$26,518.10
Rate for Payer: UnitedHealthcare Commercial	$35,495.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,478.50
Rate for Payer: Wellcare Medicare Advantage	$21,478.50

MY KNEE 2R MEDIAL

Facility

$500.00

Hospital Charge Code	270685304
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

MY KNEE 2R MEDIAL

Facility

$500.00

Hospital Charge Code	270685304
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MYKNEE FEM RM#4

Facility

$625.00

Hospital Charge Code	270687439
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MYKNEE FEM RM#4

Facility

$625.00

Hospital Charge Code	270687439
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270682050
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270675745
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270682050
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MYKNEE TIBIA BONE MODEL -LEFT

Facility

$500.00

Hospital Charge Code	270675745
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

MY KNEE TIBIAL CUT BLOCK

Facility

$625.00

Hospital Charge Code	270681471
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

MY KNEE TIBIAL CUT BLOCK

Facility

$625.00

Hospital Charge Code	270681471
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

MYNGTM INCL ASP/EUSTACH INFLAT

Facility

$14,464.70

Service Code	HCPCS 69421
Hospital Charge Code	16001046
Hospital Revenue Code	360
Min. Negotiated Rate	$2,169.70
Max. Negotiated Rate	$2,169.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,169.70

MYNGTM INCL ASP/EUSTACH INFLAT

Facility

$14,464.70

Service Code	HCPCS 69421
Hospital Charge Code	16001046
Hospital Revenue Code	360
Min. Negotiated Rate	$410.80
Max. Negotiated Rate	$14,288.18
Rate for Payer: Aetna Commercial	$10,713.67
Rate for Payer: Aetna Medicare Advantage	$12,761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,288.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,288.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,938.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,288.18
Rate for Payer: Cigna Commercial	$7,895.42
Rate for Payer: Cigna Medicare Advantage	$3,938.85
Rate for Payer: Clover Medicare Advantage	$3,741.91
Rate for Payer: EmblemHealth Commercial	$11,816.55
Rate for Payer: Humana Medicare Advantage	$4,057.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,938.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,760.82
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,169.70
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$457.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,938.85
Rate for Payer: Wellcare Medicare Advantage	$3,938.85
Rate for Payer: Wellpoint Medicaid Managed Care	$410.80

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,416.25

Service Code	HCPCS C1760
Hospital Charge Code	270662371N
Hospital Revenue Code	278
Min. Negotiated Rate	$40.22
Max. Negotiated Rate	$708.12
Rate for Payer: Aetna Commercial	$538.17
Rate for Payer: Aetna Medicare Advantage	$424.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$361.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$361.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$361.14
Rate for Payer: Cigna Commercial	$708.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.73
Rate for Payer: Qualcare PPO/HMO/WC	$212.44
Rate for Payer: UnitedHealthcare Community & State	$44.75
Rate for Payer: Wellpoint Medicaid Managed Care	$40.22

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,185.00

Service Code	HCPCS C1760
Hospital Charge Code	270662371S
Hospital Revenue Code	278
Min. Negotiated Rate	$177.75
Max. Negotiated Rate	$286.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,416.25

Service Code	HCPCS C1760
Hospital Charge Code	270662371N
Hospital Revenue Code	278
Min. Negotiated Rate	$212.44
Max. Negotiated Rate	$342.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$283.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$342.73
Rate for Payer: Qualcare PPO/HMO/WC	$212.44

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,185.00

Service Code	HCPCS C1760
Hospital Charge Code	270662371
Hospital Revenue Code	278
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$592.50
Rate for Payer: Aetna Commercial	$450.30
Rate for Payer: Aetna Medicare Advantage	$355.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$302.18
Rate for Payer: Cigna Commercial	$592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75
Rate for Payer: UnitedHealthcare Community & State	$37.45
Rate for Payer: Wellpoint Medicaid Managed Care	$33.65

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,185.00

Service Code	HCPCS C1760
Hospital Charge Code	270662371S
Hospital Revenue Code	278
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$592.50
Rate for Payer: Aetna Commercial	$450.30
Rate for Payer: Aetna Medicare Advantage	$355.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$302.18
Rate for Payer: Cigna Commercial	$592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75
Rate for Payer: UnitedHealthcare Community & State	$37.45
Rate for Payer: Wellpoint Medicaid Managed Care	$33.65

MYNX GRIP VASCULAR CL DEV 5F

Facility

$1,185.00

Service Code	HCPCS C1760
Hospital Charge Code	270662371
Hospital Revenue Code	278
Min. Negotiated Rate	$177.75
Max. Negotiated Rate	$286.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75

MYOCARDIAL PER PHARMACOLOGIC

Facility

$11,000.00

Service Code	HCPCS 93017
Hospital Charge Code	74115010
Hospital Revenue Code	482
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$1,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

MYOCARDIAL PER PHARMACOLOGIC

Facility

$11,000.00

Service Code	HCPCS 93017
Hospital Charge Code	74115010
Hospital Revenue Code	482
Min. Negotiated Rate	$243.69
Max. Negotiated Rate	$4,554.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.53
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,860.00
Rate for Payer: Oxford Commercial	$4,336.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Commercial	$4,554.00
Rate for Payer: UnitedHealthcare Community & State	$347.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$312.40

MYOCARD STRAIN IMAGE SPCKL TKG

Facility

$5,900.00

Service Code	HCPCS 93356
Hospital Charge Code	403193356
Hospital Revenue Code	480
Min. Negotiated Rate	$25.91
Max. Negotiated Rate	$2,950.00
Rate for Payer: Aetna Commercial	$2,242.00
Rate for Payer: Aetna Medicare Advantage	$1,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,504.50
Rate for Payer: Cigna Commercial	$2,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,534.00
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$186.44
Rate for Payer: Wellpoint Medicaid Managed Care	$167.56

MYOCARD STRAIN IMAGE SPCKL TKG

Facility

$5,900.00

Service Code	HCPCS 93356
Hospital Charge Code	403193356
Hospital Revenue Code	480
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

MYOCRD PERF IMG (SPECT) MULT

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5308015
Hospital Revenue Code	341
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.22
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$336.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$302.59

MYOCRD PERF IMG (SPECT) MULT

Facility

$10,654.71

Service Code	HCPCS 78452
Hospital Charge Code	5308015
Hospital Revenue Code	341
Min. Negotiated Rate	$1,598.21
Max. Negotiated Rate	$1,598.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,598.21

Know your out-of-pocket cost for care.

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