Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PACK CYSTO 3 K/C

Facility

$100.00

Hospital Charge Code	270654020
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

PACK CYSTO III K/C

Facility

$91.67

Hospital Charge Code	270653791
Hospital Revenue Code	272
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$13.75
Rate for Payer: Qualcare PPO/HMO/WC	$13.75

PACK CYSTO III K/C

Facility

$91.67

Hospital Charge Code	270653791
Hospital Revenue Code	272
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$45.84
Rate for Payer: Aetna Commercial	$34.83
Rate for Payer: Aetna Medicare Advantage	$27.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.38
Rate for Payer: Cigna Commercial	$45.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.83
Rate for Payer: Oxford Commercial	$18.33
Rate for Payer: Qualcare PPO/HMO/WC	$13.75
Rate for Payer: UnitedHealthcare Commercial	$18.33
Rate for Payer: UnitedHealthcare Community & State	$2.90
Rate for Payer: Wellpoint Medicaid Managed Care	$2.60

PACK CYSTOSCOPY IV 88618

Facility

$24.90

Hospital Charge Code	270609204
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$3.73

PACK CYSTOSCOPY IV 88618

Facility

$24.90

Hospital Charge Code	270609204
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$12.45
Rate for Payer: Aetna Commercial	$9.46
Rate for Payer: Aetna Medicare Advantage	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.35
Rate for Payer: Cigna Commercial	$12.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.47
Rate for Payer: Oxford Commercial	$4.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.98
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

PACK D & C HYSTEROSCOPY

Facility

$111.10

Hospital Charge Code	270653804
Hospital Revenue Code	272
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$55.55
Rate for Payer: Aetna Commercial	$42.22
Rate for Payer: Aetna Medicare Advantage	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.33
Rate for Payer: Cigna Commercial	$55.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.89
Rate for Payer: Oxford Commercial	$22.22
Rate for Payer: Qualcare PPO/HMO/WC	$16.66
Rate for Payer: UnitedHealthcare Commercial	$22.22
Rate for Payer: UnitedHealthcare Community & State	$3.51
Rate for Payer: Wellpoint Medicaid Managed Care	$3.16

PACK D & C HYSTEROSCOPY

Facility

$111.10

Hospital Charge Code	270653804
Hospital Revenue Code	272
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$16.66
Rate for Payer: Qualcare PPO/HMO/WC	$16.66

PACK DIAGNOSTIC CATH LAB(4CS)

Facility

$364.25

Hospital Charge Code	270653723
Hospital Revenue Code	272
Min. Negotiated Rate	$54.64
Max. Negotiated Rate	$54.64
Rate for Payer: Qualcare PPO/HMO/WC	$54.64

PACK DIAGNOSTIC CATH LAB(4CS)

Facility

$364.25

Hospital Charge Code	270653723
Hospital Revenue Code	272
Min. Negotiated Rate	$10.34
Max. Negotiated Rate	$182.12
Rate for Payer: Aetna Commercial	$138.41
Rate for Payer: Aetna Medicare Advantage	$109.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.88
Rate for Payer: Cigna Commercial	$182.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.70
Rate for Payer: Oxford Commercial	$72.85
Rate for Payer: Qualcare PPO/HMO/WC	$54.64
Rate for Payer: UnitedHealthcare Commercial	$72.85
Rate for Payer: UnitedHealthcare Community & State	$11.51
Rate for Payer: Wellpoint Medicaid Managed Care	$10.34

PACK EXTREMITY LOWER III

Facility

$517.68

Hospital Charge Code	270653807
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$258.84
Rate for Payer: Aetna Commercial	$196.72
Rate for Payer: Aetna Medicare Advantage	$155.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.01
Rate for Payer: Cigna Commercial	$258.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.60
Rate for Payer: Oxford Commercial	$103.54
Rate for Payer: Qualcare PPO/HMO/WC	$77.65
Rate for Payer: UnitedHealthcare Commercial	$103.54
Rate for Payer: UnitedHealthcare Community & State	$16.36
Rate for Payer: Wellpoint Medicaid Managed Care	$14.70

PACK EXTREMITY LOWER III

Facility

$517.68

Hospital Charge Code	270653807
Hospital Revenue Code	272
Min. Negotiated Rate	$77.65
Max. Negotiated Rate	$77.65
Rate for Payer: Qualcare PPO/HMO/WC	$77.65

PACK GYN LAPAROSCOPY III

Facility

$226.24

Hospital Charge Code	270653801
Hospital Revenue Code	272
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$113.12
Rate for Payer: Aetna Commercial	$85.97
Rate for Payer: Aetna Medicare Advantage	$67.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.69
Rate for Payer: Cigna Commercial	$113.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.82
Rate for Payer: Oxford Commercial	$45.25
Rate for Payer: Qualcare PPO/HMO/WC	$33.94
Rate for Payer: UnitedHealthcare Commercial	$45.25
Rate for Payer: UnitedHealthcare Community & State	$7.15
Rate for Payer: Wellpoint Medicaid Managed Care	$6.43

PACK GYN LAPAROSCOPY III

Facility

$226.24

Hospital Charge Code	270653801
Hospital Revenue Code	272
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$33.94
Rate for Payer: Qualcare PPO/HMO/WC	$33.94

PACK HEAD AND NECK

Facility

$52.78

Hospital Charge Code	270653742
Hospital Revenue Code	272
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$7.92
Rate for Payer: Qualcare PPO/HMO/WC	$7.92

PACK HEAD AND NECK

Facility

$52.78

Hospital Charge Code	270653742
Hospital Revenue Code	272
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$26.39
Rate for Payer: Aetna Commercial	$20.06
Rate for Payer: Aetna Medicare Advantage	$15.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.46
Rate for Payer: Cigna Commercial	$26.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.72
Rate for Payer: Oxford Commercial	$10.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.92
Rate for Payer: UnitedHealthcare Commercial	$10.56
Rate for Payer: UnitedHealthcare Community & State	$1.67
Rate for Payer: Wellpoint Medicaid Managed Care	$1.50

PACK HIP PINNING

Facility

$474.08

Hospital Charge Code	270653806
Hospital Revenue Code	272
Min. Negotiated Rate	$71.11
Max. Negotiated Rate	$71.11
Rate for Payer: Qualcare PPO/HMO/WC	$71.11

PACK HIP PINNING

Facility

$474.08

Hospital Charge Code	270653806
Hospital Revenue Code	272
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$237.04
Rate for Payer: Aetna Commercial	$180.15
Rate for Payer: Aetna Medicare Advantage	$142.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$120.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$120.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$120.89
Rate for Payer: Cigna Commercial	$237.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.26
Rate for Payer: Oxford Commercial	$94.82
Rate for Payer: Qualcare PPO/HMO/WC	$71.11
Rate for Payer: UnitedHealthcare Commercial	$94.82
Rate for Payer: UnitedHealthcare Community & State	$14.98
Rate for Payer: Wellpoint Medicaid Managed Care	$13.46

PACK I &A

Facility

$313.00

Hospital Charge Code	270331453
Hospital Revenue Code	272
Min. Negotiated Rate	$46.95
Max. Negotiated Rate	$46.95
Rate for Payer: Qualcare PPO/HMO/WC	$46.95

PACK I &A

Facility

$313.00

Hospital Charge Code	270331453
Hospital Revenue Code	272
Min. Negotiated Rate	$8.89
Max. Negotiated Rate	$156.50
Rate for Payer: Aetna Commercial	$118.94
Rate for Payer: Aetna Medicare Advantage	$93.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.81
Rate for Payer: Cigna Commercial	$156.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.38
Rate for Payer: Oxford Commercial	$62.60
Rate for Payer: Qualcare PPO/HMO/WC	$46.95
Rate for Payer: UnitedHealthcare Commercial	$62.60
Rate for Payer: UnitedHealthcare Community & State	$9.89
Rate for Payer: Wellpoint Medicaid Managed Care	$8.89

PACK ICE - ALL SIZES

Facility

$16.85

Hospital Charge Code	270301283
Hospital Revenue Code	270
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

PACK ICE - ALL SIZES

Facility

$16.85

Hospital Charge Code	270301283
Hospital Revenue Code	270
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

PACK ICE SMALL

Facility

$16.85

Hospital Charge Code	270301284
Hospital Revenue Code	270
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

PACK ICE SMALL

Facility

$16.85

Hospital Charge Code	270301284
Hospital Revenue Code	270
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

PACKING COIL

Facility

$4,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270686142
Hospital Revenue Code	278
Min. Negotiated Rate	$140.58
Max. Negotiated Rate	$2,475.00
Rate for Payer: Aetna Commercial	$1,881.00
Rate for Payer: Aetna Medicare Advantage	$1,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,262.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,262.25
Rate for Payer: Cigna Commercial	$2,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50
Rate for Payer: UnitedHealthcare Community & State	$156.42
Rate for Payer: Wellpoint Medicaid Managed Care	$140.58

PACKING COIL

Facility

$4,950.00

Service Code	HCPCS C1757
Hospital Charge Code	270686142
Hospital Revenue Code	278
Min. Negotiated Rate	$742.50
Max. Negotiated Rate	$1,197.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,197.90
Rate for Payer: Qualcare PPO/HMO/WC	$742.50

Know your out-of-pocket cost for care.

All Charges