Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RADIATION TX DELIVERY

Facility

$735.00

Service Code	HCPCS 77402
Hospital Charge Code	85000690
Hospital Revenue Code	333
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$329.69
Rate for Payer: Aetna Medicare Advantage	$392.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$439.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$439.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$121.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$439.69
Rate for Payer: Cigna Commercial	$242.98
Rate for Payer: Cigna Medicare Advantage	$84.85
Rate for Payer: Clover Medicare Advantage	$115.15
Rate for Payer: EmblemHealth Commercial	$363.63
Rate for Payer: Humana Medicare Advantage	$124.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$121.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$191.10
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$110.25
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$23.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$121.21
Rate for Payer: Wellcare Medicare Advantage	$121.21
Rate for Payer: Wellpoint Medicaid Managed Care	$20.87

RADIATION TX DELIVERY

Facility

$1,102.00

Service Code	HCPCS 77412
Hospital Charge Code	85000730
Hospital Revenue Code	333
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,785.49
Rate for Payer: Aetna Medicare Advantage	$2,126.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,381.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,381.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$656.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,381.20
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: Cigna Medicare Advantage	$459.50
Rate for Payer: Clover Medicare Advantage	$623.61
Rate for Payer: EmblemHealth Commercial	$1,969.29
Rate for Payer: Humana Medicare Advantage	$676.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$656.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.52
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$165.30
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$34.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$656.43
Rate for Payer: Wellcare Medicare Advantage	$656.43
Rate for Payer: Wellpoint Medicaid Managed Care	$31.30

RADIATION TX DELIVERY

Facility

$1,161.00

Service Code	HCPCS 77412
Hospital Charge Code	85000735
Hospital Revenue Code	333
Min. Negotiated Rate	$32.97
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,785.49
Rate for Payer: Aetna Medicare Advantage	$2,126.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,381.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,381.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$656.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,381.20
Rate for Payer: Cigna Commercial	$1,315.81
Rate for Payer: Cigna Medicare Advantage	$459.50
Rate for Payer: Clover Medicare Advantage	$623.61
Rate for Payer: EmblemHealth Commercial	$1,969.29
Rate for Payer: Humana Medicare Advantage	$676.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$656.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.86
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.15
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$656.43
Rate for Payer: Wellcare Medicare Advantage	$656.43
Rate for Payer: Wellpoint Medicaid Managed Care	$32.97

RADIATION TX DELIVERY

Facility

$1,102.00

Service Code	HCPCS 77412
Hospital Charge Code	85000730
Hospital Revenue Code	333
Min. Negotiated Rate	$165.30
Max. Negotiated Rate	$165.30
Rate for Payer: Qualcare PPO/HMO/WC	$165.30

RADIATION TX DELIVERY

Facility

$898.00

Service Code	HCPCS 77407
Hospital Charge Code	85000715
Hospital Revenue Code	333
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,246.36
Rate for Payer: Aetna Medicare Advantage	$1,484.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$458.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.19
Rate for Payer: Cigna Commercial	$918.50
Rate for Payer: Cigna Medicare Advantage	$320.75
Rate for Payer: Clover Medicare Advantage	$435.31
Rate for Payer: EmblemHealth Commercial	$1,374.66
Rate for Payer: Humana Medicare Advantage	$471.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$458.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$233.48
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$134.70
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$28.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$458.22
Rate for Payer: Wellcare Medicare Advantage	$458.22
Rate for Payer: Wellpoint Medicaid Managed Care	$25.50

RADIATION TX DELIVERY

Facility

$735.00

Service Code	HCPCS 77402
Hospital Charge Code	85000690
Hospital Revenue Code	333
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$110.25
Rate for Payer: Qualcare PPO/HMO/WC	$110.25

RADIATION TX DELIVERY

Facility

$898.00

Service Code	HCPCS 77407
Hospital Charge Code	85000715
Hospital Revenue Code	333
Min. Negotiated Rate	$134.70
Max. Negotiated Rate	$134.70
Rate for Payer: Qualcare PPO/HMO/WC	$134.70

RADIATION TX DELIVERY

Facility

$922.00

Service Code	HCPCS 77407
Hospital Charge Code	85000710
Hospital Revenue Code	333
Min. Negotiated Rate	$138.30
Max. Negotiated Rate	$138.30
Rate for Payer: Qualcare PPO/HMO/WC	$138.30

RADIATION TX DOSE PLAN-GL

Facility

$620.00

Service Code	HCPCS 77300
Hospital Charge Code	85000445
Hospital Revenue Code	333
Min. Negotiated Rate	$17.61
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$434.33
Rate for Payer: Aetna Medicare Advantage	$517.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$579.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$579.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$159.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$579.24
Rate for Payer: Cigna Commercial	$320.09
Rate for Payer: Cigna Medicare Advantage	$111.78
Rate for Payer: Clover Medicare Advantage	$151.70
Rate for Payer: EmblemHealth Commercial	$479.04
Rate for Payer: Humana Medicare Advantage	$164.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$159.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.20
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$19.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.68
Rate for Payer: Wellcare Medicare Advantage	$159.68
Rate for Payer: Wellpoint Medicaid Managed Care	$17.61

RADIATION TX DOSE PLAN-GL

Facility

$620.00

Service Code	HCPCS 77300
Hospital Charge Code	85000445
Hospital Revenue Code	333
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$93.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.00

RADIATION TX DOSE PLAN IMRT-GL

Facility

$6,384.91

Service Code	HCPCS 77301
Hospital Charge Code	85000460
Hospital Revenue Code	333
Min. Negotiated Rate	$181.33
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$4,472.71
Rate for Payer: Aetna Medicare Advantage	$5,327.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,964.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,964.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,644.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,964.99
Rate for Payer: Cigna Commercial	$3,296.16
Rate for Payer: Cigna Medicare Advantage	$1,151.07
Rate for Payer: Clover Medicare Advantage	$1,562.16
Rate for Payer: EmblemHealth Commercial	$4,933.14
Rate for Payer: Humana Medicare Advantage	$1,693.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,644.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,660.08
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$957.74
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$201.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,644.38
Rate for Payer: Wellcare Medicare Advantage	$1,644.38
Rate for Payer: Wellpoint Medicaid Managed Care	$181.33

RADIATION TX DOSE PLAN IMRT-GL

Facility

$6,384.91

Service Code	HCPCS 77301
Hospital Charge Code	85000460
Hospital Revenue Code	333
Min. Negotiated Rate	$957.74
Max. Negotiated Rate	$957.74
Rate for Payer: Qualcare PPO/HMO/WC	$957.74

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	83000371
Hospital Revenue Code	333
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$217.53
Rate for Payer: Aetna Medicare Advantage	$171.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.97
Rate for Payer: Cigna Commercial	$286.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.84
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.87
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$18.09
Rate for Payer: Wellpoint Medicaid Managed Care	$16.26

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	83000371
Hospital Revenue Code	333
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$85.87
Rate for Payer: Qualcare PPO/HMO/WC	$85.87

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	85000371
Hospital Revenue Code	333
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$85.87
Rate for Payer: Qualcare PPO/HMO/WC	$85.87

RADIATION TX INTERMEDIATE

Facility

$572.45

Service Code	HCPCS 77262
Hospital Charge Code	85000371
Hospital Revenue Code	333
Min. Negotiated Rate	$16.26
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$217.53
Rate for Payer: Aetna Medicare Advantage	$171.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.97
Rate for Payer: Cigna Commercial	$286.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.84
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.87
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$18.09
Rate for Payer: Wellpoint Medicaid Managed Care	$16.26

RADIATION TX PLANNING

Facility

$385.85

Service Code	HCPCS 77261
Hospital Charge Code	85000370
Hospital Revenue Code	333
Min. Negotiated Rate	$57.88
Max. Negotiated Rate	$57.88
Rate for Payer: Qualcare PPO/HMO/WC	$57.88

RADIATION TX PLANNING

Facility

$385.85

Service Code	HCPCS 77261
Hospital Charge Code	85000370
Hospital Revenue Code	333
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$146.62
Rate for Payer: Aetna Medicare Advantage	$115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.39
Rate for Payer: Cigna Commercial	$192.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.32
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.88
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$12.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10.96

RADICAL JAW 3 240CM FORCEP

Facility

$46.25

Hospital Charge Code	270653869
Hospital Revenue Code	272
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$23.12
Rate for Payer: Aetna Commercial	$17.57
Rate for Payer: Aetna Medicare Advantage	$13.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.79
Rate for Payer: Cigna Commercial	$23.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.03
Rate for Payer: Oxford Commercial	$9.25
Rate for Payer: Qualcare PPO/HMO/WC	$6.94
Rate for Payer: UnitedHealthcare Commercial	$9.25
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

RADICAL JAW 3 240CM FORCEP

Facility

$46.25

Hospital Charge Code	270653869
Hospital Revenue Code	272
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$6.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.94

RADICAL RESECTION OF ELBOW

Facility

$31,743.36

Service Code	HCPCS 24149
Hospital Charge Code	16000821
Hospital Revenue Code	360
Min. Negotiated Rate	$4,761.50
Max. Negotiated Rate	$4,761.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,761.50

RADICAL RESECTION OF ELBOW

Facility

$31,743.36

Service Code	HCPCS 24149
Hospital Charge Code	16000821
Hospital Revenue Code	360
Min. Negotiated Rate	$901.51
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,253.27
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,761.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,003.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$901.51

RADIESSE IMPLNT 1.0CC INJ

Facility

$390.00

Hospital Charge Code	270339131
Hospital Revenue Code	278
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$94.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RADIESSE IMPLNT 1.0CC INJ

Facility

$390.00

Hospital Charge Code	270339131
Hospital Revenue Code	278
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

RADIOFREQUENCY ABLATION, NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED TOMOGRAPHY)

Facility

$8,415.40

Service Code	CPT 64625
Hospital Revenue Code	360
Min. Negotiated Rate	$2,203.90
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89

Know your out-of-pocket cost for care.

All Charges