Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	85000903
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	9406405
Hospital Revenue Code	403
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	9406405
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	2709037
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	2709037
Hospital Revenue Code	403
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	94061497
Hospital Revenue Code	403
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	85000903
Hospital Revenue Code	403
Min. Negotiated Rate	$108.90
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SCREENING MAMMO BILAT INC CAD

Facility

$4,500.00

Service Code	HCPCS 77067
Hospital Charge Code	94061497
Hospital Revenue Code	403
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	87502810
Hospital Revenue Code	770
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

SCREENING PELVIC EXAM

Facility

$125.00

Service Code	HCPCS G0101
Hospital Charge Code	87502810
Hospital Revenue Code	770
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

SCREENING PELVIC EXAM

Facility

$405.00

Service Code	HCPCS G0101
Hospital Charge Code	87502665
Hospital Revenue Code	770
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

SCREENING PELVIC EXAM

Facility

$405.00

Service Code	HCPCS G0101
Hospital Charge Code	87502665
Hospital Revenue Code	770
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

SCREEN MAMMO,DIRECT DIG IMAGE

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	2007020
Hospital Revenue Code	403
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$91.14
Rate for Payer: Qualcare PPO/HMO/WC	$91.14

SCREEN MAMMO,DIRECT DIG IMAGE

Facility

$607.60

Service Code	HCPCS 77057
Hospital Charge Code	2007020
Hospital Revenue Code	403
Min. Negotiated Rate	$17.26
Max. Negotiated Rate	$1,884.00
Rate for Payer: Aetna Commercial	$230.89
Rate for Payer: Aetna Medicare Advantage	$182.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.94
Rate for Payer: Cigna Commercial	$303.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.98
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.14
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$19.20
Rate for Payer: Wellpoint Medicaid Managed Care	$17.26

SCREW

Facility

$396.00

Hospital Charge Code	270339475
Hospital Revenue Code	278
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$95.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.83
Rate for Payer: Qualcare PPO/HMO/WC	$59.40

SCREW

Facility

$515.00

Service Code	HCPCS C1713
Hospital Charge Code	270660699
Hospital Revenue Code	278
Min. Negotiated Rate	$14.63
Max. Negotiated Rate	$257.50
Rate for Payer: Aetna Commercial	$195.70
Rate for Payer: Aetna Medicare Advantage	$154.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.32
Rate for Payer: Cigna Commercial	$257.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.63
Rate for Payer: Qualcare PPO/HMO/WC	$77.25
Rate for Payer: UnitedHealthcare Community & State	$16.27
Rate for Payer: Wellpoint Medicaid Managed Care	$14.63

SCREW

Facility

$7,678.35

Service Code	HCPCS C1713
Hospital Charge Code	270685047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,151.75
Max. Negotiated Rate	$1,858.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.75

SCREW

Facility

$7,678.35

Service Code	HCPCS C1713
Hospital Charge Code	270685047
Hospital Revenue Code	278
Min. Negotiated Rate	$218.07
Max. Negotiated Rate	$3,839.18
Rate for Payer: Aetna Commercial	$2,917.77
Rate for Payer: Aetna Medicare Advantage	$2,303.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,957.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,957.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,535.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,957.98
Rate for Payer: Cigna Commercial	$3,839.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,858.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,151.75
Rate for Payer: UnitedHealthcare Community & State	$242.64
Rate for Payer: Wellpoint Medicaid Managed Care	$218.07

SCREW

Facility

$450.00

Hospital Charge Code	270703022
Hospital Revenue Code	270
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.00
Rate for Payer: Oxford Commercial	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Commercial	$90.00
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

SCREW

Facility

$655.20

Hospital Charge Code	270339473
Hospital Revenue Code	278
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$158.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.56
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

SCREW

Facility

$396.00

Hospital Charge Code	270339475
Hospital Revenue Code	278
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$198.00
Rate for Payer: Aetna Commercial	$150.48
Rate for Payer: Aetna Medicare Advantage	$118.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.98
Rate for Payer: Cigna Commercial	$198.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.83
Rate for Payer: Qualcare PPO/HMO/WC	$59.40
Rate for Payer: UnitedHealthcare Community & State	$12.51
Rate for Payer: Wellpoint Medicaid Managed Care	$11.25

SCREW

Facility

$450.00

Hospital Charge Code	270703022
Hospital Revenue Code	270
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$67.50
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

SCREW

Facility

$655.20

Hospital Charge Code	270339473
Hospital Revenue Code	278
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$131.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.56
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$20.70
Rate for Payer: Wellpoint Medicaid Managed Care	$18.61

SCREW

Facility

$515.00

Service Code	HCPCS C1713
Hospital Charge Code	270660699
Hospital Revenue Code	278
Min. Negotiated Rate	$77.25
Max. Negotiated Rate	$124.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.63
Rate for Payer: Qualcare PPO/HMO/WC	$77.25

SCREW 10MM X 20 MM BC VENTED

Facility

$1,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270688544
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

Know your out-of-pocket cost for care.

All Charges