Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

T3 (TRIIODOTHYRONINE)

Facility

$295.00

Service Code	HCPCS 84480
Hospital Charge Code	38472623
Hospital Revenue Code	301
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$44.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38479029
Hospital Revenue Code	301
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38472626
Hospital Revenue Code	301
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38479029
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.47
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.29

T3 UPTAKE

Facility

$292.00

Service Code	HCPCS 84479
Hospital Charge Code	38472626
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.47
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$8.29

T3 UPTAKE (THBR)

Facility

$667.59

Service Code	HCPCS 84479
Hospital Charge Code	3002516
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.47
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

T3 UPTAKE (THBR)

Facility

$667.59

Service Code	HCPCS 84479
Hospital Charge Code	3002516
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

T4 FREE

Facility

$634.20

Service Code	HCPCS 84439
Hospital Charge Code	38472632
Hospital Revenue Code	301
Min. Negotiated Rate	$95.13
Max. Negotiated Rate	$95.13
Rate for Payer: Qualcare PPO/HMO/WC	$95.13

T4 FREE

Facility

$634.20

Service Code	HCPCS 84439
Hospital Charge Code	38472632
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$317.10
Rate for Payer: Aetna Commercial	$24.53
Rate for Payer: Aetna Medicare Advantage	$29.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.72
Rate for Payer: Cigna Commercial	$317.10
Rate for Payer: Cigna Medicare Advantage	$9.02
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.89
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$95.13
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Medicare Advantage	$9.02
Rate for Payer: Wellpoint Medicaid Managed Care	$18.01

T4 FREE (THYROXINE)

Facility

$775.43

Service Code	HCPCS 84439
Hospital Charge Code	3001328
Hospital Revenue Code	301
Min. Negotiated Rate	$116.31
Max. Negotiated Rate	$116.31
Rate for Payer: Qualcare PPO/HMO/WC	$116.31

T4 FREE (THYROXINE)

Facility

$775.43

Service Code	HCPCS 84439
Hospital Charge Code	3001328
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$387.71
Rate for Payer: Aetna Commercial	$24.53
Rate for Payer: Aetna Medicare Advantage	$29.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.72
Rate for Payer: Cigna Commercial	$387.71
Rate for Payer: Cigna Medicare Advantage	$9.02
Rate for Payer: Clover Medicare Advantage	$8.57
Rate for Payer: EmblemHealth Commercial	$27.06
Rate for Payer: Humana Medicare Advantage	$9.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.61
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.31
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.02
Rate for Payer: Wellcare Medicare Advantage	$9.02
Rate for Payer: Wellpoint Medicaid Managed Care	$22.02

T4 HOODS

Facility

$98.03

Hospital Charge Code	270654872
Hospital Revenue Code	270
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$49.02
Rate for Payer: Aetna Commercial	$37.25
Rate for Payer: Aetna Medicare Advantage	$29.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.00
Rate for Payer: Cigna Commercial	$49.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.49
Rate for Payer: Oxford Commercial	$19.61
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.61
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

T4 HOODS

Facility

$98.03

Hospital Charge Code	270654872
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

T4 (THYROXINE)

Facility

$394.80

Service Code	HCPCS 84436
Hospital Charge Code	38472629
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$197.40
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.92
Rate for Payer: Cigna Commercial	$197.40
Rate for Payer: Cigna Medicare Advantage	$6.87
Rate for Payer: Clover Medicare Advantage	$6.53
Rate for Payer: EmblemHealth Commercial	$20.61
Rate for Payer: Humana Medicare Advantage	$7.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.65
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.22
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.87
Rate for Payer: Wellcare Medicare Advantage	$6.87
Rate for Payer: Wellpoint Medicaid Managed Care	$11.21

T4 (THYROXINE)

Facility

$394.80

Service Code	HCPCS 84436
Hospital Charge Code	38472629
Hospital Revenue Code	301
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$59.22
Rate for Payer: Qualcare PPO/HMO/WC	$59.22

T4 TOTAL

Facility

$675.81

Service Code	HCPCS 84436
Hospital Charge Code	3002524A
Hospital Revenue Code	301
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$337.90
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$22.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.92
Rate for Payer: Cigna Commercial	$337.90
Rate for Payer: Cigna Medicare Advantage	$6.87
Rate for Payer: Clover Medicare Advantage	$6.53
Rate for Payer: EmblemHealth Commercial	$20.61
Rate for Payer: Humana Medicare Advantage	$7.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.37
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.87
Rate for Payer: Wellcare Medicare Advantage	$6.87
Rate for Payer: Wellpoint Medicaid Managed Care	$19.19

T4 TOTAL

Facility

$675.81

Service Code	HCPCS 84436
Hospital Charge Code	3002524A
Hospital Revenue Code	301
Min. Negotiated Rate	$101.37
Max. Negotiated Rate	$101.37
Rate for Payer: Qualcare PPO/HMO/WC	$101.37

TA 11 30-3.5 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334704
Hospital Revenue Code	272
Min. Negotiated Rate	$11.62
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.34
Rate for Payer: Oxford Commercial	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$81.80
Rate for Payer: UnitedHealthcare Community & State	$12.92
Rate for Payer: Wellpoint Medicaid Managed Care	$11.62

TA 11 30-3.5 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334704
Hospital Revenue Code	272
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

TA 11 30-4.8 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334705
Hospital Revenue Code	272
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Qualcare PPO/HMO/WC	$61.35

TA 11 30-4.8 LOADING UNIT

Facility

$409.00

Hospital Charge Code	270334705
Hospital Revenue Code	272
Min. Negotiated Rate	$11.62
Max. Negotiated Rate	$204.50
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: Aetna Medicare Advantage	$122.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$104.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$104.30
Rate for Payer: Cigna Commercial	$204.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.34
Rate for Payer: Oxford Commercial	$81.80
Rate for Payer: Qualcare PPO/HMO/WC	$61.35
Rate for Payer: UnitedHealthcare Commercial	$81.80
Rate for Payer: UnitedHealthcare Community & State	$12.92
Rate for Payer: Wellpoint Medicaid Managed Care	$11.62

TA 11 55-3.5 LOADING UNIT

Facility

$366.00

Hospital Charge Code	270334710
Hospital Revenue Code	272
Min. Negotiated Rate	$54.90
Max. Negotiated Rate	$54.90
Rate for Payer: Qualcare PPO/HMO/WC	$54.90

TA 11 55-3.5 LOADING UNIT

Facility

$366.00

Hospital Charge Code	270334710
Hospital Revenue Code	272
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$139.08
Rate for Payer: Aetna Medicare Advantage	$109.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.33
Rate for Payer: Cigna Commercial	$183.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.16
Rate for Payer: Oxford Commercial	$73.20
Rate for Payer: Qualcare PPO/HMO/WC	$54.90
Rate for Payer: UnitedHealthcare Commercial	$73.20
Rate for Payer: UnitedHealthcare Community & State	$11.57
Rate for Payer: Wellpoint Medicaid Managed Care	$10.39

T & A,AGE 12 OR MORE

Facility

$22,732.05

Service Code	HCPCS 42821
Hospital Charge Code	1600000630
Hospital Revenue Code	360
Min. Negotiated Rate	$645.59
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	$5,910.33
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,409.81
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$718.33
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	$645.59

T & A,AGE 12 OR MORE

Facility

$22,732.05

Service Code	HCPCS 42821
Hospital Charge Code	1600000630
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.81
Max. Negotiated Rate	$3,409.81
Rate for Payer: Qualcare PPO/HMO/WC	$3,409.81

Know your out-of-pocket cost for care.

All Charges