Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

THERA SKIN SMALL 1x2

Facility

$4,730.00

Service Code	HCPCS Q4112
Hospital Charge Code	270647153
Hospital Revenue Code	278
Min. Negotiated Rate	$134.33
Max. Negotiated Rate	$2,365.00
Rate for Payer: Aetna Commercial	$1,797.40
Rate for Payer: Aetna Medicare Advantage	$1,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,206.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,206.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,206.15
Rate for Payer: Cigna Commercial	$2,365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.66
Rate for Payer: Qualcare PPO/HMO/WC	$709.50
Rate for Payer: UnitedHealthcare Community & State	$149.47
Rate for Payer: Wellpoint Medicaid Managed Care	$134.33

THERA SKIN SMALL 1x2

Facility

$4,730.00

Service Code	HCPCS Q4112
Hospital Charge Code	270647153
Hospital Revenue Code	278
Min. Negotiated Rate	$709.50
Max. Negotiated Rate	$1,144.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$946.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.66
Rate for Payer: Qualcare PPO/HMO/WC	$709.50

THERIGRAFT PUTTY 10 CC SYRINGE

Facility

$1,127.00

Hospital Charge Code	270339021
Hospital Revenue Code	278
Min. Negotiated Rate	$169.05
Max. Negotiated Rate	$272.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.73
Rate for Payer: Qualcare PPO/HMO/WC	$169.05

THERIGRAFT PUTTY 10 CC SYRINGE

Facility

$1,127.00

Hospital Charge Code	270339021
Hospital Revenue Code	278
Min. Negotiated Rate	$32.01
Max. Negotiated Rate	$563.50
Rate for Payer: Aetna Commercial	$428.26
Rate for Payer: Aetna Medicare Advantage	$338.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$287.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$287.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$287.38
Rate for Payer: Cigna Commercial	$563.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.73
Rate for Payer: Qualcare PPO/HMO/WC	$169.05
Rate for Payer: UnitedHealthcare Community & State	$35.61
Rate for Payer: Wellpoint Medicaid Managed Care	$32.01

THER INJECTION CARPAL TUNNEL

Facility

$1,449.20

Service Code	HCPCS 20526
Hospital Charge Code	412320526
Hospital Revenue Code	361
Min. Negotiated Rate	$41.16
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$376.79
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$217.38
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$45.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$41.16

THER INJECTION CARPAL TUNNEL

Facility

$1,449.20

Service Code	HCPCS 20526
Hospital Charge Code	412320526
Hospital Revenue Code	361
Min. Negotiated Rate	$217.38
Max. Negotiated Rate	$217.38
Rate for Payer: Qualcare PPO/HMO/WC	$217.38

THER INJECTION CARP TUNNEL

Facility

$1,630.99

Service Code	HCPCS 20526
Hospital Charge Code	321520526
Hospital Revenue Code	361
Min. Negotiated Rate	$244.65
Max. Negotiated Rate	$244.65
Rate for Payer: Qualcare PPO/HMO/WC	$244.65

THER INJECTION CARP TUNNEL

Facility

$1,630.99

Service Code	HCPCS 20526
Hospital Charge Code	321520526
Hospital Revenue Code	361
Min. Negotiated Rate	$46.32
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.06
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.65
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$51.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$46.32

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	409197129
Hospital Revenue Code	430
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GN
Hospital Charge Code	420497129
Hospital Revenue Code	440
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	420397129
Hospital Revenue Code	430
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GP
Hospital Charge Code	40919712P
Hospital Revenue Code	420
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$46.63
Rate for Payer: Aetna Medicare Advantage	$36.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.29
Rate for Payer: Cigna Commercial	$61.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.90
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	409197129
Hospital Revenue Code	430
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$46.63
Rate for Payer: Aetna Medicare Advantage	$36.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.29
Rate for Payer: Cigna Commercial	$61.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.90
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GP
Hospital Charge Code	40919712P
Hospital Revenue Code	420
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$18.41
Rate for Payer: Qualcare PPO/HMO/WC	$18.41

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GO
Hospital Charge Code	420397129
Hospital Revenue Code	430
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$46.63
Rate for Payer: Aetna Medicare Advantage	$36.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.29
Rate for Payer: Cigna Commercial	$61.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.90
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

THER INVNTJ 1ST 15 MIN

Facility

$122.70

Service Code	HCPCS 97129GN
Hospital Charge Code	420497129
Hospital Revenue Code	440
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$46.63
Rate for Payer: Aetna Medicare Advantage	$36.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.29
Rate for Payer: Cigna Commercial	$61.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.90
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.41
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.88
Rate for Payer: Wellpoint Medicaid Managed Care	$3.48

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GP
Hospital Charge Code	40919713P
Hospital Revenue Code	420
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.50
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	409197130
Hospital Revenue Code	430
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	420397130
Hospital Revenue Code	430
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.50
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GN
Hospital Charge Code	420497130
Hospital Revenue Code	440
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.50
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	420397130
Hospital Revenue Code	430
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GO
Hospital Charge Code	409197130
Hospital Revenue Code	430
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna Medicare Advantage	$35.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.91
Rate for Payer: Cigna Commercial	$58.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.50
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.59
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.71
Rate for Payer: Wellpoint Medicaid Managed Care	$3.33

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GN
Hospital Charge Code	420497130
Hospital Revenue Code	440
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THER INVNTJ EA ADDL 15 MIN

Facility

$117.30

Service Code	HCPCS 97130GP
Hospital Charge Code	40919713P
Hospital Revenue Code	420
Min. Negotiated Rate	$17.59
Max. Negotiated Rate	$17.59
Rate for Payer: Qualcare PPO/HMO/WC	$17.59

THERLOCK 10CC

Facility

$2,287.00

Hospital Charge Code	270332655
Hospital Revenue Code	278
Min. Negotiated Rate	$64.95
Max. Negotiated Rate	$1,143.50
Rate for Payer: Aetna Commercial	$869.06
Rate for Payer: Aetna Medicare Advantage	$686.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$583.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$583.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$457.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$583.18
Rate for Payer: Cigna Commercial	$1,143.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$553.45
Rate for Payer: Qualcare PPO/HMO/WC	$343.05
Rate for Payer: UnitedHealthcare Community & State	$72.27
Rate for Payer: Wellpoint Medicaid Managed Care	$64.95

Know your out-of-pocket cost for care.

All Charges