Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	2691465
Hospital Revenue Code	361
Min. Negotiated Rate	$5,056.05
Max. Negotiated Rate	$5,056.05
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05

TIB/PR ATHRCTMY ADD EA-RT

Facility

$33,707.00

Service Code	HCPCS 37233RT
Hospital Charge Code	2691465
Hospital Revenue Code	361
Min. Negotiated Rate	$957.28
Max. Negotiated Rate	$16,853.50
Rate for Payer: Aetna Commercial	$12,808.66
Rate for Payer: Aetna Medicare Advantage	$10,112.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,595.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,595.28
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	$8,595.28
Rate for Payer: Cigna Commercial	$16,853.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,763.82
Rate for Payer: Qualcare PPO/HMO/WC	$5,056.05
Rate for Payer: UnitedHealthcare Community & State	$1,065.14
Rate for Payer: Wellpoint Medicaid Managed Care	$957.28

TIB PSN POR PEG SZ D

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270693242
Hospital Revenue Code	278
Min. Negotiated Rate	$392.77
Max. Negotiated Rate	$6,915.00
Rate for Payer: Aetna Commercial	$5,255.40
Rate for Payer: Aetna Medicare Advantage	$4,149.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,526.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,526.65
Rate for Payer: Cigna Commercial	$6,915.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50
Rate for Payer: UnitedHealthcare Community & State	$437.03
Rate for Payer: Wellpoint Medicaid Managed Care	$392.77

TIB PSN POR PEG SZ D

Facility

$13,830.00

Service Code	HCPCS C1776
Hospital Charge Code	270693242
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.50
Max. Negotiated Rate	$3,346.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,766.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,346.86
Rate for Payer: Qualcare PPO/HMO/WC	$2,074.50

TIB REVASC STENT ATHER-BI

Facility

$93,917.89

Service Code	HCPCS 3723150
Hospital Charge Code	7411810
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-BI

Facility

$93,917.89

Service Code	HCPCS 3723150
Hospital Charge Code	7411810
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	321037231L
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	366837231L
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	7411940
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	2691440
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	2691440
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	321037231L
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	366837231L
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-LT

Facility

$93,917.89

Service Code	HCPCS 37231LT
Hospital Charge Code	7411940
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	366837231R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	366837231R
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	2691445
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37292RT
Hospital Charge Code	411037231
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	2691445
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37292RT
Hospital Charge Code	411037231
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	321037231R
Hospital Revenue Code	361
Min. Negotiated Rate	$14,087.68
Max. Negotiated Rate	$14,087.68
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68

TIB REVASC STENT ATHER-RT

Facility

$93,917.89

Service Code	HCPCS 37231RT
Hospital Charge Code	321037231R
Hospital Revenue Code	361
Min. Negotiated Rate	$2,667.27
Max. Negotiated Rate	$46,958.94
Rate for Payer: Aetna Commercial	$35,688.80
Rate for Payer: Aetna Medicare Advantage	$28,175.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,949.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,949.06
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	$23,949.06
Rate for Payer: Cigna Commercial	$46,958.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24,418.65
Rate for Payer: Qualcare PPO/HMO/WC	$14,087.68
Rate for Payer: UnitedHealthcare Community & State	$2,967.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2,667.27

TIB&SCRW AUG BLK11MM LLAT/RMED

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270680668
Hospital Revenue Code	278
Min. Negotiated Rate	$109.62
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$121.98
Rate for Payer: Wellpoint Medicaid Managed Care	$109.62

TIB&SCRW AUG BLK11MM LLAT/RMED

Facility

$3,860.00

Service Code	HCPCS C1713
Hospital Charge Code	270680668
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

TIB&SCRW AUG BLK11MM RLAT/LMED

Facility

$3,861.00

Service Code	HCPCS C1713
Hospital Charge Code	270680669
Hospital Revenue Code	278
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,467.18
Rate for Payer: Aetna Medicare Advantage	$1,158.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.55
Rate for Payer: Cigna Commercial	$1,930.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.36
Rate for Payer: Qualcare PPO/HMO/WC	$579.15
Rate for Payer: UnitedHealthcare Community & State	$122.01
Rate for Payer: Wellpoint Medicaid Managed Care	$109.65

Know your out-of-pocket cost for care.

All Charges