Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TX INTR/PR/S FEM FX IMED IMPLT

Facility

$19,503.55

Service Code	HCPCS 27245
Hospital Charge Code	160000197
Hospital Revenue Code	360
Min. Negotiated Rate	$2,925.53
Max. Negotiated Rate	$2,925.53
Rate for Payer: Qualcare PPO/HMO/WC	$2,925.53

TXMENT OF ANKLE FRACTURE LT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	1600000875
Hospital Revenue Code	360
Min. Negotiated Rate	$1,391.38
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	$12,737.95
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,548.15
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	$1,391.38

TXMENT OF ANKLE FRACTURE LT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	1600000875
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

TXMENT OF ANKLE FRACTURE-RT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	16000317
Hospital Revenue Code	360
Min. Negotiated Rate	$1,391.38
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	$12,737.95
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,548.15
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	$1,391.38

TXMENT OF ANKLE FRACTURE-RT

Facility

$48,992.10

Service Code	HCPCS 27822
Hospital Charge Code	16000317
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

TX SPONTAN HIP DISLOC W ANESTH

Facility

$6,353.84

Service Code	HCPCS 27257
Hospital Charge Code	16000873
Hospital Revenue Code	360
Min. Negotiated Rate	$180.45
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
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	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,652.00
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$953.08
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$200.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$180.45

TX SPONTAN HIP DISLOC W ANESTH

Facility

$6,353.84

Service Code	HCPCS 27257
Hospital Charge Code	16000873
Hospital Revenue Code	360
Min. Negotiated Rate	$953.08
Max. Negotiated Rate	$953.08
Rate for Payer: Qualcare PPO/HMO/WC	$953.08

TX S WND DEHISC; SMPL

Facility

$4,862.70

Service Code	HCPCS 12020
Hospital Charge Code	1600000502
Hospital Revenue Code	360
Min. Negotiated Rate	$138.10
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
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	$3,185.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.30
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$729.40
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$153.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$138.10

TX S WND DEHISC; SMPL

Facility

$4,862.70

Service Code	HCPCS 12020
Hospital Charge Code	1600000502
Hospital Revenue Code	360
Min. Negotiated Rate	$729.40
Max. Negotiated Rate	$729.40
Rate for Payer: Qualcare PPO/HMO/WC	$729.40

Tylenol no 2

Facility

$1.76

Hospital Charge Code	6063943297
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.26

Tylenol no 2

Facility

$1.76

Hospital Charge Code	6063943297
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.88
Rate for Payer: Aetna Commercial	$0.67
Rate for Payer: Aetna Medicare Advantage	$0.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.45
Rate for Payer: Cigna Commercial	$0.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.46
Rate for Payer: Oxford Commercial	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.26
Rate for Payer: UnitedHealthcare Commercial	$0.35
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

TYLENOL NO 4

Facility

$7.44

Service Code	NDC 68084037301
Hospital Charge Code	6063943299
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

TYLENOL NO 4

Facility

$7.44

Service Code	NDC 68084037301
Hospital Charge Code	6063943299
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.72
Rate for Payer: Aetna Commercial	$2.83
Rate for Payer: Aetna Medicare Advantage	$2.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.90
Rate for Payer: Cigna Commercial	$3.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.93
Rate for Payer: Oxford Commercial	$1.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.49
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

TYMPANOSTOMY GEN ANESTHESIA

Facility

$25,686.48

Service Code	HCPCS 69436
Hospital Charge Code	16001047
Hospital Revenue Code	360
Min. Negotiated Rate	$3,852.97
Max. Negotiated Rate	$3,852.97
Rate for Payer: Qualcare PPO/HMO/WC	$3,852.97

TYMPANOSTOMY GEN ANESTHESIA

Facility

$25,686.48

Service Code	HCPCS 69436
Hospital Charge Code	16001047
Hospital Revenue Code	360
Min. Negotiated Rate	$729.50
Max. Negotiated Rate	$6,686.64
Rate for Payer: Aetna Commercial	$5,013.83
Rate for Payer: Aetna Medicare Advantage	$5,972.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,686.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,686.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,843.32
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	$6,686.64
Rate for Payer: Cigna Commercial	$3,694.94
Rate for Payer: Cigna Medicare Advantage	$1,843.32
Rate for Payer: Clover Medicare Advantage	$1,751.15
Rate for Payer: EmblemHealth Commercial	$5,529.96
Rate for Payer: Humana Medicare Advantage	$1,898.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,843.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,678.48
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,852.97
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$811.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,843.32
Rate for Payer: Wellcare Medicare Advantage	$1,843.32
Rate for Payer: Wellpoint Medicaid Managed Care	$729.50

TYROSINE

Facility

$73.00

Service Code	HCPCS 84510
Hospital Charge Code	38477072
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.91
Rate for Payer: Aetna Medicare Advantage	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.56
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: Cigna Medicare Advantage	$10.63
Rate for Payer: Clover Medicare Advantage	$10.10
Rate for Payer: EmblemHealth Commercial	$31.89
Rate for Payer: Humana Medicare Advantage	$10.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.63
Rate for Payer: Wellcare Medicare Advantage	$10.63
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

TYROSINE

Facility

$73.00

Service Code	HCPCS 84510
Hospital Charge Code	38477072
Hospital Revenue Code	301
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

UA DIPSTICK W/O/MICRO

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502760
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

UA DIPSTICK W/O/MICRO

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	87502760
Hospital Revenue Code	307
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

UBLITUXIMAB-XIIYBRIUMVI25MG/ML

Facility

$4.00

Service Code	HCPCS J2329
Hospital Charge Code	606390554
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$249.39
Rate for Payer: Aetna Commercial	$187.00
Rate for Payer: Aetna Medicare Advantage	$222.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$68.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.39
Rate for Payer: Cigna Medicare Advantage	$68.75
Rate for Payer: Clover Medicare Advantage	$65.31
Rate for Payer: EmblemHealth Commercial	$206.25
Rate for Payer: Humana Medicare Advantage	$70.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$68.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.75
Rate for Payer: Wellcare Medicare Advantage	$68.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

UBLITUXIMAB-XIIYBRIUMVI25MG/ML

Facility

$4.00

Service Code	HCPCS J2329
Hospital Charge Code	606390554
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

UC HIP INSTRUMENT TRAY

Facility

$2,475.00

Hospital Charge Code	270679416
Hospital Revenue Code	272
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$940.50
Rate for Payer: Aetna Medicare Advantage	$742.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$631.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$631.12
Rate for Payer: Cigna Commercial	$1,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$643.50
Rate for Payer: Oxford Commercial	$495.00
Rate for Payer: Qualcare PPO/HMO/WC	$371.25
Rate for Payer: UnitedHealthcare Commercial	$495.00
Rate for Payer: UnitedHealthcare Community & State	$78.21
Rate for Payer: Wellpoint Medicaid Managed Care	$70.29

UC HIP INSTRUMENT TRAY

Facility

$2,475.00

Hospital Charge Code	270679416
Hospital Revenue Code	272
Min. Negotiated Rate	$371.25
Max. Negotiated Rate	$371.25
Rate for Payer: Qualcare PPO/HMO/WC	$371.25

UGI

Facility

$1,066.95

Service Code	HCPCS 74240
Hospital Charge Code	94061137
Hospital Revenue Code	320
Min. Negotiated Rate	$30.30
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$79.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.41
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.04
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$33.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$30.30

UGI

Facility

$1,066.95

Service Code	HCPCS 74240
Hospital Charge Code	94061137
Hospital Revenue Code	320
Min. Negotiated Rate	$160.04
Max. Negotiated Rate	$160.04
Rate for Payer: Qualcare PPO/HMO/WC	$160.04

Know your out-of-pocket cost for care.

All Charges