Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

US XTR NON-VASC LMTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	321076882
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US XTR NON-VASC LMTD

Facility

$6,700.00

Service Code	HCPCS 76882
Hospital Charge Code	2600210
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

US XTR NON-VASC LMTD

Facility

$534.78

Service Code	HCPCS 76882
Hospital Charge Code	7411751
Hospital Revenue Code	402
Min. Negotiated Rate	$80.22
Max. Negotiated Rate	$80.22
Rate for Payer: Qualcare PPO/HMO/WC	$80.22

UTAH PRENDEVILLE LOOPS

Facility

$200.00

Hospital Charge Code	270332567
Hospital Revenue Code	272
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.00
Rate for Payer: Oxford Commercial	$40.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Commercial	$40.00
Rate for Payer: UnitedHealthcare Community & State	$6.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

UTAH PRENDEVILLE LOOPS

Facility

$200.00

Hospital Charge Code	270332567
Hospital Revenue Code	272
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$12,594.52

Service Code	APR-DRG 5191
Min. Negotiated Rate	$12,347.57
Max. Negotiated Rate	$12,594.52
Rate for Payer: UnitedHealthcare Community & State	$12,347.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,594.52
Rate for Payer: Wellpoint Medicaid Managed Care	$12,347.57

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$16,101.25

Service Code	APR-DRG 5192
Min. Negotiated Rate	$15,785.54
Max. Negotiated Rate	$16,101.25
Rate for Payer: UnitedHealthcare Community & State	$15,785.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,101.25
Rate for Payer: Wellpoint Medicaid Managed Care	$15,785.54

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$25,697.37

Service Code	APR-DRG 5193
Min. Negotiated Rate	$25,193.50
Max. Negotiated Rate	$25,697.37
Rate for Payer: UnitedHealthcare Community & State	$25,193.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,697.37
Rate for Payer: Wellpoint Medicaid Managed Care	$25,193.50

UTERINE AND ADNEXA PROCEDURES FOR LEIOMYOMA

Facility

$51,842.71

Service Code	APR-DRG 5194
Min. Negotiated Rate	$50,826.19
Max. Negotiated Rate	$51,842.71
Rate for Payer: UnitedHealthcare Community & State	$50,826.19
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,842.71
Rate for Payer: Wellpoint Medicaid Managed Care	$50,826.19

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$16,016.95

Service Code	APR-DRG 5132
Min. Negotiated Rate	$15,702.89
Max. Negotiated Rate	$16,016.95
Rate for Payer: UnitedHealthcare Community & State	$15,702.89
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,016.95
Rate for Payer: Wellpoint Medicaid Managed Care	$15,702.89

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$43,436.09

Service Code	APR-DRG 5134
Min. Negotiated Rate	$42,584.40
Max. Negotiated Rate	$43,436.09
Rate for Payer: UnitedHealthcare Community & State	$42,584.40
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$43,436.09
Rate for Payer: Wellpoint Medicaid Managed Care	$42,584.40

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$13,306.53

Service Code	APR-DRG 5131
Min. Negotiated Rate	$13,045.62
Max. Negotiated Rate	$13,306.53
Rate for Payer: UnitedHealthcare Community & State	$13,045.62
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,306.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13,045.62

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA

Facility

$25,163.70

Service Code	APR-DRG 5133
Min. Negotiated Rate	$24,670.29
Max. Negotiated Rate	$25,163.70
Rate for Payer: UnitedHealthcare Community & State	$24,670.29
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,163.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24,670.29

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$77,432.57

Service Code	MSDRG 742
Min. Negotiated Rate	$23,577.22
Max. Negotiated Rate	$77,432.57
Rate for Payer: Aetna Commercial	$57,006.86
Rate for Payer: Aetna Medicare Advantage	$77,432.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,314.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,314.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,818.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,314.90
Rate for Payer: Cigna Commercial	$40,903.20
Rate for Payer: Cigna Medicare Advantage	$24,818.13
Rate for Payer: Clover Medicare Advantage	$23,577.22
Rate for Payer: EmblemHealth Commercial	$74,454.39
Rate for Payer: Humana Medicare Advantage	$25,562.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,818.13
Rate for Payer: Oxford Commercial	$32,329.18
Rate for Payer: UnitedHealthcare Commercial	$43,273.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,818.13
Rate for Payer: Wellcare Medicare Advantage	$24,818.13

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$58,662.77

Service Code	MSDRG 743
Min. Negotiated Rate	$17,862.06
Max. Negotiated Rate	$58,662.77
Rate for Payer: Aetna Commercial	$43,638.81
Rate for Payer: Aetna Medicare Advantage	$58,662.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32,137.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32,137.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,802.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32,137.80
Rate for Payer: Cigna Commercial	$27,658.93
Rate for Payer: Cigna Medicare Advantage	$18,802.17
Rate for Payer: Clover Medicare Advantage	$17,862.06
Rate for Payer: EmblemHealth Commercial	$56,406.51
Rate for Payer: Humana Medicare Advantage	$19,366.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,802.17
Rate for Payer: Oxford Commercial	$21,861.13
Rate for Payer: UnitedHealthcare Commercial	$29,261.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,802.17
Rate for Payer: Wellcare Medicare Advantage	$18,802.17

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$31,188.52

Service Code	APR-DRG 5123
Min. Negotiated Rate	$30,576.98
Max. Negotiated Rate	$31,188.52
Rate for Payer: UnitedHealthcare Community & State	$30,576.98
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$31,188.52
Rate for Payer: Wellpoint Medicaid Managed Care	$30,576.98

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$17,342.71

Service Code	APR-DRG 5121
Min. Negotiated Rate	$17,002.66
Max. Negotiated Rate	$17,342.71
Rate for Payer: UnitedHealthcare Community & State	$17,002.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,342.71
Rate for Payer: Wellpoint Medicaid Managed Care	$17,002.66

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$20,084.07

Service Code	APR-DRG 5122
Min. Negotiated Rate	$19,690.26
Max. Negotiated Rate	$20,084.07
Rate for Payer: UnitedHealthcare Community & State	$19,690.26
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,084.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19,690.26

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY

Facility

$58,777.56

Service Code	APR-DRG 5124
Min. Negotiated Rate	$57,625.06
Max. Negotiated Rate	$58,777.56
Rate for Payer: UnitedHealthcare Community & State	$57,625.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$58,777.56
Rate for Payer: Wellpoint Medicaid Managed Care	$57,625.06

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$76,636.34

Service Code	MSDRG 740
Min. Negotiated Rate	$23,334.78
Max. Negotiated Rate	$76,636.34
Rate for Payer: Aetna Commercial	$56,439.78
Rate for Payer: Aetna Medicare Advantage	$76,636.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24,562.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,591.95
Rate for Payer: Cigna Commercial	$40,341.41
Rate for Payer: Cigna Medicare Advantage	$24,562.93
Rate for Payer: Clover Medicare Advantage	$23,334.78
Rate for Payer: EmblemHealth Commercial	$73,688.79
Rate for Payer: Humana Medicare Advantage	$25,299.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24,562.93
Rate for Payer: Oxford Commercial	$31,885.15
Rate for Payer: UnitedHealthcare Commercial	$42,679.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$24,562.93
Rate for Payer: Wellcare Medicare Advantage	$24,562.93

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$132,658.06

Service Code	MSDRG 739
Min. Negotiated Rate	$40,392.68
Max. Negotiated Rate	$132,658.06
Rate for Payer: Aetna Commercial	$96,339.12
Rate for Payer: Aetna Medicare Advantage	$132,658.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100,292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100,292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42,518.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100,292.10
Rate for Payer: Cigna Commercial	$78,611.81
Rate for Payer: Cigna Medicare Advantage	$42,518.61
Rate for Payer: Clover Medicare Advantage	$40,392.68
Rate for Payer: EmblemHealth Commercial	$127,555.83
Rate for Payer: Humana Medicare Advantage	$43,794.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42,518.61
Rate for Payer: Oxford Commercial	$62,133.41
Rate for Payer: UnitedHealthcare Commercial	$83,167.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$42,518.61
Rate for Payer: Wellcare Medicare Advantage	$42,518.61

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$64,520.20

Service Code	MSDRG 741
Min. Negotiated Rate	$19,645.57
Max. Negotiated Rate	$64,520.20
Rate for Payer: Aetna Commercial	$47,810.55
Rate for Payer: Aetna Medicare Advantage	$64,520.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,679.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,016.50
Rate for Payer: Cigna Commercial	$31,792.05
Rate for Payer: Cigna Medicare Advantage	$20,679.55
Rate for Payer: Clover Medicare Advantage	$19,645.57
Rate for Payer: EmblemHealth Commercial	$62,038.65
Rate for Payer: Humana Medicare Advantage	$21,299.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,679.55
Rate for Payer: Oxford Commercial	$25,127.88
Rate for Payer: UnitedHealthcare Commercial	$33,634.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,679.55
Rate for Payer: Wellcare Medicare Advantage	$20,679.55

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$22,684.99

Service Code	APR-DRG 5112
Min. Negotiated Rate	$22,240.19
Max. Negotiated Rate	$22,684.99
Rate for Payer: UnitedHealthcare Community & State	$22,240.19
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,684.99
Rate for Payer: Wellpoint Medicaid Managed Care	$22,240.19

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$63,503.33

Service Code	APR-DRG 5114
Min. Negotiated Rate	$62,258.17
Max. Negotiated Rate	$63,503.33
Rate for Payer: UnitedHealthcare Community & State	$62,258.17
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$63,503.33
Rate for Payer: Wellpoint Medicaid Managed Care	$62,258.17

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY

Facility

$18,742.87

Service Code	APR-DRG 5111
Min. Negotiated Rate	$18,375.36
Max. Negotiated Rate	$18,742.87
Rate for Payer: UnitedHealthcare Community & State	$18,375.36
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,742.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18,375.36

Know your out-of-pocket cost for care.

All Charges