Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

XR CHEST SPECIAL VIEW

Facility

$268.00

Service Code	HCPCS 71035
Hospital Charge Code	2002319
Hospital Revenue Code	324
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$101.84
Rate for Payer: Aetna Medicare Advantage	$80.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.34
Rate for Payer: Cigna Commercial	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.68
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.20
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$8.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,236.59
Rate for Payer: Wellpoint Medicaid Managed Care	$7.61

XR CHEST W/APICAL

Facility

$498.00

Service Code	HCPCS 71021
Hospital Charge Code	2002301
Hospital Revenue Code	324
Min. Negotiated Rate	$74.70
Max. Negotiated Rate	$74.70
Rate for Payer: Qualcare PPO/HMO/WC	$74.70

XR CHEST W/APICAL

Facility

$498.00

Service Code	HCPCS 71021
Hospital Charge Code	2002301
Hospital Revenue Code	324
Min. Negotiated Rate	$14.14
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$189.24
Rate for Payer: Aetna Medicare Advantage	$149.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$126.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$126.99
Rate for Payer: Cigna Commercial	$249.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.48
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.70
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$15.74
Rate for Payer: Wellpoint Medicaid Managed Care	$14.14

XR CHEST W/ OBLIQUE

Facility

$506.00

Service Code	HCPCS 71022
Hospital Charge Code	2002293
Hospital Revenue Code	324
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$192.28
Rate for Payer: Aetna Medicare Advantage	$151.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.03
Rate for Payer: Cigna Commercial	$253.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.56
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.90
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$15.99
Rate for Payer: Wellpoint Medicaid Managed Care	$14.37

XR CHEST W/ OBLIQUE

Facility

$506.00

Service Code	HCPCS 71022
Hospital Charge Code	2002293
Hospital Revenue Code	324
Min. Negotiated Rate	$75.90
Max. Negotiated Rate	$75.90
Rate for Payer: Qualcare PPO/HMO/WC	$75.90

XR CHOLANGIOGRAM OPERATIVE

Facility

$5,100.00

Service Code	HCPCS 74300
Hospital Charge Code	2001444
Hospital Revenue Code	320
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR CHOLANGIOGRAM OPERATIVE

Facility

$5,100.00

Service Code	HCPCS 74300
Hospital Charge Code	2001444
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR CLAVICLE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	2011326
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

XR CLAVICLE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7300050
Hospital Charge Code	2011326
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR CLAVICLE LT COMPL

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	2000016
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR CLAVICLE LT COMPL

Facility

$6,601.19

Service Code	HCPCS 73000LT
Hospital Charge Code	2000016
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

XR COCCYX

Facility

$747.00

Service Code	HCPCS 72220
Hospital Charge Code	2000727
Hospital Revenue Code	320
Min. Negotiated Rate	$21.21
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$281.22
Rate for Payer: Aetna Medicare Advantage	$334.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$103.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.05
Rate for Payer: Cigna Commercial	$207.24
Rate for Payer: Cigna Medicare Advantage	$72.37
Rate for Payer: Clover Medicare Advantage	$98.22
Rate for Payer: EmblemHealth Commercial	$310.17
Rate for Payer: Humana Medicare Advantage	$106.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$103.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.22
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.05
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$23.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$247.19
Rate for Payer: Wellpoint Medicaid Managed Care	$21.21

XR COCCYX

Facility

$747.00

Service Code	HCPCS 72220
Hospital Charge Code	2000727
Hospital Revenue Code	320
Min. Negotiated Rate	$112.05
Max. Negotiated Rate	$112.05
Rate for Payer: Qualcare PPO/HMO/WC	$112.05

XR COMPLETE CLAVICLE RT

Facility

$6,601.19

Service Code	HCPCS 73000RT
Hospital Charge Code	2000017
Hospital Revenue Code	320
Min. Negotiated Rate	$187.47
Max. Negotiated Rate	$3,300.59
Rate for Payer: Aetna Commercial	$2,508.45
Rate for Payer: Aetna Medicare Advantage	$1,980.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.30
Rate for Payer: Cigna Commercial	$3,300.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

XR COMPLETE CLAVICLE RT

Facility

$6,601.19

Service Code	HCPCS 73000RT
Hospital Charge Code	2000017
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR COMPLEX DYN PHARYN VIDEO EV

Facility

$919.00

Service Code	HCPCS 70371
Hospital Charge Code	2002764
Hospital Revenue Code	320
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.94
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$137.85
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$29.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$26.10

XR COMPLEX DYN PHARYN VIDEO EV

Facility

$919.00

Service Code	HCPCS 70371
Hospital Charge Code	2002764
Hospital Revenue Code	320
Min. Negotiated Rate	$137.85
Max. Negotiated Rate	$137.85
Rate for Payer: Qualcare PPO/HMO/WC	$137.85

XR COMPUTER MAMMO ADD ON DIAG

Facility

$424.00

Service Code	HCPCS 77051
Hospital Charge Code	2002586
Hospital Revenue Code	401
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$1,884.00
Rate for Payer: Aetna Commercial	$161.12
Rate for Payer: Aetna Medicare Advantage	$127.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.12
Rate for Payer: Cigna Commercial	$212.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.24
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.60
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$13.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.04

XR COMPUTER MAMMO ADD ON DIAG

Facility

$424.00

Service Code	HCPCS 77051
Hospital Charge Code	2002586
Hospital Revenue Code	401
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$63.60
Rate for Payer: Qualcare PPO/HMO/WC	$63.60

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,097.60

Service Code	HCPCS 77052
Hospital Charge Code	2002587
Hospital Revenue Code	403
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$164.64
Rate for Payer: Qualcare PPO/HMO/WC	$164.64

XR COMPUTER MAMMO ADD ON SCRN

Facility

$1,097.60

Service Code	HCPCS 77052
Hospital Charge Code	2002587
Hospital Revenue Code	403
Min. Negotiated Rate	$31.17
Max. Negotiated Rate	$1,884.00
Rate for Payer: Aetna Commercial	$417.09
Rate for Payer: Aetna Medicare Advantage	$329.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.89
Rate for Payer: Cigna Commercial	$548.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.38
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.64
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$34.68
Rate for Payer: Wellpoint Medicaid Managed Care	$31.17

XR CYSTOGRAM MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 74430
Hospital Charge Code	2001485
Hospital Revenue Code	320
Min. Negotiated Rate	$34.65
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR CYSTOGRAM MIN 3 VWS

Facility

$5,100.00

Service Code	HCPCS 74430
Hospital Charge Code	2001485
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR DECLOT VASCULAR DEVICE

Facility

$15,468.50

Service Code	HCPCS 36593
Hospital Charge Code	321036593
Hospital Revenue Code	361
Min. Negotiated Rate	$2,320.28
Max. Negotiated Rate	$2,320.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,320.28

XR DECLOT VASCULAR DEVICE

Facility

$1,487.70

Service Code	HCPCS 36593
Hospital Charge Code	366836593
Hospital Revenue Code	361
Min. Negotiated Rate	$223.16
Max. Negotiated Rate	$223.16
Rate for Payer: Qualcare PPO/HMO/WC	$223.16

Know your out-of-pocket cost for care.

All Charges