Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

XR HIP LT 2 VIEWS

Facility

$470.00

Hospital Charge Code	2000107
Hospital Revenue Code	320
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$178.60
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.20
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$14.85
Rate for Payer: Wellpoint Medicaid Managed Care	$13.35

XR HIP LT 2 VIEWS

Facility

$470.00

Hospital Charge Code	2000107
Hospital Revenue Code	320
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

XR HIP RT 2 VIEWS

Facility

$470.00

Hospital Charge Code	2000108
Hospital Revenue Code	320
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

XR HIP RT 2 VIEWS

Facility

$470.00

Hospital Charge Code	2000108
Hospital Revenue Code	320
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$178.60
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.20
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$14.85
Rate for Payer: Wellpoint Medicaid Managed Care	$13.35

XR HUMERUS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7306050
Hospital Charge Code	2011348
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR HUMERUS BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7306050
Hospital Charge Code	2011348
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
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) 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 HUMERUS MIN 2 VWS LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2000032
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
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) 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 HUMERUS MIN 2 VWS LT

Facility

$5,100.00

Service Code	HCPCS 73060LT
Hospital Charge Code	2000032
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR HUMERUS MIN 2 VWS RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	2000033
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR HUMERUS MIN 2 VWS RT

Facility

$5,100.00

Service Code	HCPCS 73060RT
Hospital Charge Code	2000033
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
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) 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 HYSTEROSALPINGRAPH

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	2000826
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR HYSTEROSALPINGRAPH

Facility

$5,100.00

Service Code	HCPCS 74740
Hospital Charge Code	2000826
Hospital Revenue Code	320
Min. Negotiated Rate	$46.20
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	$46.20
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	$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	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR IMA GUID PLCMT MET LOC CLIP

Facility

$274.00

Service Code	HCPCS 19282
Hospital Charge Code	2004735
Hospital Revenue Code	361
Min. Negotiated Rate	$41.10
Max. Negotiated Rate	$41.10
Rate for Payer: Qualcare PPO/HMO/WC	$41.10

XR IMA GUID PLCMT MET LOC CLIP

Facility

$274.00

Service Code	HCPCS 19282
Hospital Charge Code	2004735
Hospital Revenue Code	361
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$104.12
Rate for Payer: Aetna Medicare Advantage	$82.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.87
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	$69.87
Rate for Payer: Cigna Commercial	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.24
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$8.66
Rate for Payer: Wellpoint Medicaid Managed Care	$7.78

XR INFANTOGRAM

Facility

$5,100.00

Service Code	HCPCS 77076
Hospital Charge Code	2002152
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR INFANTOGRAM

Facility

$5,100.00

Service Code	HCPCS 77076
Hospital Charge Code	2002152
Hospital Revenue Code	320
Min. Negotiated Rate	$28.68
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
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	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

XR INJ/ASP RENAL CYST/PELVIS P

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2004836
Hospital Revenue Code	361
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.57
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$706.49
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$148.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$133.76

XR INJ/ASP RENAL CYST/PELVIS P

Facility

$4,709.90

Service Code	HCPCS 50390
Hospital Charge Code	2004836
Hospital Revenue Code	361
Min. Negotiated Rate	$706.49
Max. Negotiated Rate	$706.49
Rate for Payer: Qualcare PPO/HMO/WC	$706.49

XR INJECTION FOR URETER X RAY

Facility

$1,766.00

Service Code	HCPCS 50684
Hospital Charge Code	5600173
Hospital Revenue Code	361
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$671.08
Rate for Payer: Aetna Medicare Advantage	$529.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.33
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	$450.33
Rate for Payer: Cigna Commercial	$883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.16
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.90
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$55.81
Rate for Payer: Wellpoint Medicaid Managed Care	$50.15

XR INJECTION FOR URETER X RAY

Facility

$1,766.00

Service Code	HCPCS 50684
Hospital Charge Code	7411615
Hospital Revenue Code	361
Min. Negotiated Rate	$50.15
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$671.08
Rate for Payer: Aetna Medicare Advantage	$529.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.33
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	$450.33
Rate for Payer: Cigna Commercial	$883.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.16
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$264.90
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$55.81
Rate for Payer: Wellpoint Medicaid Managed Care	$50.15

XR INJECTION FOR URETER X RAY

Facility

$1,766.00

Service Code	HCPCS 50684
Hospital Charge Code	7411615
Hospital Revenue Code	361
Min. Negotiated Rate	$264.90
Max. Negotiated Rate	$264.90
Rate for Payer: Qualcare PPO/HMO/WC	$264.90

XR INJECTION FOR URETER X RAY

Facility

$1,766.00

Service Code	HCPCS 50684
Hospital Charge Code	5600173
Hospital Revenue Code	361
Min. Negotiated Rate	$264.90
Max. Negotiated Rate	$264.90
Rate for Payer: Qualcare PPO/HMO/WC	$264.90

XR INJ HYSTEROSALPING

Facility

$746.20

Service Code	HCPCS 58340
Hospital Charge Code	2004448
Hospital Revenue Code	361
Min. Negotiated Rate	$111.93
Max. Negotiated Rate	$111.93
Rate for Payer: Qualcare PPO/HMO/WC	$111.93

XR INJ HYSTEROSALPING

Facility

$746.20

Service Code	HCPCS 58340
Hospital Charge Code	2004448
Hospital Revenue Code	361
Min. Negotiated Rate	$21.19
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$283.56
Rate for Payer: Aetna Medicare Advantage	$223.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.28
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	$190.28
Rate for Payer: Cigna Commercial	$373.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.01
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.93
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$23.58
Rate for Payer: Wellpoint Medicaid Managed Care	$21.19

XR INJ IL COND/URETEROPYLOGRAM

Facility

$414.00

Service Code	HCPCS 50690
Hospital Charge Code	2004349
Hospital Revenue Code	361
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$157.32
Rate for Payer: Aetna Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.57
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	$105.57
Rate for Payer: Cigna Commercial	$207.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.76

Know your out-of-pocket cost for care.

All Charges