Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

XR SACRUM & COCCYX MIN 2 VWS

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	2000693
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SACRUM & COCCYX MIN 2 VWS

Facility

$5,100.00

Service Code	HCPCS 72220
Hospital Charge Code	2000693
Hospital Revenue Code	320
Min. Negotiated Rate	$27.23
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	$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	$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	$144.84

XR SALIVARY GLAND FOR CALCULUS

Facility

$267.00

Service Code	HCPCS 70380
Hospital Charge Code	2004638
Hospital Revenue Code	320
Min. Negotiated Rate	$7.58
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	$24.75
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	$69.42
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.05
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$8.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7.58

XR SALIVARY GLAND FOR CALCULUS

Facility

$267.00

Service Code	HCPCS 70380
Hospital Charge Code	2004638
Hospital Revenue Code	320
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

XR SCANOGRAM BONE LENGTH STUDY

Facility

$1,219.00

Service Code	HCPCS 77073
Hospital Charge Code	2002079
Hospital Revenue Code	320
Min. Negotiated Rate	$182.85
Max. Negotiated Rate	$182.85
Rate for Payer: Qualcare PPO/HMO/WC	$182.85

XR SCANOGRAM BONE LENGTH STUDY

Facility

$1,219.00

Service Code	HCPCS 77073
Hospital Charge Code	2002079
Hospital Revenue Code	320
Min. Negotiated Rate	$21.38
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	$21.38
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	$316.94
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$182.85
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$38.52
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	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$34.62

XR SCAPULA BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7301050
Hospital Charge Code	2011381
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SCAPULA BILATERAL

Facility

$5,100.00

Service Code	HCPCS 7301050
Hospital Charge Code	2011381
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 SCAPULA LT

Facility

$5,100.00

Service Code	HCPCS 73010LT
Hospital Charge Code	2002244
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 SCAPULA LT

Facility

$5,100.00

Service Code	HCPCS 73010LT
Hospital Charge Code	2002244
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SCAPULA RT COMPL

Facility

$5,100.00

Service Code	HCPCS 73010RT
Hospital Charge Code	2002245
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 SCAPULA RT COMPL

Facility

$5,100.00

Service Code	HCPCS 73010RT
Hospital Charge Code	2002245
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	321037186
Hospital Revenue Code	361
Min. Negotiated Rate	$344.46
Max. Negotiated Rate	$6,064.50
Rate for Payer: Aetna Commercial	$4,609.02
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$6,064.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.54
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$383.28
Rate for Payer: Wellpoint Medicaid Managed Care	$344.46

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	411037186
Hospital Revenue Code	361
Min. Negotiated Rate	$519.94
Max. Negotiated Rate	$9,153.90
Rate for Payer: Aetna Commercial	$6,956.96
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$9,153.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,760.03
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$578.53
Rate for Payer: Wellpoint Medicaid Managed Care	$519.94

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	366837186
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	321037186
Hospital Revenue Code	361
Min. Negotiated Rate	$1,819.35
Max. Negotiated Rate	$1,819.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	5600142
Hospital Revenue Code	361
Min. Negotiated Rate	$1,819.35
Max. Negotiated Rate	$1,819.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35

XR SEC ART M-THROMBECT ADD ON

Facility

$12,129.00

Service Code	HCPCS 37186
Hospital Charge Code	5600142
Hospital Revenue Code	361
Min. Negotiated Rate	$344.46
Max. Negotiated Rate	$6,064.50
Rate for Payer: Aetna Commercial	$4,609.02
Rate for Payer: Aetna Medicare Advantage	$3,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,092.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,092.89
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	$3,092.89
Rate for Payer: Cigna Commercial	$6,064.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,153.54
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,819.35
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$383.28
Rate for Payer: Wellpoint Medicaid Managed Care	$344.46

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	411037186
Hospital Revenue Code	361
Min. Negotiated Rate	$2,746.17
Max. Negotiated Rate	$2,746.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17

XR SEC ART M-THROMBECT ADD ON

Facility

$18,307.80

Service Code	HCPCS 37186
Hospital Charge Code	366837186
Hospital Revenue Code	361
Min. Negotiated Rate	$519.94
Max. Negotiated Rate	$9,153.90
Rate for Payer: Aetna Commercial	$6,956.96
Rate for Payer: Aetna Medicare Advantage	$5,492.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,668.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,668.49
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	$4,668.49
Rate for Payer: Cigna Commercial	$9,153.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,760.03
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,746.17
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$578.53
Rate for Payer: Wellpoint Medicaid Managed Care	$519.94

XR SELLA TURCICA

Facility

$432.00

Service Code	HCPCS 70240
Hospital Charge Code	2000461
Hospital Revenue Code	320
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$64.80
Rate for Payer: Qualcare PPO/HMO/WC	$64.80

XR SELLA TURCICA

Facility

$432.00

Service Code	HCPCS 70240
Hospital Charge Code	2000461
Hospital Revenue Code	320
Min. Negotiated Rate	$12.27
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	$112.32
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.80
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$13.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.39
Rate for Payer: Wellcare Medicare Advantage	$103.39
Rate for Payer: Wellpoint Medicaid Managed Care	$12.27

XR SHOULDER 1 VIEW BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7302050
Hospital Charge Code	2011382
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 SHOULDER 1 VIEW BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7302050
Hospital Charge Code	2011382
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

XR SHOULDER COMPLETE BILATERAL

Facility

$6,601.19

Service Code	HCPCS 7303050
Hospital Charge Code	2011383
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

Know your out-of-pocket cost for care.

All Charges