Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BRACHYTX ISODOSE INTERMED

Facility

$1,867.31

Service Code	HCPCS 77317
Hospital Charge Code	85000894
Hospital Revenue Code	333
Min. Negotiated Rate	$280.10
Max. Negotiated Rate	$280.10
Rate for Payer: Qualcare PPO/HMO/WC	$280.10

BRACHYTX ISODOSE INTERMED

Facility

$1,867.31

Service Code	HCPCS 77317
Hospital Charge Code	85000894
Hospital Revenue Code	333
Min. Negotiated Rate	$53.03
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,613.62
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.50
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$280.10
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$59.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$53.03

BRACHYTX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77316
Hospital Charge Code	85000893
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

BRACHYTX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77316
Hospital Charge Code	85000893
Hospital Revenue Code	333
Min. Negotiated Rate	$19.08
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,613.62
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.67
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$21.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$19.08

BRACHYTX, NON-STR,YTTRIUM-90

Facility

$82,538.65

Service Code	HCPCS C2616
Hospital Charge Code	5701123
Hospital Revenue Code	278
Min. Negotiated Rate	$12,380.80
Max. Negotiated Rate	$19,974.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,507.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,974.35
Rate for Payer: Qualcare PPO/HMO/WC	$12,380.80

BRACHYTX, NON-STR,YTTRIUM-90

Facility

$82,538.65

Service Code	HCPCS C2616
Hospital Charge Code	5701123
Hospital Revenue Code	278
Min. Negotiated Rate	$2,344.10
Max. Negotiated Rate	$74,961.71
Rate for Payer: Aetna Commercial	$56,208.36
Rate for Payer: Aetna Medicare Advantage	$66,954.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74,961.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74,961.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,664.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16,507.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74,961.71
Rate for Payer: Cigna Commercial	$41,422.60
Rate for Payer: Cigna Medicare Advantage	$20,664.84
Rate for Payer: Clover Medicare Advantage	$19,631.60
Rate for Payer: EmblemHealth Commercial	$61,994.52
Rate for Payer: Humana Medicare Advantage	$21,284.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,664.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19,974.35
Rate for Payer: Qualcare PPO/HMO/WC	$12,380.80
Rate for Payer: UnitedHealthcare Community & State	$2,608.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,664.84
Rate for Payer: Wellcare Medicare Advantage	$20,664.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2,344.10

BRACKET HOLDER 4P HALF MOON

Facility

$81.40

Hospital Charge Code	270678364
Hospital Revenue Code	272
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$12.21
Rate for Payer: Qualcare PPO/HMO/WC	$12.21

BRACKET HOLDER 4P HALF MOON

Facility

$81.40

Hospital Charge Code	270678364
Hospital Revenue Code	272
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$40.70
Rate for Payer: Aetna Commercial	$30.93
Rate for Payer: Aetna Medicare Advantage	$24.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.76
Rate for Payer: Cigna Commercial	$40.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.16
Rate for Payer: Oxford Commercial	$16.28
Rate for Payer: Qualcare PPO/HMO/WC	$12.21
Rate for Payer: UnitedHealthcare Commercial	$16.28
Rate for Payer: UnitedHealthcare Community & State	$2.57
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

BRACKET UNIVRL KEYHOLE 9.25 14

Facility

$270.00

Hospital Charge Code	270665198
Hospital Revenue Code	270
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

BRACKET UNIVRL KEYHOLE 9.25 14

Facility

$270.00

Hospital Charge Code	270665198
Hospital Revenue Code	270
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.67

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$10,899.38

Service Code	APR-DRG 0562
Min. Negotiated Rate	$10,685.67
Max. Negotiated Rate	$10,899.38
Rate for Payer: UnitedHealthcare Community & State	$10,685.67
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,899.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10,685.67

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$16,500.10

Service Code	APR-DRG 0563
Min. Negotiated Rate	$16,176.57
Max. Negotiated Rate	$16,500.10
Rate for Payer: UnitedHealthcare Community & State	$16,176.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,500.10
Rate for Payer: Wellpoint Medicaid Managed Care	$16,176.57

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$8,159.49

Service Code	APR-DRG 0561
Min. Negotiated Rate	$7,999.50
Max. Negotiated Rate	$8,159.49
Rate for Payer: UnitedHealthcare Community & State	$7,999.50
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,159.49
Rate for Payer: Wellpoint Medicaid Managed Care	$7,999.50

BRAIN CONTUSION OR LACERATION AND COMPLICATED SKULL FRACTURE, COMA < 1 HOUR OR NO COMA

Facility

$26,370.07

Service Code	APR-DRG 0564
Min. Negotiated Rate	$25,853.01
Max. Negotiated Rate	$26,370.07
Rate for Payer: UnitedHealthcare Community & State	$25,853.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,370.07
Rate for Payer: Wellpoint Medicaid Managed Care	$25,853.01

BRA SURGICAL EXTRA EXTRA LARGE

Facility

$132.50

Hospital Charge Code	270665572
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$19.88
Rate for Payer: Qualcare PPO/HMO/WC	$19.88

BRA SURGICAL EXTRA EXTRA LARGE

Facility

$132.50

Hospital Charge Code	270665572
Hospital Revenue Code	272
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$66.25
Rate for Payer: Aetna Commercial	$50.35
Rate for Payer: Aetna Medicare Advantage	$39.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.79
Rate for Payer: Cigna Commercial	$66.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.45
Rate for Payer: Oxford Commercial	$26.50
Rate for Payer: Qualcare PPO/HMO/WC	$19.88
Rate for Payer: UnitedHealthcare Commercial	$26.50
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.76

BRA SURGICAL MED

Facility

$133.33

Hospital Charge Code	270665569
Hospital Revenue Code	270
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.00

BRA SURGICAL MED

Facility

$133.33

Hospital Charge Code	270665569
Hospital Revenue Code	270
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$66.67
Rate for Payer: Aetna Commercial	$50.67
Rate for Payer: Aetna Medicare Advantage	$40.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.00
Rate for Payer: Cigna Commercial	$66.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.67
Rate for Payer: Oxford Commercial	$26.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.00
Rate for Payer: UnitedHealthcare Commercial	$26.67
Rate for Payer: UnitedHealthcare Community & State	$4.21
Rate for Payer: Wellpoint Medicaid Managed Care	$3.79

BRA SURGICAL SUPPORT SURGI 3XL

Facility

$208.70

Hospital Charge Code	270676375
Hospital Revenue Code	272
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

BRA SURGICAL SUPPORT SURGI 3XL

Facility

$208.70

Hospital Charge Code	270676375
Hospital Revenue Code	272
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$79.31
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.26
Rate for Payer: Oxford Commercial	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$41.74
Rate for Payer: UnitedHealthcare Community & State	$6.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.93

BRA SURGICAL SUPPORT SURGI 4XL

Facility

$208.70

Hospital Charge Code	270676376
Hospital Revenue Code	272
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$79.31
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.26
Rate for Payer: Oxford Commercial	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$41.74
Rate for Payer: UnitedHealthcare Community & State	$6.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.93

BRA SURGICAL SUPPORT SURGI 4XL

Facility

$208.70

Hospital Charge Code	270676376
Hospital Revenue Code	272
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

BRA SURGICAL SUPPORT SURGI MED

Facility

$209.10

Hospital Charge Code	270650798
Hospital Revenue Code	272
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$31.36
Rate for Payer: Qualcare PPO/HMO/WC	$31.36

BRA SURGICAL SUPPORT SURGI MED

Facility

$209.10

Hospital Charge Code	270650798
Hospital Revenue Code	272
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$104.55
Rate for Payer: Aetna Commercial	$79.46
Rate for Payer: Aetna Medicare Advantage	$62.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.32
Rate for Payer: Cigna Commercial	$104.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.37
Rate for Payer: Oxford Commercial	$41.82
Rate for Payer: Qualcare PPO/HMO/WC	$31.36
Rate for Payer: UnitedHealthcare Commercial	$41.82
Rate for Payer: UnitedHealthcare Community & State	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

BRA SURGICAL SUPPORT SURGI SM.

Facility

$209.10

Hospital Charge Code	270655494
Hospital Revenue Code	272
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$31.36
Rate for Payer: Qualcare PPO/HMO/WC	$31.36

Know your out-of-pocket cost for care.

All Charges