Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CADMIUM

Facility

$157.60

Hospital Charge Code	39990166B
Hospital Revenue Code	301
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$23.64
Rate for Payer: Qualcare PPO/HMO/WC	$23.64

CADMIUM

Facility

$157.60

Hospital Charge Code	39990166B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$59.89
Rate for Payer: Aetna Medicare Advantage	$47.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.19
Rate for Payer: Cigna Commercial	$78.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.64
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.48

CAD-SCREENING MAMMOGRAPHY

Facility

$1,097.60

Service Code	HCPCS 77052
Hospital Charge Code	2008050
Hospital Revenue Code	403
Min. Negotiated Rate	$164.64
Max. Negotiated Rate	$164.64
Rate for Payer: Qualcare PPO/HMO/WC	$164.64

CAD-SCREENING MAMMOGRAPHY

Facility

$1,097.60

Service Code	HCPCS 77052
Hospital Charge Code	2008050
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

CAFFEINE

Facility

$272.00

Service Code	HCPCS 80299
Hospital Charge Code	38472922
Hospital Revenue Code	301
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$136.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.72

CAFFEINE

Facility

$272.00

Service Code	HCPCS 80299
Hospital Charge Code	38472922
Hospital Revenue Code	301
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$40.80

CAFFEINE CITRATE 20MG/ML INJ

Facility

$93.80

Service Code	HCPCS J0706
Hospital Charge Code	6063943068
Hospital Revenue Code	636
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$46.90
Rate for Payer: Aetna Commercial	$35.64
Rate for Payer: Aetna Medicare Advantage	$28.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.92
Rate for Payer: Cigna Commercial	$46.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.07
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

CAFFEINE CITRATE 20MG/ML INJ

Facility

$93.80

Service Code	HCPCS J0706
Hospital Charge Code	6063943068
Hospital Revenue Code	636
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$22.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.07

CAGE 10MM X-WIDE

Facility

$16,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270688899
Hospital Revenue Code	278
Min. Negotiated Rate	$458.66
Max. Negotiated Rate	$8,075.00
Rate for Payer: Aetna Commercial	$6,137.00
Rate for Payer: Aetna Medicare Advantage	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,118.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,118.25
Rate for Payer: Cigna Commercial	$8,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50
Rate for Payer: UnitedHealthcare Community & State	$510.34
Rate for Payer: Wellpoint Medicaid Managed Care	$458.66

CAGE 10MM X-WIDE

Facility

$16,150.00

Service Code	HCPCS C1713
Hospital Charge Code	270688899
Hospital Revenue Code	278
Min. Negotiated Rate	$2,422.50
Max. Negotiated Rate	$3,908.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,908.30
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.50

CAGE 10X24X8MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705766
Hospital Revenue Code	278
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$4,840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

CAGE 10X24X8MM

Facility

$20,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705766
Hospital Revenue Code	278
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,000.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,840.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

CAGE 10 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667337
Hospital Revenue Code	278
Min. Negotiated Rate	$757.14
Max. Negotiated Rate	$13,330.00
Rate for Payer: Aetna Commercial	$10,130.80
Rate for Payer: Aetna Medicare Advantage	$7,998.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,798.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,798.30
Rate for Payer: Cigna Commercial	$13,330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00
Rate for Payer: UnitedHealthcare Community & State	$842.46
Rate for Payer: Wellpoint Medicaid Managed Care	$757.14

CAGE 10 X 9 X 23MM

Facility

$26,660.00

Hospital Charge Code	270667337
Hospital Revenue Code	278
Min. Negotiated Rate	$3,999.00
Max. Negotiated Rate	$6,451.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,332.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,451.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,999.00

CAGE 13MM 15DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705050
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 13MM 15DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705050
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

CAGE 14X12X7MM 10DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705355
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAGE 14X12X7MM 10DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705355
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

CAGE 14X12X9MM 6DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705356
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAGE 14X12X9MM 6DEG

Facility

$4,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270705356
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

CAGE 15MM 8DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705049
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

CAGE 15MM 8DEG

Facility

$25,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270705049
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

CAGE 16X14MM 7DEG 7H

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704846
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

CAGE 16X14MM 7DEG 7H

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704846
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

CAGE 16X14MM 7DEG 8H

Facility

$6,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704843
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

Know your out-of-pocket cost for care.

All Charges