Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CFH WC IUD INSERTION

Facility

$376.00

Service Code	HCPCS 58300
Hospital Charge Code	83652163
Hospital Revenue Code	761
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$188.00
Rate for Payer: Aetna Commercial	$142.88
Rate for Payer: Aetna Medicare Advantage	$112.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.88
Rate for Payer: Cigna Commercial	$188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.76
Rate for Payer: Oxford Commercial	$75.20
Rate for Payer: Qualcare PPO/HMO/WC	$56.40
Rate for Payer: UnitedHealthcare Commercial	$75.20
Rate for Payer: UnitedHealthcare Community & State	$11.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

CFH WC IUD REMOVAL

Facility

$669.00

Service Code	HCPCS 58301
Hospital Charge Code	83652165
Hospital Revenue Code	761
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$1,313.26
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.26
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.94
Rate for Payer: Oxford Commercial	$133.80
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$133.80
Rate for Payer: UnitedHealthcare Community & State	$21.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$19.00

CFH WC IUD REMOVAL

Facility

$669.00

Service Code	HCPCS 58301
Hospital Charge Code	83652165
Hospital Revenue Code	761
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

CFH WC LAPAROSCOPY, DX ONLY

Professional

Both

$692.00

Service Code	HCPCS 49320
Hospital Charge Code	83652109
Hospital Revenue Code	960
Min. Negotiated Rate	$35.18
Max. Negotiated Rate	$35.18
Rate for Payer: Aetna Commercial	$35.18
Rate for Payer: Aetna Medicare Advantage	$35.18

CFH WC NP OV E&M COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	83652401
Hospital Revenue Code	514
Min. Negotiated Rate	$28.49
Max. Negotiated Rate	$501.50
Rate for Payer: Aetna Commercial	$381.14
Rate for Payer: Aetna Medicare Advantage	$300.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.76
Rate for Payer: Cigna Commercial	$501.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.78
Rate for Payer: Qualcare PPO/HMO/WC	$150.45
Rate for Payer: UnitedHealthcare Community & State	$31.69
Rate for Payer: Wellpoint Medicaid Managed Care	$28.49

CFH WC NP OV E&M COMPLEX

Facility

$1,003.00

Service Code	HCPCS 99205
Hospital Charge Code	83652401
Hospital Revenue Code	514
Min. Negotiated Rate	$150.45
Max. Negotiated Rate	$150.45
Rate for Payer: Qualcare PPO/HMO/WC	$150.45

CFH WC NP OV E&M COMPREHENSIVE

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	83652399
Hospital Revenue Code	514
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.73
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$33.76
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

CFH WC NP OV E&M COMPREHENSIVE

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	83652399
Hospital Revenue Code	514
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

CFH WC PAP SMEAR

Facility

$390.00

Service Code	HCPCS Q0091
Hospital Charge Code	83652537
Hospital Revenue Code	923
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CFH WC PAP SMEAR

Facility

$390.00

Service Code	HCPCS Q0091
Hospital Charge Code	83652537
Hospital Revenue Code	923
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CFH WC PPD

Facility

$390.00

Service Code	HCPCS 86580
Hospital Charge Code	83652285
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CFH WC PPD

Facility

$390.00

Service Code	HCPCS 86580
Hospital Charge Code	83652285
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CFH WC PRIV PT POST PARTUM

Facility

$139.00

Service Code	HCPCS 59430
Hospital Charge Code	83652229
Hospital Revenue Code	514
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$20.85
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

CFH WC PRIV PT POST PARTUM

Facility

$139.00

Service Code	HCPCS 59430
Hospital Charge Code	83652229
Hospital Revenue Code	514
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$105.60
Rate for Payer: Aetna Commercial	$52.82
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.14
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

CFH WC RUBELLA VAC

Facility

$98.00

Hospital Charge Code	83652325
Hospital Revenue Code	636
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

CFH WC RUBELLA VAC

Facility

$98.00

Hospital Charge Code	83652325
Hospital Revenue Code	636
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$23.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.72
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

CFH WC SIMPLE CLOSURE

Facility

$1,519.00

Service Code	HCPCS 12020
Hospital Charge Code	83652069
Hospital Revenue Code	761
Min. Negotiated Rate	$43.14
Max. Negotiated Rate	$3,185.09
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,185.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$394.94
Rate for Payer: Oxford Commercial	$303.80
Rate for Payer: Qualcare PPO/HMO/WC	$227.85
Rate for Payer: UnitedHealthcare Commercial	$303.80
Rate for Payer: UnitedHealthcare Community & State	$48.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$43.14

CFH WC SIMPLE CLOSURE

Facility

$1,519.00

Service Code	HCPCS 12020
Hospital Charge Code	83652069
Hospital Revenue Code	761
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$227.85
Rate for Payer: Qualcare PPO/HMO/WC	$227.85

CFH WC SUP-CERV ABD HYSTERTMY

Professional

Both

$9,489.90

Service Code	HCPCS 58180
Hospital Charge Code	83652161
Hospital Revenue Code	960
Min. Negotiated Rate	$268.83
Max. Negotiated Rate	$268.83
Rate for Payer: Aetna Commercial	$268.83
Rate for Payer: Aetna Medicare Advantage	$268.83

CFH WC TUBAL LIAGATION W C/S

Professional

Both

$17,601.15

Service Code	HCPCS 58611
Hospital Charge Code	83652177
Hospital Revenue Code	960
Min. Negotiated Rate	$79.15
Max. Negotiated Rate	$168.40
Rate for Payer: Aetna Medicare Advantage	$168.40
Rate for Payer: Cigna Commercial	$168.40
Rate for Payer: Cigna Medicare Advantage	$168.40
Rate for Payer: Wellpoint Medicaid Managed Care	$79.15

CFH WC UA DIPSTICK/TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	83652273
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CFH WC UA DIPSTICK/TAB

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	83652273
Hospital Revenue Code	307
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CFH WC URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	83652275
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

CFH WC URINE PREGNANCY TEST

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	83652275
Hospital Revenue Code	307
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.23
Rate for Payer: Cigna Commercial	$207.20
Rate for Payer: Cigna Medicare Advantage	$8.61
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Medicare Advantage	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.77

CFH WC V BAC ONLY

Professional

Both

$2,395.00

Service Code	HCPCS 59612
Hospital Charge Code	83652239
Hospital Revenue Code	960
Min. Negotiated Rate	$357.95
Max. Negotiated Rate	$2,721.55
Rate for Payer: Aetna Medicare Advantage	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,721.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,721.55
Rate for Payer: UnitedHealthcare Commercial	$357.95
Rate for Payer: UnitedHealthcare Community & State	$357.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$357.95

Know your out-of-pocket cost for care.

All Charges