Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CONTRAST VISIPAQUE 320mg 50cc

Facility

$124.56

Hospital Charge Code	270642102
Hospital Revenue Code	272
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$62.28
Rate for Payer: Aetna Commercial	$47.33
Rate for Payer: Aetna Medicare Advantage	$37.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.76
Rate for Payer: Cigna Commercial	$62.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.39
Rate for Payer: Oxford Commercial	$24.91
Rate for Payer: Qualcare PPO/HMO/WC	$18.68
Rate for Payer: UnitedHealthcare Commercial	$24.91
Rate for Payer: UnitedHealthcare Community & State	$3.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

CONTRAST VISIPAQUE 320mg 50cc

Facility

$124.56

Hospital Charge Code	270642102
Hospital Revenue Code	272
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$18.68
Rate for Payer: Qualcare PPO/HMO/WC	$18.68

CONTROLLER DETACHMENT V-GRIP

Facility

$925.00

Hospital Charge Code	270700465S
Hospital Revenue Code	272
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CONTROLLER DETACHMENT V-GRIP

Facility

$925.00

Hospital Charge Code	270700465S
Hospital Revenue Code	272
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.50
Rate for Payer: Oxford Commercial	$185.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$185.00
Rate for Payer: UnitedHealthcare Community & State	$29.23
Rate for Payer: Wellpoint Medicaid Managed Care	$26.27

CONTROLLER EMBOLIZATION DETACH

Facility

$925.00

Hospital Charge Code	270696909S
Hospital Revenue Code	272
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.50
Rate for Payer: Oxford Commercial	$185.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Commercial	$185.00
Rate for Payer: UnitedHealthcare Community & State	$29.23
Rate for Payer: Wellpoint Medicaid Managed Care	$26.27

CONTROLLER EMBOLIZATION DETACH

Facility

$925.00

Hospital Charge Code	270696909S
Hospital Revenue Code	272
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$138.75
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

CONTROLLER PT PROCLAIM

Facility

$8,125.00

Hospital Charge Code	270677806
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

CONTROLLER PT PROCLAIM

Facility

$8,125.00

Hospital Charge Code	270677806
Hospital Revenue Code	278
Min. Negotiated Rate	$230.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$256.75
Rate for Payer: Wellpoint Medicaid Managed Care	$230.75

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040N
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040
Hospital Revenue Code	272
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040
Hospital Revenue Code	272
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

CONTROLLER SURESCAN

Facility

$4,500.00

Hospital Charge Code	270682040N
Hospital Revenue Code	272
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$900.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

CONTROL NASAL HEMMRGE ANT-SIMP

Facility

$696.50

Service Code	HCPCS 30901
Hospital Charge Code	87502570
Hospital Revenue Code	761
Min. Negotiated Rate	$104.47
Max. Negotiated Rate	$104.47
Rate for Payer: Qualcare PPO/HMO/WC	$104.47

CONTROL NASAL HEMMRGE ANT-SIMP

Facility

$696.50

Service Code	HCPCS 30901
Hospital Charge Code	87502570
Hospital Revenue Code	761
Min. Negotiated Rate	$19.78
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.09
Rate for Payer: Oxford Commercial	$139.30
Rate for Payer: Qualcare PPO/HMO/WC	$104.47
Rate for Payer: UnitedHealthcare Commercial	$139.30
Rate for Payer: UnitedHealthcare Community & State	$22.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$19.78

CONTROL NASAL HEMRRHAGE ANT-SI

Facility

$463.00

Service Code	HCPCS 30901
Hospital Charge Code	83652099
Hospital Revenue Code	761
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$573.36
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.38
Rate for Payer: Oxford Commercial	$92.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
Rate for Payer: UnitedHealthcare Commercial	$92.60
Rate for Payer: UnitedHealthcare Community & State	$14.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$13.15

CONTROL NASAL HEMRRHAGE ANT-SI

Facility

$463.00

Service Code	HCPCS 30901
Hospital Charge Code	83652099
Hospital Revenue Code	761
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

CONTROL OROPHARYNGEAL HEMORRHC

Facility

$2,070.48

Service Code	HCPCS 42960
Hospital Charge Code	16000287
Hospital Revenue Code	360
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,742.81
Rate for Payer: Aetna Medicare Advantage	$2,076.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,324.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,324.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$640.74
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	$2,324.28
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: Cigna Medicare Advantage	$640.74
Rate for Payer: Clover Medicare Advantage	$608.70
Rate for Payer: EmblemHealth Commercial	$1,922.22
Rate for Payer: Humana Medicare Advantage	$659.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$640.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.32
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.57
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$65.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$58.80

CONTROL OROPHARYNGEAL HEMORRHC

Facility

$2,070.48

Service Code	HCPCS 42960
Hospital Charge Code	16000287
Hospital Revenue Code	360
Min. Negotiated Rate	$310.57
Max. Negotiated Rate	$310.57
Rate for Payer: Qualcare PPO/HMO/WC	$310.57

CONTROL SYRINGE 5CC W/STOP

Facility

$54.00

Hospital Charge Code	270332030
Hospital Revenue Code	272
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$20.52
Rate for Payer: Aetna Medicare Advantage	$16.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.77
Rate for Payer: Cigna Commercial	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.04
Rate for Payer: Oxford Commercial	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.10
Rate for Payer: UnitedHealthcare Commercial	$10.80
Rate for Payer: UnitedHealthcare Community & State	$1.71
Rate for Payer: Wellpoint Medicaid Managed Care	$1.53

CONTROL SYRINGE 5CC W/STOP

Facility

$54.00

Hospital Charge Code	270332030
Hospital Revenue Code	272
Min. Negotiated Rate	$8.10
Max. Negotiated Rate	$8.10
Rate for Payer: Qualcare PPO/HMO/WC	$8.10

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$7,683.40

Service Code	APR-DRG 3841
Min. Negotiated Rate	$7,532.75
Max. Negotiated Rate	$7,683.40
Rate for Payer: UnitedHealthcare Community & State	$7,532.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,683.40
Rate for Payer: Wellpoint Medicaid Managed Care	$7,532.75

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$9,552.59

Service Code	APR-DRG 3842
Min. Negotiated Rate	$9,365.28
Max. Negotiated Rate	$9,552.59
Rate for Payer: UnitedHealthcare Community & State	$9,365.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,552.59
Rate for Payer: Wellpoint Medicaid Managed Care	$9,365.28

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$14,048.03

Service Code	APR-DRG 3843
Min. Negotiated Rate	$13,772.58
Max. Negotiated Rate	$14,048.03
Rate for Payer: UnitedHealthcare Community & State	$13,772.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,048.03
Rate for Payer: Wellpoint Medicaid Managed Care	$13,772.58

CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE

Facility

$23,332.37

Service Code	APR-DRG 3844
Min. Negotiated Rate	$22,874.87
Max. Negotiated Rate	$23,332.37
Rate for Payer: UnitedHealthcare Community & State	$22,874.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,332.37
Rate for Payer: Wellpoint Medicaid Managed Care	$22,874.87

CONVALESCENT PLASMA [EUA]

Facility

$0.01

Service Code	HCPCS P9017
Hospital Charge Code	4025P9017
Hospital Revenue Code	390
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$271.95
Rate for Payer: Aetna Medicare Advantage	$323.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$99.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.68
Rate for Payer: Cigna Commercial	$200.40
Rate for Payer: Cigna Medicare Advantage	$99.98
Rate for Payer: Clover Medicare Advantage	$94.98
Rate for Payer: EmblemHealth Commercial	$299.94
Rate for Payer: Humana Medicare Advantage	$102.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$99.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$1,028.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$99.98
Rate for Payer: Wellcare Medicare Advantage	$99.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Know your out-of-pocket cost for care.

All Charges