Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CT GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	7411757
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	7411757
Hospital Revenue Code	350
Min. Negotiated Rate	$138.62
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$1,854.75
Rate for Payer: Aetna Medicare Advantage	$1,464.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.63
Rate for Payer: Cigna Commercial	$2,440.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.04
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.14
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$154.24
Rate for Payer: Wellpoint Medicaid Managed Care	$138.62

CT GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	321077012
Hospital Revenue Code	350
Min. Negotiated Rate	$138.62
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$1,854.75
Rate for Payer: Aetna Medicare Advantage	$1,464.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,244.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,244.63
Rate for Payer: Cigna Commercial	$2,440.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.04
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$732.14
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$154.24
Rate for Payer: Wellpoint Medicaid Managed Care	$138.62

CT GUIDED NEEDLE INSERTION

Facility

$4,880.92

Service Code	HCPCS 77012
Hospital Charge Code	321077012
Hospital Revenue Code	350
Min. Negotiated Rate	$732.14
Max. Negotiated Rate	$732.14
Rate for Payer: Qualcare PPO/HMO/WC	$732.14

CT GUI MONITOR TIS ABLATION

Facility

$1,605.00

Service Code	HCPCS 77013
Hospital Charge Code	2200240
Hospital Revenue Code	350
Min. Negotiated Rate	$240.75
Max. Negotiated Rate	$240.75
Rate for Payer: Qualcare PPO/HMO/WC	$240.75

CT GUI MONITOR TIS ABLATION

Facility

$1,605.00

Service Code	HCPCS 77013
Hospital Charge Code	2200240
Hospital Revenue Code	350
Min. Negotiated Rate	$45.58
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$609.90
Rate for Payer: Aetna Medicare Advantage	$481.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$409.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$409.27
Rate for Payer: Cigna Commercial	$802.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$417.30
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$240.75
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$50.72
Rate for Payer: Wellpoint Medicaid Managed Care	$45.58

CT HAND W/ CONTRAST BILATERAL

Facility

$1,833.00

Service Code	HCPCS 7320150
Hospital Charge Code	2205371
Hospital Revenue Code	352
Min. Negotiated Rate	$274.95
Max. Negotiated Rate	$274.95
Rate for Payer: Qualcare PPO/HMO/WC	$274.95

CT HAND W/ CONTRAST BILATERAL

Facility

$1,833.00

Service Code	HCPCS 7320150
Hospital Charge Code	2205371
Hospital Revenue Code	352
Min. Negotiated Rate	$52.06
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$696.54
Rate for Payer: Aetna Medicare Advantage	$549.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$467.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$467.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$467.42
Rate for Payer: Cigna Commercial	$916.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.58
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$274.95
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$57.92
Rate for Payer: Wellpoint Medicaid Managed Care	$52.06

CT HIP W/ CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370150
Hospital Charge Code	2205380
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT HIP W/ CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370150
Hospital Charge Code	2205380
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT HIP W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205495
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT HIP W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205495
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT HIP W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205384
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT HIP W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205384
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT KNEE W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 73700
Hospital Charge Code	2205401
Hospital Revenue Code	352
Min. Negotiated Rate	$86.94
Max. Negotiated Rate	$3,916.00
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	$206.25
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	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT KNEE W/O CONTRAST BILATERAL

Facility

$9,500.00

Service Code	HCPCS 73700
Hospital Charge Code	2205401
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT KNEE W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205402
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT KNEE W/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2205402
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT KNEE W/O CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2205403
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT KNEE W/O CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2205403
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT LOWER EXT W/ CONTRAST BILAT

Facility

$9,500.00

Service Code	HCPCS 7370150
Hospital Charge Code	2205404
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT LOWER EXT W/ CONTRAST BILAT

Facility

$9,500.00

Service Code	HCPCS 7370150
Hospital Charge Code	2205404
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT W/ CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73701LT
Hospital Charge Code	2205302
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT LOWER EXT W/ CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73701LT
Hospital Charge Code	2205302
Hospital Revenue Code	352
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT W/ CONTRAST RIGHT

Facility

$9,500.00

Service Code	HCPCS 73701RT
Hospital Charge Code	2205304
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

Know your out-of-pocket cost for care.

All Charges