Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

CT LOWER EXT W/O CONTRAST BIL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205434
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/O CONTRAST BIL

Facility

$9,500.00

Service Code	HCPCS 7370050
Hospital Charge Code	2205434
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/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2200319
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/O CONTRAST LEFT

Facility

$9,500.00

Service Code	HCPCS 73700LT
Hospital Charge Code	2200319
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/O CONTRAST RGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2200196
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/O CONTRAST RGHT

Facility

$9,500.00

Service Code	HCPCS 73700RT
Hospital Charge Code	2200196
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 WO&W CONTRAST BI

Facility

$9,500.00

Service Code	HCPCS 7370250
Hospital Charge Code	404373702B
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 WO&W CONTRAST BI

Facility

$9,500.00

Service Code	HCPCS 7370250
Hospital Charge Code	404373702B
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 WO&W CONTRAST L

Facility

$9,500.00

Service Code	HCPCS 73702LT
Hospital Charge Code	404373702L
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 WO&W CONTRAST L

Facility

$9,500.00

Service Code	HCPCS 73702LT
Hospital Charge Code	404373702L
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 WO&W CONTRAST R

Facility

$9,500.00

Service Code	HCPCS 73702RT
Hospital Charge Code	404373702R
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 WO&W CONTRAST R

Facility

$9,500.00

Service Code	HCPCS 73702RT
Hospital Charge Code	404373702R
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&W/O CNTRST BLTL

Facility

$1,984.00

Service Code	HCPCS 7370250
Hospital Charge Code	2205405
Hospital Revenue Code	352
Min. Negotiated Rate	$56.35
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$753.92
Rate for Payer: Aetna Medicare Advantage	$595.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$505.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$505.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$505.92
Rate for Payer: Cigna Commercial	$992.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$515.84
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$297.60
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$62.69
Rate for Payer: Wellpoint Medicaid Managed Care	$56.35

CT LOWER EXT W&W/O CNTRST BLTL

Facility

$1,984.00

Service Code	HCPCS 7370250
Hospital Charge Code	2205405
Hospital Revenue Code	352
Min. Negotiated Rate	$297.60
Max. Negotiated Rate	$297.60
Rate for Payer: Qualcare PPO/HMO/WC	$297.60

CT LOWER EXT W&W/O CNTRST RGHT

Facility

$2,084.00

Service Code	HCPCS 73702RT
Hospital Charge Code	2205308
Hospital Revenue Code	352
Min. Negotiated Rate	$59.19
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$791.92
Rate for Payer: Aetna Medicare Advantage	$625.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.42
Rate for Payer: Cigna Commercial	$1,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.84
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.60
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$65.85
Rate for Payer: Wellpoint Medicaid Managed Care	$59.19

CT LOWER EXT W&W/O CNTRST RGHT

Facility

$2,084.00

Service Code	HCPCS 73702RT
Hospital Charge Code	2205308
Hospital Revenue Code	352
Min. Negotiated Rate	$312.60
Max. Negotiated Rate	$312.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.60

CT LOWER EXT W&W/O CONTRST LFT

Facility

$2,084.00

Service Code	HCPCS 73702LT
Hospital Charge Code	2205306
Hospital Revenue Code	352
Min. Negotiated Rate	$59.19
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$791.92
Rate for Payer: Aetna Medicare Advantage	$625.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.42
Rate for Payer: Cigna Commercial	$1,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$541.84
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$312.60
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$65.85
Rate for Payer: Wellpoint Medicaid Managed Care	$59.19

CT LOWER EXT W&W/O CONTRST LFT

Facility

$2,084.00

Service Code	HCPCS 73702LT
Hospital Charge Code	2205306
Hospital Revenue Code	352
Min. Negotiated Rate	$312.60
Max. Negotiated Rate	$312.60
Rate for Payer: Qualcare PPO/HMO/WC	$312.60

CT LUMBAR SPINE W/ C

Facility

$9,500.00

Service Code	HCPCS 72132
Hospital Charge Code	2200112
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 LUMBAR SPINE W/ C

Facility

$9,500.00

Service Code	HCPCS 72132
Hospital Charge Code	2200112
Hospital Revenue Code	352
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$1,127.36
Rate for Payer: Aetna Medicare Advantage	$1,342.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,503.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$414.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$280.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,503.49
Rate for Payer: Cigna Commercial	$830.80
Rate for Payer: Cigna Medicare Advantage	$290.13
Rate for Payer: Clover Medicare Advantage	$393.75
Rate for Payer: EmblemHealth Commercial	$1,243.41
Rate for Payer: Humana Medicare Advantage	$426.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$414.47
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	$414.47
Rate for Payer: Wellcare Medicare Advantage	$414.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,543.21
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT LUMBAR SPINE WO C

Facility

$9,500.00

Service Code	HCPCS 72131
Hospital Charge Code	2200111
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	$240.85
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 LUMBAR SPINE WO C

Facility

$9,500.00

Service Code	HCPCS 72131
Hospital Charge Code	2200111
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 LUMBAR SPINE W/O & W/ C

Facility

$9,500.00

Service Code	HCPCS 72133
Hospital Charge Code	2200113
Hospital Revenue Code	352
Min. Negotiated Rate	$145.87
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$566.79
Rate for Payer: Aetna Medicare Advantage	$675.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$755.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$208.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$288.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$755.90
Rate for Payer: Cigna Commercial	$417.70
Rate for Payer: Cigna Medicare Advantage	$145.87
Rate for Payer: Clover Medicare Advantage	$197.96
Rate for Payer: EmblemHealth Commercial	$625.14
Rate for Payer: Humana Medicare Advantage	$214.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$208.38
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	$208.38
Rate for Payer: Wellcare Medicare Advantage	$208.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$958.88
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

CT LUMBAR SPINE W/O & W/ C

Facility

$9,500.00

Service Code	HCPCS 72133
Hospital Charge Code	2200113
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

Know your out-of-pocket cost for care.

All Charges