Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DILANTIN (PHENYTOIN)

Facility

$303.00

Service Code	HCPCS 80185
Hospital Charge Code	38472536
Hospital Revenue Code	301
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

DILANTIN PHENYTOIN

Facility

$390.00

Service Code	HCPCS 80185
Hospital Charge Code	3003977
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DILANTIN PHENYTOIN

Facility

$390.00

Service Code	HCPCS 80185
Hospital Charge Code	3003977
Hospital Revenue Code	301
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.06
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
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	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DILATE ANAL SPHINCTER UNDER AN

Facility

$17,147.43

Service Code	HCPCS 45905
Hospital Charge Code	16000748
Hospital Revenue Code	360
Min. Negotiated Rate	$486.99
Max. Negotiated Rate	$5,347.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
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	$5,157.00
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,458.33
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,572.11
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$541.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$486.99

DILATE ANAL SPHINCTER UNDER AN

Facility

$17,147.43

Service Code	HCPCS 45905
Hospital Charge Code	16000748
Hospital Revenue Code	360
Min. Negotiated Rate	$2,572.11
Max. Negotiated Rate	$2,572.11
Rate for Payer: Qualcare PPO/HMO/WC	$2,572.11

DILATE BILIARY DUCT/AMPULLA

Facility

$8,460.00

Service Code	HCPCS 47543
Hospital Charge Code	321047543
Hospital Revenue Code	361
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$1,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00

DILATE BILIARY DUCT/AMPULLA

Facility

$8,460.00

Service Code	HCPCS 47543
Hospital Charge Code	404647543
Hospital Revenue Code	361
Min. Negotiated Rate	$1,269.00
Max. Negotiated Rate	$1,269.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00

DILATE BILIARY DUCT/AMPULLA

Facility

$8,460.00

Service Code	HCPCS 47543
Hospital Charge Code	321047543
Hospital Revenue Code	361
Min. Negotiated Rate	$240.26
Max. Negotiated Rate	$4,230.00
Rate for Payer: Aetna Commercial	$3,214.80
Rate for Payer: Aetna Medicare Advantage	$2,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,157.30
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	$2,157.30
Rate for Payer: Cigna Commercial	$4,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,199.60
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$267.34
Rate for Payer: Wellpoint Medicaid Managed Care	$240.26

DILATE BILIARY DUCT/AMPULLA

Facility

$8,460.00

Service Code	HCPCS 47543
Hospital Charge Code	404647543
Hospital Revenue Code	361
Min. Negotiated Rate	$240.26
Max. Negotiated Rate	$4,230.00
Rate for Payer: Aetna Commercial	$3,214.80
Rate for Payer: Aetna Medicare Advantage	$2,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,157.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,157.30
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	$2,157.30
Rate for Payer: Cigna Commercial	$4,230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,199.60
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,269.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$267.34
Rate for Payer: Wellpoint Medicaid Managed Care	$240.26

DILATE IC VASOSPASM INIT

Facility

$61,616.39

Service Code	HCPCS 61640
Hospital Charge Code	411061640
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

DILATE IC VASOSPASM INIT

Facility

$61,616.39

Service Code	HCPCS 61640
Hospital Charge Code	411061640
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

DILATE IC VSPSM EA DIFF TERR

Facility

$61,616.39

Service Code	HCPCS 61642
Hospital Charge Code	411061642
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

DILATE IC VSPSM EA DIFF TERR

Facility

$61,616.39

Service Code	HCPCS 61642
Hospital Charge Code	411061642
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

DILATE IC VSPSM EA VSL SM TER

Facility

$61,616.39

Service Code	HCPCS 61641
Hospital Charge Code	411061641
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

DILATE IC VSPSM EA VSL SM TER

Facility

$61,616.39

Service Code	HCPCS 61641
Hospital Charge Code	411061641
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
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	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$11,907.76

Service Code	APR-DRG 5172
Min. Negotiated Rate	$11,674.27
Max. Negotiated Rate	$11,907.76
Rate for Payer: UnitedHealthcare Community & State	$11,674.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,907.76
Rate for Payer: Wellpoint Medicaid Managed Care	$11,674.27

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$33,925.65

Service Code	APR-DRG 5174
Min. Negotiated Rate	$33,260.44
Max. Negotiated Rate	$33,925.65
Rate for Payer: UnitedHealthcare Community & State	$33,260.44
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$33,925.65
Rate for Payer: Wellpoint Medicaid Managed Care	$33,260.44

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$19,202.14

Service Code	APR-DRG 5173
Min. Negotiated Rate	$18,825.63
Max. Negotiated Rate	$19,202.14
Rate for Payer: UnitedHealthcare Community & State	$18,825.63
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,202.14
Rate for Payer: Wellpoint Medicaid Managed Care	$18,825.63

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$9,631.28

Service Code	APR-DRG 5171
Min. Negotiated Rate	$9,442.43
Max. Negotiated Rate	$9,631.28
Rate for Payer: UnitedHealthcare Community & State	$9,442.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,631.28
Rate for Payer: Wellpoint Medicaid Managed Care	$9,442.43

DILATIONS SYS ENTERAL ACCES 24

Facility

$493.75

Hospital Charge Code	270683432
Hospital Revenue Code	272
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$246.88
Rate for Payer: Aetna Commercial	$187.62
Rate for Payer: Aetna Medicare Advantage	$148.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.91
Rate for Payer: Cigna Commercial	$246.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.38
Rate for Payer: Oxford Commercial	$98.75
Rate for Payer: Qualcare PPO/HMO/WC	$74.06
Rate for Payer: UnitedHealthcare Commercial	$98.75
Rate for Payer: UnitedHealthcare Community & State	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$14.02

DILATIONS SYS ENTERAL ACCES 24

Facility

$493.75

Hospital Charge Code	270683432
Hospital Revenue Code	272
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$74.06
Rate for Payer: Qualcare PPO/HMO/WC	$74.06

DILATION SYSTEM ENTERAL ACCESS

Facility

$493.75

Hospital Charge Code	270672030N
Hospital Revenue Code	272
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$246.88
Rate for Payer: Aetna Commercial	$187.62
Rate for Payer: Aetna Medicare Advantage	$148.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.91
Rate for Payer: Cigna Commercial	$246.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$128.38
Rate for Payer: Oxford Commercial	$98.75
Rate for Payer: Qualcare PPO/HMO/WC	$74.06
Rate for Payer: UnitedHealthcare Commercial	$98.75
Rate for Payer: UnitedHealthcare Community & State	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$14.02

DILATION SYSTEM ENTERAL ACCESS

Facility

$501.25

Hospital Charge Code	270672030
Hospital Revenue Code	272
Min. Negotiated Rate	$75.19
Max. Negotiated Rate	$75.19
Rate for Payer: Qualcare PPO/HMO/WC	$75.19

DILATION SYSTEM ENTERAL ACCESS

Facility

$501.25

Hospital Charge Code	270672030
Hospital Revenue Code	272
Min. Negotiated Rate	$14.24
Max. Negotiated Rate	$250.62
Rate for Payer: Aetna Commercial	$190.47
Rate for Payer: Aetna Medicare Advantage	$150.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.82
Rate for Payer: Cigna Commercial	$250.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.32
Rate for Payer: Oxford Commercial	$100.25
Rate for Payer: Qualcare PPO/HMO/WC	$75.19
Rate for Payer: UnitedHealthcare Commercial	$100.25
Rate for Payer: UnitedHealthcare Community & State	$15.84
Rate for Payer: Wellpoint Medicaid Managed Care	$14.24

DILATION SYSTEM ENTERAL ACCESS

Facility

$493.75

Hospital Charge Code	270672030N
Hospital Revenue Code	272
Min. Negotiated Rate	$74.06
Max. Negotiated Rate	$74.06
Rate for Payer: Qualcare PPO/HMO/WC	$74.06

Know your out-of-pocket cost for care.

All Charges