Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DRAIN/INJ MAJOR JNT W US

Facility

$1,449.20

Service Code	HCPCS 20611
Hospital Charge Code	323020611
Hospital Revenue Code	450
Min. Negotiated Rate	$217.38
Max. Negotiated Rate	$217.38
Rate for Payer: Qualcare PPO/HMO/WC	$217.38

DRAIN/INJ MAJOR JNT W US

Facility

$1,253.85

Service Code	HCPCS 20611
Hospital Charge Code	7411347
Hospital Revenue Code	361
Min. Negotiated Rate	$35.61
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
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	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.00
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$188.08
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$39.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$35.61

DRAIN/INJ MAJOR JNT W US

Facility

$1,253.85

Service Code	HCPCS 20611
Hospital Charge Code	7411347
Hospital Revenue Code	361
Min. Negotiated Rate	$188.08
Max. Negotiated Rate	$188.08
Rate for Payer: Qualcare PPO/HMO/WC	$188.08

DRAIN INTRAORAL SUBMAX/SUBLING

Facility

$1,453.00

Service Code	HCPCS 42310
Hospital Charge Code	5780225
Hospital Revenue Code	450
Min. Negotiated Rate	$217.95
Max. Negotiated Rate	$217.95
Rate for Payer: Qualcare PPO/HMO/WC	$217.95

DRAIN INTRAORAL SUBMAX/SUBLING

Facility

$1,453.00

Service Code	HCPCS 42310
Hospital Charge Code	5780225
Hospital Revenue Code	450
Min. Negotiated Rate	$41.27
Max. Negotiated Rate	$2,324.28
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	$55.90
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	$377.78
Rate for Payer: Qualcare PPO/HMO/WC	$217.95
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$41.27

DRAIN JACKSON-PRT 15/FR W/TROC

Facility

$59.00

Hospital Charge Code	270655679
Hospital Revenue Code	271
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

DRAIN JACKSON-PRT 15/FR W/TROC

Facility

$59.00

Hospital Charge Code	270655679
Hospital Revenue Code	271
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

DRAIN J P 7MM FLAT

Facility

$22.95

Hospital Charge Code	270600249
Hospital Revenue Code	270
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.47
Rate for Payer: Aetna Commercial	$8.72
Rate for Payer: Aetna Medicare Advantage	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.85
Rate for Payer: Cigna Commercial	$11.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.97
Rate for Payer: Oxford Commercial	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$4.59
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

DRAIN J P 7MM FLAT

Facility

$22.95

Hospital Charge Code	270600249
Hospital Revenue Code	270
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

DRAIN J P RESERVIOR

Facility

$27.91

Hospital Charge Code	270605540
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$13.96
Rate for Payer: Aetna Commercial	$10.61
Rate for Payer: Aetna Medicare Advantage	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.12
Rate for Payer: Cigna Commercial	$13.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.26
Rate for Payer: Oxford Commercial	$5.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$5.58
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

DRAIN J P RESERVIOR

Facility

$27.91

Hospital Charge Code	270605540
Hospital Revenue Code	272
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

DRAIN MALECOT 22FR. FOUR-WING

Facility

$131.00

Hospital Charge Code	270331377
Hospital Revenue Code	272
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$65.50
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.06
Rate for Payer: Oxford Commercial	$26.20
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$26.20
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

DRAIN MALECOT 22FR. FOUR-WING

Facility

$131.00

Hospital Charge Code	270331377
Hospital Revenue Code	272
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

DRAIN NECK/CHEST LESION

Facility

$11,141.64

Service Code	HCPCS 21501
Hospital Charge Code	16000540
Hospital Revenue Code	360
Min. Negotiated Rate	$1,671.25
Max. Negotiated Rate	$1,671.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25

DRAIN NECK/CHEST LESION

Facility

$11,141.64

Service Code	HCPCS 21501
Hospital Charge Code	16000540
Hospital Revenue Code	360
Min. Negotiated Rate	$316.42
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
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	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,896.83
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,671.25
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$352.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellpoint Medicaid Managed Care	$316.42

DRAIN OUTER EAR CANAL LESION

Facility

$3,005.56

Service Code	HCPCS 69020
Hospital Charge Code	16001045
Hospital Revenue Code	360
Min. Negotiated Rate	$450.83
Max. Negotiated Rate	$450.83
Rate for Payer: Qualcare PPO/HMO/WC	$450.83

DRAIN OUTER EAR CANAL LESION

Facility

$3,005.56

Service Code	HCPCS 69020
Hospital Charge Code	16001045
Hospital Revenue Code	360
Min. Negotiated Rate	$85.36
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$781.45
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.83
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$94.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$85.36

DRAIN PENROSE 1/2x12

Facility

$3.85

Hospital Charge Code	270649921
Hospital Revenue Code	278
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58

DRAIN PENROSE 1/2x12

Facility

$3.85

Hospital Charge Code	270649921
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$1.93
Rate for Payer: Aetna Commercial	$1.46
Rate for Payer: Aetna Medicare Advantage	$1.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.98
Rate for Payer: Cigna Commercial	$1.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.58
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DRAIN PETONEAL ABSCESS/CYST,OP

Facility

$19,658.35

Service Code	HCPCS 49020
Hospital Charge Code	16000591
Hospital Revenue Code	360
Min. Negotiated Rate	$2,948.75
Max. Negotiated Rate	$2,948.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,948.75

DRAIN PETONEAL ABSCESS/CYST,OP

Facility

$19,658.35

Service Code	HCPCS 49020
Hospital Charge Code	16000591
Hospital Revenue Code	360
Min. Negotiated Rate	$558.30
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$7,470.17
Rate for Payer: Aetna Medicare Advantage	$5,897.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,012.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,012.88
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	$5,012.88
Rate for Payer: Cigna Commercial	$9,829.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,111.17
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,948.75
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$621.20
Rate for Payer: Wellpoint Medicaid Managed Care	$558.30

DRAIN PLEUREVAC SYS DOUBLE

Facility

$290.77

Service Code	HCPCS C1729
Hospital Charge Code	270652876
Hospital Revenue Code	278
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$145.38
Rate for Payer: Aetna Commercial	$110.49
Rate for Payer: Aetna Medicare Advantage	$87.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.15
Rate for Payer: Cigna Commercial	$145.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.37
Rate for Payer: Qualcare PPO/HMO/WC	$43.62
Rate for Payer: UnitedHealthcare Community & State	$9.19
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

DRAIN PLEUREVAC SYS DOUBLE

Facility

$290.77

Service Code	HCPCS C1729
Hospital Charge Code	270652876
Hospital Revenue Code	278
Min. Negotiated Rate	$43.62
Max. Negotiated Rate	$70.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.37
Rate for Payer: Qualcare PPO/HMO/WC	$43.62

DRAIN RETROPETONEAL ABSCES,OPN

Facility

$12,226.80

Service Code	HCPCS 49060
Hospital Charge Code	16000487
Hospital Revenue Code	360
Min. Negotiated Rate	$1,834.02
Max. Negotiated Rate	$1,834.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,834.02

DRAIN RETROPETONEAL ABSCES,OPN

Facility

$12,226.80

Service Code	HCPCS 49060
Hospital Charge Code	16000487
Hospital Revenue Code	360
Min. Negotiated Rate	$347.24
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$4,646.18
Rate for Payer: Aetna Medicare Advantage	$3,668.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,117.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,117.83
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	$3,117.83
Rate for Payer: Cigna Commercial	$6,113.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,178.97
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,834.02
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$386.37
Rate for Payer: Wellpoint Medicaid Managed Care	$347.24

Know your out-of-pocket cost for care.

All Charges