Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	7411992
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-LT

Facility

$5,100.00

Service Code	HCPCS 74425LT
Hospital Charge Code	7411992
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	321074425R
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	321074425R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	7411993
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	2691765
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	7411993
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	366874425R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	366874425R
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-NEPHROSTOGRAM-RT

Facility

$5,100.00

Service Code	HCPCS 74425RT
Hospital Charge Code	2691765
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-ORBITS COMP MIN 4VW-BI

Facility

$5,100.00

Service Code	HCPCS 70200
Hospital Charge Code	2009150
Hospital Revenue Code	320
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$2,231.00
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	$41.25
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	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-ORBITS COMP MIN 4VW-BI

Facility

$5,100.00

Service Code	HCPCS 70200
Hospital Charge Code	2009150
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-ORBITS COMP MIN 4VW-LT

Facility

$5,100.00

Service Code	HCPCS 70200LT
Hospital Charge Code	2009210
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-ORBITS COMP MIN 4VW-LT

Facility

$5,100.00

Service Code	HCPCS 70200LT
Hospital Charge Code	2009210
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-ORBITS COMP MIN 4VW-RT

Facility

$5,100.00

Service Code	HCPCS 70200RT
Hospital Charge Code	2009215
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

DX-ORBITS COMP MIN 4VW-RT

Facility

$5,100.00

Service Code	HCPCS 70200RT
Hospital Charge Code	2009215
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-PERC NEPH DRN/INJ REN PL LT

Facility

$7,186.00

Hospital Charge Code	2008065
Hospital Revenue Code	320
Min. Negotiated Rate	$204.08
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,730.68
Rate for Payer: Aetna Medicare Advantage	$2,155.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,832.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,832.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,832.43
Rate for Payer: Cigna Commercial	$3,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,868.36
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.90
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$227.08
Rate for Payer: Wellpoint Medicaid Managed Care	$204.08

DX-PERC NEPH DRN/INJ REN PL LT

Facility

$7,186.00

Hospital Charge Code	2008065
Hospital Revenue Code	320
Min. Negotiated Rate	$1,077.90
Max. Negotiated Rate	$1,077.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.90

DX-PERC NEPH DRN/INJ RN PEL B

Facility

$7,186.00

Hospital Charge Code	2008055
Hospital Revenue Code	320
Min. Negotiated Rate	$1,077.90
Max. Negotiated Rate	$1,077.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.90

DX-PERC NEPH DRN/INJ RN PEL B

Facility

$7,186.00

Hospital Charge Code	2008055
Hospital Revenue Code	320
Min. Negotiated Rate	$204.08
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,730.68
Rate for Payer: Aetna Medicare Advantage	$2,155.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,832.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,832.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,832.43
Rate for Payer: Cigna Commercial	$3,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,868.36
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.90
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$227.08
Rate for Payer: Wellpoint Medicaid Managed Care	$204.08

DX-PERC NEPH DRN/INJ RN PEL RT

Facility

$7,186.00

Hospital Charge Code	2008060
Hospital Revenue Code	320
Min. Negotiated Rate	$204.08
Max. Negotiated Rate	$3,593.00
Rate for Payer: Aetna Commercial	$2,730.68
Rate for Payer: Aetna Medicare Advantage	$2,155.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,832.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,832.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,832.43
Rate for Payer: Cigna Commercial	$3,593.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,868.36
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.90
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$227.08
Rate for Payer: Wellpoint Medicaid Managed Care	$204.08

DX-PERC NEPH DRN/INJ RN PEL RT

Facility

$7,186.00

Hospital Charge Code	2008060
Hospital Revenue Code	320
Min. Negotiated Rate	$1,077.90
Max. Negotiated Rate	$1,077.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,077.90

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	321075741L
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	2691895
Hospital Revenue Code	320
Min. Negotiated Rate	$967.02
Max. Negotiated Rate	$17,025.00
Rate for Payer: Aetna Commercial	$12,939.00
Rate for Payer: Aetna Medicare Advantage	$10,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,682.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,682.75
Rate for Payer: Cigna Commercial	$17,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,853.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$1,075.98
Rate for Payer: Wellpoint Medicaid Managed Care	$967.02

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	2691895
Hospital Revenue Code	320
Min. Negotiated Rate	$5,107.50
Max. Negotiated Rate	$5,107.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,107.50

Know your out-of-pocket cost for care.

All Charges