Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DX-PULMONARY SELECTIVE-LT

Facility

$34,050.00

Service Code	HCPCS 75741LT
Hospital Charge Code	321075741L
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-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	321075741R
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-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	321075741R
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-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	2691900
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-RT

Facility

$34,050.00

Service Code	HCPCS 75741RT
Hospital Charge Code	2691900
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-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	2691940
Hospital Revenue Code	320
Min. Negotiated Rate	$415.05
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,799.76
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$461.82
Rate for Payer: Wellpoint Medicaid Managed Care	$415.05

DX-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	2691940
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	366875831L
Hospital Revenue Code	320
Min. Negotiated Rate	$415.05
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,799.76
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$461.82
Rate for Payer: Wellpoint Medicaid Managed Care	$415.05

DX-RENAL VENOGRAPHY-LT

Facility

$14,614.45

Service Code	HCPCS 75831LT
Hospital Charge Code	366875831L
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	366875831R
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	366875831R
Hospital Revenue Code	320
Min. Negotiated Rate	$415.05
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,799.76
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$461.82
Rate for Payer: Wellpoint Medicaid Managed Care	$415.05

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	2691945
Hospital Revenue Code	320
Min. Negotiated Rate	$2,192.17
Max. Negotiated Rate	$2,192.17
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17

DX-RENAL VENOGRAPHY-RT

Facility

$14,614.45

Service Code	HCPCS 75831RT
Hospital Charge Code	2691945
Hospital Revenue Code	320
Min. Negotiated Rate	$415.05
Max. Negotiated Rate	$7,307.23
Rate for Payer: Aetna Commercial	$5,553.49
Rate for Payer: Aetna Medicare Advantage	$4,384.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,726.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,726.68
Rate for Payer: Cigna Commercial	$7,307.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,799.76
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,192.17
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$461.82
Rate for Payer: Wellpoint Medicaid Managed Care	$415.05

DX-REPL IV CATH (LYSIS)

Facility

$5,100.00

Hospital Charge Code	2690255
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-REPL IV CATH (LYSIS)

Facility

$5,100.00

Hospital Charge Code	2690255
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	411075984L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	2692000
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	2692000
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-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	321075984L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	411075984L
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-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	366875984L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	366875984L
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-REPL PERC DRAIN-LT

Facility

$5,100.00

Service Code	HCPCS 75984LT
Hospital Charge Code	321075984L
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-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	321075984R
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-REPL PERC DRAIN-RT

Facility

$5,100.00

Service Code	HCPCS 75984RT
Hospital Charge Code	321075984R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

Know your out-of-pocket cost for care.

All Charges