Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DX-UPPER GI/AIR CONTRAST W/KUB

Facility

$938.00

Service Code	HCPCS 74247
Hospital Charge Code	2007015
Hospital Revenue Code	320
Min. Negotiated Rate	$140.70
Max. Negotiated Rate	$140.70
Rate for Payer: Qualcare PPO/HMO/WC	$140.70

DX-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	2691925
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-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	2691925
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	321075820L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENO EXTREMITY-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	321075820L
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-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	7411151
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	366875820L
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	7411151
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-VENOGRAM EXT-LT

Facility

$5,100.00

Service Code	HCPCS 75820LT
Hospital Charge Code	366875820L
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-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	321075822
Hospital Revenue Code	320
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,665.09
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$202.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

DX-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	321075822
Hospital Revenue Code	320
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

DX-VENOGRAPH EXTREMITY-BI

Facility

$3,057.00

Service Code	HCPCS 75822
Hospital Charge Code	366875822
Hospital Revenue Code	320
Min. Negotiated Rate	$86.82
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$794.82
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$458.55
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$96.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$86.82

DX-VENOGRAPH EXTREMITY-BI

Facility

$3,057.00

Service Code	HCPCS 75822
Hospital Charge Code	366875822
Hospital Revenue Code	320
Min. Negotiated Rate	$458.55
Max. Negotiated Rate	$458.55
Rate for Payer: Qualcare PPO/HMO/WC	$458.55

DX-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	2690755
Hospital Revenue Code	320
Min. Negotiated Rate	$130.35
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,309.10
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,665.09
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$960.63
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$202.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$181.88

DX-VENOGRAPH EXTREMITY-BI

Facility

$6,404.20

Service Code	HCPCS 75822
Hospital Charge Code	2690755
Hospital Revenue Code	320
Min. Negotiated Rate	$960.63
Max. Negotiated Rate	$960.63
Rate for Payer: Qualcare PPO/HMO/WC	$960.63

DX-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	2691930
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-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	2691930
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	321075820R
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-VENOGRAPH EXTREMITY-RT

Facility

$5,100.00

Service Code	HCPCS 75820RT
Hospital Charge Code	321075820R
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

DX-VISCERAL ATHERECTOM-LT

Facility

$37,614.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	41100235T
Hospital Revenue Code	361
Min. Negotiated Rate	$1,068.25
Max. Negotiated Rate	$18,807.17
Rate for Payer: Aetna Commercial	$14,293.45
Rate for Payer: Aetna Medicare Advantage	$11,284.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,591.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,591.66
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	$9,591.66
Rate for Payer: Cigna Commercial	$18,807.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,779.73
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15
Rate for Payer: UnitedHealthcare Community & State	$1,188.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1,068.25

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	36680235T
Hospital Revenue Code	361
Min. Negotiated Rate	$1,076.77
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,857.73
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$1,198.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1,076.77

DX-VISCERAL ATHERECTOM-LT

Facility

$37,614.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	41100235T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,642.15
Max. Negotiated Rate	$5,642.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,642.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	36680235T
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	32100235TL
Hospital Revenue Code	361
Min. Negotiated Rate	$1,076.77
Max. Negotiated Rate	$18,957.17
Rate for Payer: Aetna Commercial	$14,407.45
Rate for Payer: Aetna Medicare Advantage	$11,374.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,668.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,668.16
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	$9,668.16
Rate for Payer: Cigna Commercial	$18,957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,857.73
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15
Rate for Payer: UnitedHealthcare Community & State	$1,198.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1,076.77

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	2690815
Hospital Revenue Code	361
Min. Negotiated Rate	$5,687.15
Max. Negotiated Rate	$5,687.15
Rate for Payer: Qualcare PPO/HMO/WC	$5,687.15

Know your out-of-pocket cost for care.

All Charges