Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DX-VISCERAL ATHERECTOM-LT

Facility

$37,914.35

Service Code	HCPCS 0235TLT
Hospital Charge Code	32100235TL
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	2690815
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 SEL EA ADD-LT

Facility

$5,100.00

Service Code	HCPCS 75774LT
Hospital Charge Code	321075774L
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 SEL EA ADD-LT

Facility

$5,100.00

Service Code	HCPCS 75774LT
Hospital Charge Code	2691915
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-VISCERAL SEL EA ADD-LT

Facility

$5,100.00

Service Code	HCPCS 75774LT
Hospital Charge Code	2691915
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 SEL EA ADD-LT

Facility

$5,100.00

Service Code	HCPCS 75774LT
Hospital Charge Code	366875774L
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-VISCERAL SEL EA ADD-LT

Facility

$5,100.00

Service Code	HCPCS 75774LT
Hospital Charge Code	366875774L
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 SEL EA ADD-LT

Facility

$5,100.00

Service Code	HCPCS 75774LT
Hospital Charge Code	321075774L
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-VISCERAL SEL EA ADD-LT

Facility

$5,000.00

Service Code	HCPCS 75774LT
Hospital Charge Code	7412012
Hospital Revenue Code	320
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

DX-VISCERAL SEL EA ADD-LT

Facility

$5,000.00

Service Code	HCPCS 75774LT
Hospital Charge Code	7412012
Hospital Revenue Code	320
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

DX-VISCERAL SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	366875774R
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-VISCERAL SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	366875774R
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 SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	7412013
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-VISCERAL SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	321075774R
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-VISCERAL SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	321075774R
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 SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	2691920
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-VISCERAL SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	7412013
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 SEL EA ADD-RT

Facility

$5,100.00

Service Code	HCPCS 75774RT
Hospital Charge Code	2691920
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

D-XYLOSE ABSORPTION,B, 1 HR

Facility

$390.00

Service Code	HCPCS 84620
Hospital Charge Code	3990247
Hospital Revenue Code	301
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.12
Rate for Payer: Aetna Medicare Advantage	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.91
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.73
Rate for Payer: Humana Medicare Advantage	$13.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.91
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	$10.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Medicare Advantage	$12.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

D-XYLOSE ABSORPTION,B, 1 HR

Facility

$390.00

Service Code	HCPCS 84620
Hospital Charge Code	3990247
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

D-XYLOSE ABSORPTION,B,1HR

Facility

$390.00

Service Code	HCPCS 84620
Hospital Charge Code	4010846201
Hospital Revenue Code	301
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.12
Rate for Payer: Aetna Medicare Advantage	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.91
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.73
Rate for Payer: Humana Medicare Advantage	$13.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.91
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	$10.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Medicare Advantage	$12.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

D-XYLOSE ABSORPTION,B,1HR

Facility

$390.00

Service Code	HCPCS 84620
Hospital Charge Code	4010846201
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

D-XYLOSE ABSORPTION,B, 2 HR

Facility

$397.50

Service Code	HCPCS 84620
Hospital Charge Code	3990248
Hospital Revenue Code	301
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$198.75
Rate for Payer: Aetna Commercial	$35.12
Rate for Payer: Aetna Medicare Advantage	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.83
Rate for Payer: Cigna Commercial	$198.75
Rate for Payer: Cigna Medicare Advantage	$12.91
Rate for Payer: Clover Medicare Advantage	$12.26
Rate for Payer: EmblemHealth Commercial	$38.73
Rate for Payer: Humana Medicare Advantage	$13.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.35
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.62
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.91
Rate for Payer: Wellcare Medicare Advantage	$12.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.29

D-XYLOSE ABSORPTION,B, 2 HR

Facility

$397.50

Service Code	HCPCS 84620
Hospital Charge Code	3990248
Hospital Revenue Code	301
Min. Negotiated Rate	$59.62
Max. Negotiated Rate	$59.62
Rate for Payer: Qualcare PPO/HMO/WC	$59.62

D-XYLOSE ABSORPTION,B,2HR

Facility

$390.00

Service Code	HCPCS 84620
Hospital Charge Code	4010846202
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges