Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IO LENS 24.5D

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270652483
Hospital Revenue Code	276
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

IO LENS 24.5D

Facility

$745.00

Service Code	HCPCS C1780
Hospital Charge Code	270652483
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL LENS

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270661727
Hospital Revenue Code	276
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$372.50
Rate for Payer: Aetna Commercial	$283.10
Rate for Payer: Aetna Medicare Advantage	$223.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.97
Rate for Payer: Cigna Commercial	$372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

IOL LENS

Facility

$745.00

Service Code	HCPCS V2632
Hospital Charge Code	270661727
Hospital Revenue Code	276
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$180.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.29
Rate for Payer: Qualcare PPO/HMO/WC	$111.75

IOL STAAR SURGICAL

Facility

$950.00

Hospital Charge Code	270339093
Hospital Revenue Code	276
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$229.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50

IOL STAAR SURGICAL

Facility

$950.00

Hospital Charge Code	270339093
Hospital Revenue Code	276
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$30.02
Rate for Payer: Wellpoint Medicaid Managed Care	$26.98

IONTOPHORESIS EA 15 MIN CQ

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	409197033Q
Hospital Revenue Code	420
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2.21

IONTOPHORESIS EA 15 MIN CQ

Facility

$77.65

Service Code	HCPCS 97033GP
Hospital Charge Code	409197033Q
Hospital Revenue Code	420
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033
Hospital Charge Code	9108040
Hospital Revenue Code	420
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033
Hospital Charge Code	9108040
Hospital Revenue Code	420
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$88.54
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.58
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.36
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033GP
Hospital Charge Code	1008175
Hospital Revenue Code	420
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$88.54
Rate for Payer: Aetna Medicare Advantage	$69.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.41
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.58
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.36
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

IONTOPHORESIS EA 15 MINUTES

Facility

$233.00

Service Code	HCPCS 97033GP
Hospital Charge Code	1008175
Hospital Revenue Code	420
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

IOPAMIDOL-200 10ML

Facility

$110.15

Service Code	NDC 270141111
Hospital Charge Code	606390373
Hospital Revenue Code	255
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$55.08
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$33.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.09
Rate for Payer: Cigna Commercial	$55.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.64
Rate for Payer: Oxford Commercial	$22.03
Rate for Payer: Qualcare PPO/HMO/WC	$16.52
Rate for Payer: UnitedHealthcare Commercial	$22.03
Rate for Payer: UnitedHealthcare Community & State	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$3.13

IOPAMIDOL-200 10ML

Facility

$110.15

Service Code	NDC 270141111
Hospital Charge Code	606390373
Hospital Revenue Code	255
Min. Negotiated Rate	$16.52
Max. Negotiated Rate	$16.52
Rate for Payer: Qualcare PPO/HMO/WC	$16.52

IOPAMIDOL-250 100ML

Facility

$657.61

Service Code	NDC 270131702
Hospital Charge Code	606390379
Hospital Revenue Code	255
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$328.81
Rate for Payer: Aetna Commercial	$249.89
Rate for Payer: Aetna Medicare Advantage	$197.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.69
Rate for Payer: Cigna Commercial	$328.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.98
Rate for Payer: Oxford Commercial	$131.52
Rate for Payer: Qualcare PPO/HMO/WC	$98.64
Rate for Payer: UnitedHealthcare Commercial	$131.52
Rate for Payer: UnitedHealthcare Community & State	$20.78
Rate for Payer: Wellpoint Medicaid Managed Care	$18.68

IOPAMIDOL-250 100ML

Facility

$657.61

Service Code	NDC 270131702
Hospital Charge Code	606390379
Hospital Revenue Code	255
Min. Negotiated Rate	$98.64
Max. Negotiated Rate	$98.64
Rate for Payer: Qualcare PPO/HMO/WC	$98.64

IOPAMIDOL-300 100ML

Facility

$752.75

Service Code	NDC 270131535
Hospital Charge Code	606390362
Hospital Revenue Code	255
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$376.38
Rate for Payer: Aetna Commercial	$286.05
Rate for Payer: Aetna Medicare Advantage	$225.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.95
Rate for Payer: Cigna Commercial	$376.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.72
Rate for Payer: Oxford Commercial	$150.55
Rate for Payer: Qualcare PPO/HMO/WC	$112.91
Rate for Payer: UnitedHealthcare Commercial	$150.55
Rate for Payer: UnitedHealthcare Community & State	$23.79
Rate for Payer: Wellpoint Medicaid Managed Care	$21.38

IOPAMIDOL-300 100ML

Facility

$752.75

Service Code	NDC 270131535
Hospital Charge Code	606390362
Hospital Revenue Code	255
Min. Negotiated Rate	$112.91
Max. Negotiated Rate	$112.91
Rate for Payer: Qualcare PPO/HMO/WC	$112.91

IOPAMIDOL-300 150ML

Facility

$1,097.13

Service Code	NDC 270131550
Hospital Charge Code	606390367
Hospital Revenue Code	255
Min. Negotiated Rate	$164.57
Max. Negotiated Rate	$164.57
Rate for Payer: Qualcare PPO/HMO/WC	$164.57

IOPAMIDOL-300 150ML

Facility

$1,097.13

Service Code	NDC 270131550
Hospital Charge Code	606390367
Hospital Revenue Code	255
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$548.57
Rate for Payer: Aetna Commercial	$416.91
Rate for Payer: Aetna Medicare Advantage	$329.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.77
Rate for Payer: Cigna Commercial	$548.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.25
Rate for Payer: Oxford Commercial	$219.43
Rate for Payer: Qualcare PPO/HMO/WC	$164.57
Rate for Payer: UnitedHealthcare Commercial	$219.43
Rate for Payer: UnitedHealthcare Community & State	$34.67
Rate for Payer: Wellpoint Medicaid Managed Care	$31.16

IOPAMIDOL-300 15ML

Facility

$146.33

Service Code	NDC 270141215
Hospital Charge Code	606390371
Hospital Revenue Code	255
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$21.95
Rate for Payer: Qualcare PPO/HMO/WC	$21.95

IOPAMIDOL-300 15ML

Facility

$146.33

Service Code	NDC 270141215
Hospital Charge Code	606390371
Hospital Revenue Code	255
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$73.17
Rate for Payer: Aetna Commercial	$55.61
Rate for Payer: Aetna Medicare Advantage	$43.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.31
Rate for Payer: Cigna Commercial	$73.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.05
Rate for Payer: Oxford Commercial	$29.27
Rate for Payer: Qualcare PPO/HMO/WC	$21.95
Rate for Payer: UnitedHealthcare Commercial	$29.27
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

IOPAMIDOL-300 200ML

Facility

$128.31

Service Code	NDC 270131545
Hospital Charge Code	606390366
Hospital Revenue Code	255
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$64.16
Rate for Payer: Aetna Commercial	$48.76
Rate for Payer: Aetna Medicare Advantage	$38.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.72
Rate for Payer: Cigna Commercial	$64.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.36
Rate for Payer: Oxford Commercial	$25.66
Rate for Payer: Qualcare PPO/HMO/WC	$19.25
Rate for Payer: UnitedHealthcare Commercial	$25.66
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

IOPAMIDOL-300 200ML

Facility

$128.31

Service Code	NDC 270131545
Hospital Charge Code	606390366
Hospital Revenue Code	255
Min. Negotiated Rate	$19.25
Max. Negotiated Rate	$19.25
Rate for Payer: Qualcare PPO/HMO/WC	$19.25

IOPAMIDOL 300U/50ML ISOVUE-300

Facility

$385.18

Service Code	NDC 270131530
Hospital Charge Code	606390381
Hospital Revenue Code	255
Min. Negotiated Rate	$57.78
Max. Negotiated Rate	$57.78
Rate for Payer: Qualcare PPO/HMO/WC	$57.78

Know your out-of-pocket cost for care.

All Charges