Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IOPAMIDOL 300U/50ML ISOVUE-300

Facility

$385.18

Service Code	NDC 270131530
Hospital Charge Code	606390381
Hospital Revenue Code	255
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$192.59
Rate for Payer: Aetna Commercial	$146.37
Rate for Payer: Aetna Medicare Advantage	$115.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.22
Rate for Payer: Cigna Commercial	$192.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.15
Rate for Payer: Oxford Commercial	$77.04
Rate for Payer: Qualcare PPO/HMO/WC	$57.78
Rate for Payer: UnitedHealthcare Commercial	$77.04
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$10.94

IOPAMIDOL-370 100ML

Facility

$835.42

Service Code	NDC 270131635
Hospital Charge Code	606390364
Hospital Revenue Code	255
Min. Negotiated Rate	$23.73
Max. Negotiated Rate	$417.71
Rate for Payer: Aetna Commercial	$317.46
Rate for Payer: Aetna Medicare Advantage	$250.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$213.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$213.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$213.03
Rate for Payer: Cigna Commercial	$417.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$217.21
Rate for Payer: Oxford Commercial	$167.08
Rate for Payer: Qualcare PPO/HMO/WC	$125.31
Rate for Payer: UnitedHealthcare Commercial	$167.08
Rate for Payer: UnitedHealthcare Community & State	$26.40
Rate for Payer: Wellpoint Medicaid Managed Care	$23.73

IOPAMIDOL-370 100ML

Facility

$835.42

Service Code	NDC 270131635
Hospital Charge Code	606390364
Hospital Revenue Code	255
Min. Negotiated Rate	$125.31
Max. Negotiated Rate	$125.31
Rate for Payer: Qualcare PPO/HMO/WC	$125.31

IOPAMIDOL-370 150ML

Facility

$1,155.75

Service Code	NDC 270131637
Hospital Charge Code	606390365
Hospital Revenue Code	255
Min. Negotiated Rate	$173.36
Max. Negotiated Rate	$173.36
Rate for Payer: Qualcare PPO/HMO/WC	$173.36

IOPAMIDOL-370 150ML

Facility

$1,155.75

Service Code	NDC 270131637
Hospital Charge Code	606390365
Hospital Revenue Code	255
Min. Negotiated Rate	$32.82
Max. Negotiated Rate	$577.88
Rate for Payer: Aetna Commercial	$439.19
Rate for Payer: Aetna Medicare Advantage	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$294.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$294.72
Rate for Payer: Cigna Commercial	$577.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$300.50
Rate for Payer: Oxford Commercial	$231.15
Rate for Payer: Qualcare PPO/HMO/WC	$173.36
Rate for Payer: UnitedHealthcare Commercial	$231.15
Rate for Payer: UnitedHealthcare Community & State	$36.52
Rate for Payer: Wellpoint Medicaid Managed Care	$32.82

IOPAMIDOL-370 50ML

Facility

$418.75

Service Code	NDC 270131630
Hospital Charge Code	606390363
Hospital Revenue Code	255
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$209.38
Rate for Payer: Aetna Commercial	$159.12
Rate for Payer: Aetna Medicare Advantage	$125.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.78
Rate for Payer: Cigna Commercial	$209.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.88
Rate for Payer: Oxford Commercial	$83.75
Rate for Payer: Qualcare PPO/HMO/WC	$62.81
Rate for Payer: UnitedHealthcare Commercial	$83.75
Rate for Payer: UnitedHealthcare Community & State	$13.23
Rate for Payer: Wellpoint Medicaid Managed Care	$11.89

IOPAMIDOL-370 50ML

Facility

$418.75

Service Code	NDC 270131630
Hospital Charge Code	606390363
Hospital Revenue Code	255
Min. Negotiated Rate	$62.81
Max. Negotiated Rate	$62.81
Rate for Payer: Qualcare PPO/HMO/WC	$62.81

IPAS BEVEL III NV STER

Facility

$2,980.00

Hospital Charge Code	270691371
Hospital Revenue Code	272
Min. Negotiated Rate	$84.63
Max. Negotiated Rate	$1,490.00
Rate for Payer: Aetna Commercial	$1,132.40
Rate for Payer: Aetna Medicare Advantage	$894.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$759.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$759.90
Rate for Payer: Cigna Commercial	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.80
Rate for Payer: Oxford Commercial	$596.00
Rate for Payer: Qualcare PPO/HMO/WC	$447.00
Rate for Payer: UnitedHealthcare Commercial	$596.00
Rate for Payer: UnitedHealthcare Community & State	$94.17
Rate for Payer: Wellpoint Medicaid Managed Care	$84.63

IPAS BEVEL III NV STER

Facility

$2,980.00

Hospital Charge Code	270691371
Hospital Revenue Code	272
Min. Negotiated Rate	$447.00
Max. Negotiated Rate	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$447.00

IPG2000/IPG2500 TEMPLATE KIT

Facility

$375.00

Hospital Charge Code	270703930
Hospital Revenue Code	279
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

IPG2000/IPG2500 TEMPLATE KIT

Facility

$375.00

Hospital Charge Code	270703930
Hospital Revenue Code	279
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

IPG KIT

Facility

$120,000.00

Service Code	HCPCS C1767
Hospital Charge Code	270703696
Hospital Revenue Code	278
Min. Negotiated Rate	$3,408.00
Max. Negotiated Rate	$60,000.00
Rate for Payer: Aetna Commercial	$45,600.00
Rate for Payer: Aetna Medicare Advantage	$36,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30,600.00
Rate for Payer: Cigna Commercial	$60,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,000.00
Rate for Payer: UnitedHealthcare Community & State	$3,792.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3,408.00

IPG KIT

Facility

$120,000.00

Service Code	HCPCS C1767
Hospital Charge Code	270703696
Hospital Revenue Code	278
Min. Negotiated Rate	$18,000.00
Max. Negotiated Rate	$29,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29,040.00
Rate for Payer: Qualcare PPO/HMO/WC	$18,000.00

IPG KIT SENZA OMNIA

Facility

$130,000.00

Service Code	HCPCS C1822
Hospital Charge Code	270693282
Hospital Revenue Code	278
Min. Negotiated Rate	$3,692.00
Max. Negotiated Rate	$65,000.00
Rate for Payer: Aetna Commercial	$49,400.00
Rate for Payer: Aetna Medicare Advantage	$39,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33,150.00
Rate for Payer: Cigna Commercial	$65,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31,460.00
Rate for Payer: Qualcare PPO/HMO/WC	$19,500.00
Rate for Payer: UnitedHealthcare Community & State	$4,108.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3,692.00

IPG KIT SENZA OMNIA

Facility

$130,000.00

Service Code	HCPCS C1822
Hospital Charge Code	270693282
Hospital Revenue Code	278
Min. Negotiated Rate	$19,500.00
Max. Negotiated Rate	$31,460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31,460.00
Rate for Payer: Qualcare PPO/HMO/WC	$19,500.00

IPG MRI

Facility

$23,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677
Hospital Revenue Code	278
Min. Negotiated Rate	$3,525.00
Max. Negotiated Rate	$5,687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00

IPG MRI

Facility

$23,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270681677
Hospital Revenue Code	278
Min. Negotiated Rate	$667.40
Max. Negotiated Rate	$11,750.00
Rate for Payer: Aetna Commercial	$8,930.00
Rate for Payer: Aetna Medicare Advantage	$7,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,992.50
Rate for Payer: Cigna Commercial	$11,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,687.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,525.00
Rate for Payer: UnitedHealthcare Community & State	$742.60
Rate for Payer: Wellpoint Medicaid Managed Care	$667.40

IPRATROPIUM BROMIDE 2.5 ML SOL

Facility

$4.00

Service Code	NDC 487980101
Hospital Charge Code	60627436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

IPRATROPIUM BROMIDE 2.5 ML SOL

Facility

$4.00

Service Code	NDC 487980101
Hospital Charge Code	60627436
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IPRATROPIUM INH ORAL 18MCG

Facility

$2,089.53

Service Code	NDC 597008717
Hospital Charge Code	60627437
Hospital Revenue Code	250
Min. Negotiated Rate	$313.43
Max. Negotiated Rate	$313.43
Rate for Payer: Qualcare PPO/HMO/WC	$313.43

IPRATROPIUM INH ORAL 18MCG

Facility

$2,089.53

Service Code	NDC 597008717
Hospital Charge Code	60627437
Hospital Revenue Code	250
Min. Negotiated Rate	$59.34
Max. Negotiated Rate	$1,044.77
Rate for Payer: Aetna Commercial	$794.02
Rate for Payer: Aetna Medicare Advantage	$626.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.83
Rate for Payer: Cigna Commercial	$1,044.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$543.28
Rate for Payer: Oxford Commercial	$417.91
Rate for Payer: Qualcare PPO/HMO/WC	$313.43
Rate for Payer: UnitedHealthcare Commercial	$417.91
Rate for Payer: UnitedHealthcare Community & State	$66.03
Rate for Payer: Wellpoint Medicaid Managed Care	$59.34

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$9,489.90

Service Code	HCPCS 75953
Hospital Charge Code	7411733
Hospital Revenue Code	320
Min. Negotiated Rate	$269.51
Max. Negotiated Rate	$4,744.95
Rate for Payer: Aetna Commercial	$3,606.16
Rate for Payer: Aetna Medicare Advantage	$2,846.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,419.92
Rate for Payer: Cigna Commercial	$4,744.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,467.37
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$299.88
Rate for Payer: Wellpoint Medicaid Managed Care	$269.51

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$9,489.90

Service Code	HCPCS 75953
Hospital Charge Code	2011297
Hospital Revenue Code	320
Min. Negotiated Rate	$269.51
Max. Negotiated Rate	$4,744.95
Rate for Payer: Aetna Commercial	$3,606.16
Rate for Payer: Aetna Medicare Advantage	$2,846.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,419.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,419.92
Rate for Payer: Cigna Commercial	$4,744.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,467.37
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$299.88
Rate for Payer: Wellpoint Medicaid Managed Care	$269.51

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$9,489.90

Service Code	HCPCS 75953
Hospital Charge Code	7411733
Hospital Revenue Code	320
Min. Negotiated Rate	$1,423.48
Max. Negotiated Rate	$1,423.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48

IR ABDOM ANEURYSM ENDOVASC REP

Facility

$9,489.90

Service Code	HCPCS 75953
Hospital Charge Code	2011297
Hospital Revenue Code	320
Min. Negotiated Rate	$1,423.48
Max. Negotiated Rate	$1,423.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48

Know your out-of-pocket cost for care.

All Charges