Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR CATH IN ART INIT 2ND BILAT

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	2101167
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	411036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	2101171
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	2101171
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	366836246L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	411036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	366836246L
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	321036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND LEFT

Facility

$8,697.00

Service Code	HCPCS 36246LT
Hospital Charge Code	321036246L
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	321036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	2101172
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	321036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	411036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	366836246R
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	2101172
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	366836246R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

IR CATH IN ART INIT 2ND RIGHT

Facility

$8,697.00

Service Code	HCPCS 36246RT
Hospital Charge Code	411036246R
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	2101168
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	321036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$493.99
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,522.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$549.65
Rate for Payer: Wellpoint Medicaid Managed Care	$493.99

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	3668362475
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	411036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$493.99
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,522.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$549.65
Rate for Payer: Wellpoint Medicaid Managed Care	$493.99

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	321036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	2101168
Hospital Revenue Code	361
Min. Negotiated Rate	$493.99
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,522.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$549.65
Rate for Payer: Wellpoint Medicaid Managed Care	$493.99

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	411036247B
Hospital Revenue Code	361
Min. Negotiated Rate	$2,609.10
Max. Negotiated Rate	$2,609.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10

IR CATH IN ART INIT 3RD BILAT

Facility

$17,394.00

Service Code	HCPCS 3624750
Hospital Charge Code	3668362475
Hospital Revenue Code	361
Min. Negotiated Rate	$493.99
Max. Negotiated Rate	$8,697.00
Rate for Payer: Aetna Commercial	$6,609.72
Rate for Payer: Aetna Medicare Advantage	$5,218.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,435.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,435.47
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	$4,435.47
Rate for Payer: Cigna Commercial	$8,697.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,522.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,609.10
Rate for Payer: UnitedHealthcare Community & State	$549.65
Rate for Payer: Wellpoint Medicaid Managed Care	$493.99

Know your out-of-pocket cost for care.

All Charges