Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IRR NOZZLE-MED F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674695
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE-MED F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674695
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRR NOZZLE-SHORT F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674694
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRR NOZZLE-SHORT F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674694
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IRR NOZZLE XXL F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674703
Hospital Revenue Code	272
Min. Negotiated Rate	$23.66
Max. Negotiated Rate	$416.50
Rate for Payer: Aetna Commercial	$316.54
Rate for Payer: Aetna Medicare Advantage	$249.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$212.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$212.41
Rate for Payer: Cigna Commercial	$416.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$216.58
Rate for Payer: Oxford Commercial	$166.60
Rate for Payer: Qualcare PPO/HMO/WC	$124.95
Rate for Payer: UnitedHealthcare Commercial	$166.60
Rate for Payer: UnitedHealthcare Community & State	$26.32
Rate for Payer: Wellpoint Medicaid Managed Care	$23.66

IRR NOZZLE XXL F/E-PEN DRIVE

Facility

$833.00

Hospital Charge Code	270674703
Hospital Revenue Code	272
Min. Negotiated Rate	$124.95
Max. Negotiated Rate	$124.95
Rate for Payer: Qualcare PPO/HMO/WC	$124.95

IR-SEL CATH PLACET 1ST-RT

Facility

$242.00

Service Code	HCPCS 36011RT
Hospital Charge Code	321036011R
Hospital Revenue Code	361
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

IR-SEL CATH PLACET 1ST-RT

Facility

$242.00

Service Code	HCPCS 36011RT
Hospital Charge Code	2691160
Hospital Revenue Code	361
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

IR-SEL CATH PLACET 1ST-RT

Facility

$242.00

Service Code	HCPCS 36011RT
Hospital Charge Code	321036011R
Hospital Revenue Code	361
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$91.96
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
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	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

IR-SEL CATH PLACET 1ST-RT

Facility

$242.00

Service Code	HCPCS 36011RT
Hospital Charge Code	2691160
Hospital Revenue Code	361
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$91.96
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
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	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

IR SEL EACH INTRACRANIAL BRANC

Facility

$18,125.00

Service Code	HCPCS 36228
Hospital Charge Code	7411430
Hospital Revenue Code	361
Min. Negotiated Rate	$514.75
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$6,887.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
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	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.50
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$572.75
Rate for Payer: Wellpoint Medicaid Managed Care	$514.75

IR SEL EACH INTRACRANIAL BRANC

Facility

$18,125.00

Service Code	HCPCS 36228
Hospital Charge Code	2680180
Hospital Revenue Code	361
Min. Negotiated Rate	$514.75
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$6,887.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
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	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.50
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$572.75
Rate for Payer: Wellpoint Medicaid Managed Care	$514.75

IR SEL EACH INTRACRANIAL BRANC

Facility

$18,125.00

Service Code	HCPCS 36228
Hospital Charge Code	7411430A
Hospital Revenue Code	361
Min. Negotiated Rate	$514.75
Max. Negotiated Rate	$9,062.50
Rate for Payer: Aetna Commercial	$6,887.50
Rate for Payer: Aetna Medicare Advantage	$5,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,621.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,621.88
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	$4,621.88
Rate for Payer: Cigna Commercial	$9,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,712.50
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$572.75
Rate for Payer: Wellpoint Medicaid Managed Care	$514.75

IR SEL EACH INTRACRANIAL BRANC

Facility

$18,125.00

Service Code	HCPCS 36228
Hospital Charge Code	7411430A
Hospital Revenue Code	361
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$2,718.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

IR SEL EACH INTRACRANIAL BRANC

Facility

$18,125.00

Service Code	HCPCS 36228
Hospital Charge Code	7411430
Hospital Revenue Code	361
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$2,718.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

IR SEL EACH INTRACRANIAL BRANC

Facility

$18,125.00

Service Code	HCPCS 36228
Hospital Charge Code	2680180
Hospital Revenue Code	361
Min. Negotiated Rate	$2,718.75
Max. Negotiated Rate	$2,718.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,718.75

IR SEL VEN CATH 1ST ORD

Facility

$242.00

Service Code	HCPCS 36011
Hospital Charge Code	2680170
Hospital Revenue Code	361
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$91.96
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
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	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$7.65

IR SEL VEN CATH 1ST ORD

Facility

$2,053.00

Service Code	HCPCS 36011
Hospital Charge Code	7411415
Hospital Revenue Code	361
Min. Negotiated Rate	$307.95
Max. Negotiated Rate	$307.95
Rate for Payer: Qualcare PPO/HMO/WC	$307.95

IR SEL VEN CATH 1ST ORD

Facility

$242.00

Service Code	HCPCS 36011
Hospital Charge Code	321036011
Hospital Revenue Code	361
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

IR SEL VEN CATH 1ST ORD

Facility

$2,053.00

Service Code	HCPCS 36011
Hospital Charge Code	7411415
Hospital Revenue Code	361
Min. Negotiated Rate	$64.87
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$780.14
Rate for Payer: Aetna Medicare Advantage	$615.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$523.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$523.51
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	$523.51
Rate for Payer: Cigna Commercial	$1,026.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.78
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.95
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$64.87

IR SEL VEN CATH 1ST ORD

Facility

$242.00

Service Code	HCPCS 36011
Hospital Charge Code	321036011
Hospital Revenue Code	361
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$91.96
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
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	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$7.65

IR SEL VEN CATH 1ST ORD

Facility

$242.00

Service Code	HCPCS 36011
Hospital Charge Code	2680170
Hospital Revenue Code	361
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

IR SEL VEN CATH 2ND ORD

Facility

$2,919.00

Service Code	HCPCS 36012
Hospital Charge Code	7411416
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

IR SEL VEN CATH 2ND ORD

Facility

$2,919.00

Service Code	HCPCS 36012
Hospital Charge Code	321036012
Hospital Revenue Code	361
Min. Negotiated Rate	$437.85
Max. Negotiated Rate	$437.85
Rate for Payer: Qualcare PPO/HMO/WC	$437.85

IR SEL VEN CATH 2ND ORD

Facility

$2,919.00

Service Code	HCPCS 36012
Hospital Charge Code	321036012
Hospital Revenue Code	361
Min. Negotiated Rate	$82.90
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,109.22
Rate for Payer: Aetna Medicare Advantage	$875.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$744.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$744.35
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	$744.35
Rate for Payer: Cigna Commercial	$1,459.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$758.94
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.85
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$92.24
Rate for Payer: Wellpoint Medicaid Managed Care	$82.90

Know your out-of-pocket cost for care.

All Charges