Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LDCT FOR LUNG CA SCREENING

Facility

$599.85

Service Code	HCPCS G0297
Hospital Charge Code	2250425
Hospital Revenue Code	352
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$3,916.00
Rate for Payer: Aetna Commercial	$227.94
Rate for Payer: Aetna Medicare Advantage	$179.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.96
Rate for Payer: Cigna Commercial	$299.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.96
Rate for Payer: Oxford Commercial	$3,774.00
Rate for Payer: Qualcare PPO/HMO/WC	$89.98
Rate for Payer: UnitedHealthcare Commercial	$3,916.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

LDCT FOR LUNG CA SCREENING

Facility

$599.85

Service Code	HCPCS G0297
Hospital Charge Code	2250425
Hospital Revenue Code	352
Min. Negotiated Rate	$89.98
Max. Negotiated Rate	$89.98
Rate for Payer: Qualcare PPO/HMO/WC	$89.98

LD,FLUID

Facility

$282.00

Service Code	HCPCS 83615
Hospital Charge Code	38479016
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.91
Rate for Payer: Cigna Commercial	$141.00
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.32
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$8.01

LD,FLUID

Facility

$282.00

Service Code	HCPCS 83615
Hospital Charge Code	38479016
Hospital Revenue Code	301
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.30

LDH, CSF

Facility

$419.12

Service Code	HCPCS 83615
Hospital Charge Code	3030939
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$209.56
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.91
Rate for Payer: Cigna Commercial	$209.56
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.87
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.90

LDH, CSF

Facility

$419.12

Service Code	HCPCS 83615
Hospital Charge Code	3030939
Hospital Revenue Code	301
Min. Negotiated Rate	$62.87
Max. Negotiated Rate	$62.87
Rate for Payer: Qualcare PPO/HMO/WC	$62.87

LDH ISOENZYMES I

Facility

$390.00

Service Code	HCPCS 83615
Hospital Charge Code	39990135A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.91
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
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	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LDH ISOENZYMES I

Facility

$390.00

Service Code	HCPCS 83615
Hospital Charge Code	39990135A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LDH ISOENZYMES II

Facility

$390.00

Service Code	HCPCS 83625
Hospital Charge Code	39990135B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LDH ISOENZYMES II

Facility

$390.00

Service Code	HCPCS 83625
Hospital Charge Code	39990135B
Hospital Revenue Code	301
Min. Negotiated Rate	$10.23
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$34.79
Rate for Payer: Aetna Medicare Advantage	$41.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.40
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.79
Rate for Payer: Clover Medicare Advantage	$12.15
Rate for Payer: EmblemHealth Commercial	$38.37
Rate for Payer: Humana Medicare Advantage	$13.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.79
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	$10.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.79
Rate for Payer: Wellcare Medicare Advantage	$12.79
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LDH PERITONEAL FLUID

Facility

$717.44

Service Code	HCPCS 83615
Hospital Charge Code	3000513
Hospital Revenue Code	301
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$358.72
Rate for Payer: Aetna Commercial	$16.43
Rate for Payer: Aetna Medicare Advantage	$19.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.91
Rate for Payer: Cigna Commercial	$358.72
Rate for Payer: Cigna Medicare Advantage	$6.04
Rate for Payer: Clover Medicare Advantage	$5.74
Rate for Payer: EmblemHealth Commercial	$18.12
Rate for Payer: Humana Medicare Advantage	$6.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$186.53
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$107.62
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.04
Rate for Payer: Wellcare Medicare Advantage	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$20.38

LDH PERITONEAL FLUID

Facility

$717.44

Service Code	HCPCS 83615
Hospital Charge Code	3000513
Hospital Revenue Code	301
Min. Negotiated Rate	$107.62
Max. Negotiated Rate	$107.62
Rate for Payer: Qualcare PPO/HMO/WC	$107.62

LD ISOENZYMES

Facility

$349.00

Service Code	HCPCS 83625
Hospital Charge Code	38472010
Hospital Revenue Code	301
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

LD ISOENZYMES

Facility

$349.00

Service Code	HCPCS 83625
Hospital Charge Code	38472010
Hospital Revenue Code	301
Min. Negotiated Rate	$9.91
Max. Negotiated Rate	$174.50
Rate for Payer: Aetna Commercial	$34.79
Rate for Payer: Aetna Medicare Advantage	$41.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.40
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: Cigna Medicare Advantage	$12.79
Rate for Payer: Clover Medicare Advantage	$12.15
Rate for Payer: EmblemHealth Commercial	$38.37
Rate for Payer: Humana Medicare Advantage	$13.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.79
Rate for Payer: Wellcare Medicare Advantage	$12.79
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

L&D NITROUS OXIDE ANALGESIA

Facility

$15.29

Hospital Charge Code	3190999015
Hospital Revenue Code	270
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Qualcare PPO/HMO/WC	$2.29

L&D NITROUS OXIDE ANALGESIA

Facility

$15.29

Hospital Charge Code	3190999015
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.64
Rate for Payer: Aetna Commercial	$5.81
Rate for Payer: Aetna Medicare Advantage	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.90
Rate for Payer: Cigna Commercial	$7.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.98
Rate for Payer: Oxford Commercial	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.29
Rate for Payer: UnitedHealthcare Commercial	$3.06
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

L&D OR: 106-120 MIN

Facility

$13,230.00

Hospital Charge Code	7319093
Hospital Revenue Code	360
Min. Negotiated Rate	$1,984.50
Max. Negotiated Rate	$1,984.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,984.50

L&D OR: 106-120 MIN

Facility

$13,230.00

Hospital Charge Code	7319093
Hospital Revenue Code	360
Min. Negotiated Rate	$375.73
Max. Negotiated Rate	$6,615.00
Rate for Payer: Aetna Commercial	$5,027.40
Rate for Payer: Aetna Medicare Advantage	$3,969.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,373.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,373.65
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	$3,373.65
Rate for Payer: Cigna Commercial	$6,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,439.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,984.50
Rate for Payer: UnitedHealthcare Community & State	$418.07
Rate for Payer: Wellpoint Medicaid Managed Care	$375.73

L&D OR: 1-15 MIN

Facility

$1,654.00

Hospital Charge Code	7319079
Hospital Revenue Code	360
Min. Negotiated Rate	$248.10
Max. Negotiated Rate	$248.10
Rate for Payer: Qualcare PPO/HMO/WC	$248.10

L&D OR: 1-15 MIN

Facility

$1,654.00

Hospital Charge Code	7319079
Hospital Revenue Code	360
Min. Negotiated Rate	$46.97
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$628.52
Rate for Payer: Aetna Medicare Advantage	$496.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$421.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$421.77
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	$421.77
Rate for Payer: Cigna Commercial	$827.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$430.04
Rate for Payer: Qualcare PPO/HMO/WC	$248.10
Rate for Payer: UnitedHealthcare Community & State	$52.27
Rate for Payer: Wellpoint Medicaid Managed Care	$46.97

L&D OR: 121-135 MIN

Facility

$14,884.00

Hospital Charge Code	7319095
Hospital Revenue Code	360
Min. Negotiated Rate	$2,232.60
Max. Negotiated Rate	$2,232.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,232.60

L&D OR: 121-135 MIN

Facility

$14,884.00

Hospital Charge Code	7319095
Hospital Revenue Code	360
Min. Negotiated Rate	$422.71
Max. Negotiated Rate	$7,442.00
Rate for Payer: Aetna Commercial	$5,655.92
Rate for Payer: Aetna Medicare Advantage	$4,465.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,795.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,795.42
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	$3,795.42
Rate for Payer: Cigna Commercial	$7,442.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,869.84
Rate for Payer: Qualcare PPO/HMO/WC	$2,232.60
Rate for Payer: UnitedHealthcare Community & State	$470.33
Rate for Payer: Wellpoint Medicaid Managed Care	$422.71

L&D OR: 136-150 MIN

Facility

$16,538.00

Hospital Charge Code	7319097
Hospital Revenue Code	360
Min. Negotiated Rate	$469.68
Max. Negotiated Rate	$8,269.00
Rate for Payer: Aetna Commercial	$6,284.44
Rate for Payer: Aetna Medicare Advantage	$4,961.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,217.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,217.19
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	$4,217.19
Rate for Payer: Cigna Commercial	$8,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,299.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,480.70
Rate for Payer: UnitedHealthcare Community & State	$522.60
Rate for Payer: Wellpoint Medicaid Managed Care	$469.68

L&D OR: 136-150 MIN

Facility

$16,538.00

Hospital Charge Code	7319097
Hospital Revenue Code	360
Min. Negotiated Rate	$2,480.70
Max. Negotiated Rate	$2,480.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,480.70

L&D OR: 151-165 MIN

Facility

$18,191.00

Hospital Charge Code	7319099
Hospital Revenue Code	360
Min. Negotiated Rate	$516.62
Max. Negotiated Rate	$9,095.50
Rate for Payer: Aetna Commercial	$6,912.58
Rate for Payer: Aetna Medicare Advantage	$5,457.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,638.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,638.70
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	$4,638.70
Rate for Payer: Cigna Commercial	$9,095.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,729.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,728.65
Rate for Payer: UnitedHealthcare Community & State	$574.84
Rate for Payer: Wellpoint Medicaid Managed Care	$516.62

Know your out-of-pocket cost for care.

All Charges