Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NM INDIUM II,UP TO 6 MCI

Facility

$3,503.00

Hospital Charge Code	4508065
Hospital Revenue Code	343
Min. Negotiated Rate	$99.49
Max. Negotiated Rate	$1,751.50
Rate for Payer: Aetna Commercial	$1,331.14
Rate for Payer: Aetna Medicare Advantage	$1,050.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$893.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$893.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$893.26
Rate for Payer: Cigna Commercial	$1,751.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.78
Rate for Payer: Qualcare PPO/HMO/WC	$525.45
Rate for Payer: UnitedHealthcare Community & State	$110.69
Rate for Payer: Wellpoint Medicaid Managed Care	$99.49

NM INDIUM II,UP TO 6 MCI

Facility

$3,503.00

Hospital Charge Code	4508065
Hospital Revenue Code	343
Min. Negotiated Rate	$525.45
Max. Negotiated Rate	$525.45
Rate for Payer: Qualcare PPO/HMO/WC	$525.45

NM INJECTION KIT

Facility

$134.45

Hospital Charge Code	4500865
Hospital Revenue Code	272
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$67.22
Rate for Payer: Aetna Commercial	$51.09
Rate for Payer: Aetna Medicare Advantage	$40.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.28
Rate for Payer: Cigna Commercial	$67.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.96
Rate for Payer: Oxford Commercial	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$20.17
Rate for Payer: UnitedHealthcare Commercial	$26.89
Rate for Payer: UnitedHealthcare Community & State	$4.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

NM INJECTION KIT

Facility

$134.45

Hospital Charge Code	4500865
Hospital Revenue Code	272
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$20.17
Rate for Payer: Qualcare PPO/HMO/WC	$20.17

NM IODINE 131CAP PERmCi THERAP

Facility

$382.45

Service Code	HCPCS A9517
Hospital Charge Code	4500799
Hospital Revenue Code	344
Min. Negotiated Rate	$57.37
Max. Negotiated Rate	$57.37
Rate for Payer: Qualcare PPO/HMO/WC	$57.37

NM IODINE 131CAP PERmCi THERAP

Facility

$382.45

Service Code	HCPCS A9517
Hospital Charge Code	4500799
Hospital Revenue Code	344
Min. Negotiated Rate	$10.86
Max. Negotiated Rate	$99.44
Rate for Payer: Aetna Commercial	$65.47
Rate for Payer: Aetna Medicare Advantage	$77.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.31
Rate for Payer: Cigna Medicare Advantage	$16.85
Rate for Payer: Clover Medicare Advantage	$22.87
Rate for Payer: EmblemHealth Commercial	$72.21
Rate for Payer: Humana Medicare Advantage	$24.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.44
Rate for Payer: Qualcare PPO/HMO/WC	$57.37
Rate for Payer: UnitedHealthcare Community & State	$12.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.07
Rate for Payer: Wellcare Medicare Advantage	$24.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.86

NM IODINE I-131/0.5 MCI

Facility

$1,637.00

Hospital Charge Code	4508050
Hospital Revenue Code	343
Min. Negotiated Rate	$46.49
Max. Negotiated Rate	$818.50
Rate for Payer: Aetna Commercial	$622.06
Rate for Payer: Aetna Medicare Advantage	$491.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$417.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$417.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$417.44
Rate for Payer: Cigna Commercial	$818.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$425.62
Rate for Payer: Qualcare PPO/HMO/WC	$245.55
Rate for Payer: UnitedHealthcare Community & State	$51.73
Rate for Payer: Wellpoint Medicaid Managed Care	$46.49

NM IODINE I-131/0.5 MCI

Facility

$1,637.00

Hospital Charge Code	4508050
Hospital Revenue Code	343
Min. Negotiated Rate	$245.55
Max. Negotiated Rate	$245.55
Rate for Payer: Qualcare PPO/HMO/WC	$245.55

NM-KIDNEY FUNCT W/O PHARMACOL

Facility

$1,892.00

Service Code	HCPCS 78725
Hospital Charge Code	4508030
Hospital Revenue Code	341
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,722.84
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$491.92
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.80
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$59.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$53.73

NM-KIDNEY FUNCT W/O PHARMACOL

Facility

$1,892.00

Service Code	HCPCS 78725
Hospital Charge Code	4508030
Hospital Revenue Code	341
Min. Negotiated Rate	$283.80
Max. Negotiated Rate	$283.80
Rate for Payer: Qualcare PPO/HMO/WC	$283.80

NM KIDNEY W/VASC F/F

Facility

$12,000.00

Service Code	HCPCS 78707
Hospital Charge Code	4500892
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM KIDNEY W/VASC F/F

Facility

$12,000.00

Service Code	HCPCS 78707
Hospital Charge Code	4500892
Hospital Revenue Code	341
Min. Negotiated Rate	$181.50
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

NM KIDNEY W/VASC FFMULT W/WOPH

Facility

$12,000.00

Service Code	HCPCS 78709
Hospital Charge Code	4500890
Hospital Revenue Code	341
Min. Negotiated Rate	$237.60
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

NM KIDNEY W/VASC FFMULT W/WOPH

Facility

$12,000.00

Service Code	HCPCS 78709
Hospital Charge Code	4500890
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM KIDNEY W/VASC FLOW/FUNC W/P

Facility

$12,000.00

Service Code	HCPCS 78708
Hospital Charge Code	4500888
Hospital Revenue Code	341
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

NM KIDNEY W/VASC FLOW/FUNC W/P

Facility

$12,000.00

Service Code	HCPCS 78708
Hospital Charge Code	4500888
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM LIVER IMAGING STATIC ONLY

Facility

$1,574.00

Service Code	HCPCS 78201
Hospital Charge Code	4500936
Hospital Revenue Code	341
Min. Negotiated Rate	$236.10
Max. Negotiated Rate	$236.10
Rate for Payer: Qualcare PPO/HMO/WC	$236.10

NM LIVER IMAGING STATIC ONLY

Facility

$1,574.00

Service Code	HCPCS 78201
Hospital Charge Code	4500936
Hospital Revenue Code	341
Min. Negotiated Rate	$44.70
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.24
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.10
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$49.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$44.70

NM LIVER SCAN STATIC

Facility

$12,000.00

Service Code	HCPCS 78215
Hospital Charge Code	4500104
Hospital Revenue Code	341
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

NM LIVER SCAN STATIC

Facility

$12,000.00

Service Code	HCPCS 78215
Hospital Charge Code	4500104
Hospital Revenue Code	341
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,722.84
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

NM-LIVER SCAN W/ VASCULAR FLOW

Facility

$1,574.00

Service Code	HCPCS 78202
Hospital Charge Code	4508005
Hospital Revenue Code	341
Min. Negotiated Rate	$236.10
Max. Negotiated Rate	$236.10
Rate for Payer: Qualcare PPO/HMO/WC	$236.10

NM-LIVER SCAN W/ VASCULAR FLOW

Facility

$1,574.00

Service Code	HCPCS 78202
Hospital Charge Code	4508005
Hospital Revenue Code	341
Min. Negotiated Rate	$44.70
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,754.56
Rate for Payer: Aetna Medicare Advantage	$2,089.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,339.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$645.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,339.96
Rate for Payer: Cigna Commercial	$1,293.03
Rate for Payer: Cigna Medicare Advantage	$451.54
Rate for Payer: Clover Medicare Advantage	$612.81
Rate for Payer: EmblemHealth Commercial	$1,935.18
Rate for Payer: Humana Medicare Advantage	$664.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$645.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.24
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$236.10
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$49.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$44.70

NM LIVER SPECT

Facility

$2,309.00

Service Code	HCPCS 78205
Hospital Charge Code	4500450
Hospital Revenue Code	341
Min. Negotiated Rate	$346.35
Max. Negotiated Rate	$346.35
Rate for Payer: Qualcare PPO/HMO/WC	$346.35

NM LIVER SPECT

Facility

$2,309.00

Service Code	HCPCS 78205
Hospital Charge Code	4500450
Hospital Revenue Code	341
Min. Negotiated Rate	$65.58
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$877.42
Rate for Payer: Aetna Medicare Advantage	$692.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$588.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$588.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$588.79
Rate for Payer: Cigna Commercial	$1,154.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.34
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$346.35
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$72.96
Rate for Payer: Wellpoint Medicaid Managed Care	$65.58

NM LIVER SPECT W VAS FLOW

Facility

$12,000.00

Service Code	HCPCS 78206
Hospital Charge Code	4507001
Hospital Revenue Code	341
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

Know your out-of-pocket cost for care.

All Charges