Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NM TC99 ALBUMIN 0019N350A1 DOS

Facility

$267.00

Service Code	HCPCS A9540
Hospital Charge Code	4500864
Hospital Revenue Code	343
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$40.05
Rate for Payer: Qualcare PPO/HMO/WC	$40.05

NM TC99 CERETEC DOSE UP TO 25M

Facility

$4,309.00

Service Code	HCPCS A9521
Hospital Charge Code	4500849
Hospital Revenue Code	343
Min. Negotiated Rate	$122.38
Max. Negotiated Rate	$2,154.50
Rate for Payer: Aetna Commercial	$1,637.42
Rate for Payer: Aetna Medicare Advantage	$1,292.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,098.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,098.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,150.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,098.80
Rate for Payer: Cigna Commercial	$2,154.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,120.34
Rate for Payer: Qualcare PPO/HMO/WC	$646.35
Rate for Payer: UnitedHealthcare Community & State	$136.16
Rate for Payer: Wellpoint Medicaid Managed Care	$122.38

NM TC99 CERETEC DOSE UP TO 25M

Facility

$4,309.00

Service Code	HCPCS A9521
Hospital Charge Code	4500849
Hospital Revenue Code	343
Min. Negotiated Rate	$646.35
Max. Negotiated Rate	$646.35
Rate for Payer: Qualcare PPO/HMO/WC	$646.35

NM TC99 DEPREOTIDE DOSE UP TO

Facility

$3,332.00

Hospital Charge Code	4500299
Hospital Revenue Code	343
Min. Negotiated Rate	$499.80
Max. Negotiated Rate	$499.80
Rate for Payer: Qualcare PPO/HMO/WC	$499.80

NM TC99 DEPREOTIDE DOSE UP TO

Facility

$3,332.00

Hospital Charge Code	4500299
Hospital Revenue Code	343
Min. Negotiated Rate	$94.63
Max. Negotiated Rate	$1,666.00
Rate for Payer: Aetna Commercial	$1,266.16
Rate for Payer: Aetna Medicare Advantage	$999.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$849.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$849.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$849.66
Rate for Payer: Cigna Commercial	$1,666.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$866.32
Rate for Payer: Qualcare PPO/HMO/WC	$499.80
Rate for Payer: UnitedHealthcare Community & State	$105.29
Rate for Payer: Wellpoint Medicaid Managed Care	$94.63

NM TC99 LABELED RBC DOSE UP TO

Facility

$134.00

Service Code	HCPCS A9560
Hospital Charge Code	4500304
Hospital Revenue Code	343
Min. Negotiated Rate	$20.10
Max. Negotiated Rate	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$20.10

NM TC99 LABELED RBC DOSE UP TO

Facility

$134.00

Service Code	HCPCS A9560
Hospital Charge Code	4500304
Hospital Revenue Code	343
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$183.15
Rate for Payer: Aetna Commercial	$50.92
Rate for Payer: Aetna Medicare Advantage	$40.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$183.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.17
Rate for Payer: Cigna Commercial	$67.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.84
Rate for Payer: Qualcare PPO/HMO/WC	$20.10
Rate for Payer: UnitedHealthcare Community & State	$4.23
Rate for Payer: Wellpoint Medicaid Managed Care	$3.81

NM TC99M ALBUMIN AGGRPERVIAL

Facility

$2,093.50

Service Code	HCPCS A9524
Hospital Charge Code	4509025
Hospital Revenue Code	343
Min. Negotiated Rate	$314.02
Max. Negotiated Rate	$314.02
Rate for Payer: Qualcare PPO/HMO/WC	$314.02

NM TC99M ALBUMIN AGGRPERVIAL

Facility

$2,093.50

Service Code	HCPCS A9524
Hospital Charge Code	4509025
Hospital Revenue Code	343
Min. Negotiated Rate	$59.46
Max. Negotiated Rate	$1,046.75
Rate for Payer: Aetna Commercial	$795.53
Rate for Payer: Aetna Medicare Advantage	$628.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.84
Rate for Payer: Cigna Commercial	$1,046.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.31
Rate for Payer: Qualcare PPO/HMO/WC	$314.02
Rate for Payer: UnitedHealthcare Community & State	$66.15
Rate for Payer: Wellpoint Medicaid Managed Care	$59.46

NM TC 99M DISOFENIN UP TO 15 M

Facility

$61.00

Service Code	HCPCS A9510
Hospital Charge Code	4508045
Hospital Revenue Code	343
Min. Negotiated Rate	$9.15
Max. Negotiated Rate	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.15

NM TC 99M DISOFENIN UP TO 15 M

Facility

$61.00

Service Code	HCPCS A9510
Hospital Charge Code	4508045
Hospital Revenue Code	343
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$113.85
Rate for Payer: Aetna Commercial	$23.18
Rate for Payer: Aetna Medicare Advantage	$18.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.55
Rate for Payer: Cigna Commercial	$30.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$9.15
Rate for Payer: UnitedHealthcare Community & State	$1.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1.73

NM TC99 MERTIATIDE MAG 3 DOSE

Facility

$557.00

Hospital Charge Code	4500765
Hospital Revenue Code	343
Min. Negotiated Rate	$15.82
Max. Negotiated Rate	$278.50
Rate for Payer: Aetna Commercial	$211.66
Rate for Payer: Aetna Medicare Advantage	$167.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.03
Rate for Payer: Cigna Commercial	$278.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.82
Rate for Payer: Qualcare PPO/HMO/WC	$83.55
Rate for Payer: UnitedHealthcare Community & State	$17.60
Rate for Payer: Wellpoint Medicaid Managed Care	$15.82

NM TC99 MERTIATIDE MAG 3 DOSE

Facility

$557.00

Hospital Charge Code	4500765
Hospital Revenue Code	343
Min. Negotiated Rate	$83.55
Max. Negotiated Rate	$83.55
Rate for Payer: Qualcare PPO/HMO/WC	$83.55

NM TC-99M SUCCIMER,UP TO 10 MC

Facility

$803.00

Hospital Charge Code	4508060
Hospital Revenue Code	343
Min. Negotiated Rate	$120.45
Max. Negotiated Rate	$120.45
Rate for Payer: Qualcare PPO/HMO/WC	$120.45

NM TC-99M SUCCIMER,UP TO 10 MC

Facility

$803.00

Hospital Charge Code	4508060
Hospital Revenue Code	343
Min. Negotiated Rate	$22.81
Max. Negotiated Rate	$401.50
Rate for Payer: Aetna Commercial	$305.14
Rate for Payer: Aetna Medicare Advantage	$240.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.76
Rate for Payer: Cigna Commercial	$401.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.78
Rate for Payer: Qualcare PPO/HMO/WC	$120.45
Rate for Payer: UnitedHealthcare Community & State	$25.37
Rate for Payer: Wellpoint Medicaid Managed Care	$22.81

NM TC99 MYOVIEW, PER DOSE

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	4500659
Hospital Revenue Code	343
Min. Negotiated Rate	$115.23
Max. Negotiated Rate	$115.23
Rate for Payer: Qualcare PPO/HMO/WC	$115.23

NM TC99 MYOVIEW, PER DOSE

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	4500659
Hospital Revenue Code	343
Min. Negotiated Rate	$21.82
Max. Negotiated Rate	$384.10
Rate for Payer: Aetna Commercial	$291.91
Rate for Payer: Aetna Medicare Advantage	$230.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$195.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$195.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$195.89
Rate for Payer: Cigna Commercial	$384.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.73
Rate for Payer: Qualcare PPO/HMO/WC	$115.23
Rate for Payer: UnitedHealthcare Community & State	$24.27
Rate for Payer: Wellpoint Medicaid Managed Care	$21.82

NM TC99 OXIDRONATE HDP DOSE UP

Facility

$106.00

Service Code	HCPCS A9561
Hospital Charge Code	4500308
Hospital Revenue Code	343
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

NM TC99 OXIDRONATE HDP DOSE UP

Facility

$106.00

Service Code	HCPCS A9561
Hospital Charge Code	4500308
Hospital Revenue Code	343
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$72.60
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

NM TC99 PENTETATE DTPA DOSE UP

Facility

$115.00

Service Code	HCPCS A9539
Hospital Charge Code	4500300
Hospital Revenue Code	343
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$57.50
Rate for Payer: Aetna Commercial	$43.70
Rate for Payer: Aetna Medicare Advantage	$34.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.32
Rate for Payer: Cigna Commercial	$57.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.90
Rate for Payer: Qualcare PPO/HMO/WC	$17.25
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

NM TC99 PENTETATE DTPA DOSE UP

Facility

$115.00

Service Code	HCPCS A9539
Hospital Charge Code	4500300
Hospital Revenue Code	343
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$17.25
Rate for Payer: Qualcare PPO/HMO/WC	$17.25

NM TC99 PERTECHNETATE PER MCI

Facility

$62.10

Hospital Charge Code	4500309
Hospital Revenue Code	343
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

NM TC99 PERTECHNETATE PER MCI

Facility

$62.10

Hospital Charge Code	4500309
Hospital Revenue Code	343
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.15
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

NM TC99 PYP DOSE UP TO 25MCI

Facility

$117.00

Hospital Charge Code	4500298
Hospital Revenue Code	343
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare Advantage	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.84
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.42
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Community & State	$3.70
Rate for Payer: Wellpoint Medicaid Managed Care	$3.32

NM TC99 PYP DOSE UP TO 25MCI

Facility

$117.00

Hospital Charge Code	4500298
Hospital Revenue Code	343
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

Know your out-of-pocket cost for care.

All Charges