Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NM TC99 SESTAMIBI, DOSE

Facility

$795.00

Service Code	HCPCS A9500
Hospital Charge Code	4500658
Hospital Revenue Code	343
Min. Negotiated Rate	$22.58
Max. Negotiated Rate	$397.50
Rate for Payer: Aetna Commercial	$302.10
Rate for Payer: Aetna Medicare Advantage	$238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.72
Rate for Payer: Cigna Commercial	$397.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.70
Rate for Payer: Qualcare PPO/HMO/WC	$119.25
Rate for Payer: UnitedHealthcare Community & State	$25.12
Rate for Payer: Wellpoint Medicaid Managed Care	$22.58

NM TC99 SESTAMIBI, DOSE

Facility

$795.00

Service Code	HCPCS A9500
Hospital Charge Code	4500658
Hospital Revenue Code	343
Min. Negotiated Rate	$119.25
Max. Negotiated Rate	$119.25
Rate for Payer: Qualcare PPO/HMO/WC	$119.25

NM TC99 SULPHUR COLL DOSE UP T

Facility

$201.00

Service Code	HCPCS A9541
Hospital Charge Code	4500306
Hospital Revenue Code	343
Min. Negotiated Rate	$30.15
Max. Negotiated Rate	$30.15
Rate for Payer: Qualcare PPO/HMO/WC	$30.15

NM TC99 SULPHUR COLL DOSE UP T

Facility

$201.00

Service Code	HCPCS A9541
Hospital Charge Code	4500306
Hospital Revenue Code	343
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$146.85
Rate for Payer: Aetna Commercial	$76.38
Rate for Payer: Aetna Medicare Advantage	$60.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$146.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.26
Rate for Payer: Cigna Commercial	$100.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$30.15
Rate for Payer: UnitedHealthcare Community & State	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5.71

NM TESTICULAR IMAGING

Facility

$1,908.00

Service Code	HCPCS 78761
Hospital Charge Code	4500997
Hospital Revenue Code	341
Min. Negotiated Rate	$54.19
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	$92.40
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	$496.08
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$286.20
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$60.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$54.19

NM TESTICULAR IMAGING

Facility

$1,908.00

Service Code	HCPCS 78761
Hospital Charge Code	4500997
Hospital Revenue Code	341
Min. Negotiated Rate	$286.20
Max. Negotiated Rate	$286.20
Rate for Payer: Qualcare PPO/HMO/WC	$286.20

NM TESTICULAR SCAN

Facility

$12,000.00

Service Code	HCPCS 78761
Hospital Charge Code	4500377
Hospital Revenue Code	341
Min. Negotiated Rate	$92.40
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	$92.40
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 TESTICULAR SCAN

Facility

$12,000.00

Service Code	HCPCS 78761
Hospital Charge Code	4500377
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 THYROID IMAGING ONLY

Facility

$788.00

Service Code	HCPCS 78010
Hospital Charge Code	4507005
Hospital Revenue Code	341
Min. Negotiated Rate	$118.20
Max. Negotiated Rate	$118.20
Rate for Payer: Qualcare PPO/HMO/WC	$118.20

NM THYROID IMAGING ONLY

Facility

$788.00

Service Code	HCPCS 78010
Hospital Charge Code	4507005
Hospital Revenue Code	341
Min. Negotiated Rate	$22.38
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$299.44
Rate for Payer: Aetna Medicare Advantage	$236.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$200.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$200.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$200.94
Rate for Payer: Cigna Commercial	$394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.88
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.20
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$24.90
Rate for Payer: Wellpoint Medicaid Managed Care	$22.38

NM-THYROID IMAGING W/UPTAKE S

Facility

$2,043.00

Service Code	HCPCS 78014
Hospital Charge Code	4507010
Hospital Revenue Code	341
Min. Negotiated Rate	$58.02
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	$178.99
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	$531.18
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$306.45
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$64.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$58.02

NM-THYROID IMAGING W/UPTAKE S

Facility

$2,043.00

Service Code	HCPCS 78014
Hospital Charge Code	4507010
Hospital Revenue Code	341
Min. Negotiated Rate	$306.45
Max. Negotiated Rate	$306.45
Rate for Payer: Qualcare PPO/HMO/WC	$306.45

NM THYROID METS IMAG W ADD ST

Facility

$1,722.00

Service Code	HCPCS 78016
Hospital Charge Code	4500934
Hospital Revenue Code	341
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$258.30
Rate for Payer: Qualcare PPO/HMO/WC	$258.30

NM THYROID METS IMAG W ADD ST

Facility

$1,722.00

Service Code	HCPCS 78016
Hospital Charge Code	4500934
Hospital Revenue Code	341
Min. Negotiated Rate	$48.90
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	$101.64
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	$447.72
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.30
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$54.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$48.90

NM THYROID METS IMA LIMIT AREA

Facility

$1,722.00

Service Code	HCPCS 78015
Hospital Charge Code	4500900
Hospital Revenue Code	341
Min. Negotiated Rate	$258.30
Max. Negotiated Rate	$258.30
Rate for Payer: Qualcare PPO/HMO/WC	$258.30

NM THYROID METS IMA LIMIT AREA

Facility

$1,722.00

Service Code	HCPCS 78015
Hospital Charge Code	4500900
Hospital Revenue Code	341
Min. Negotiated Rate	$48.90
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	$82.50
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	$447.72
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$258.30
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$54.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellpoint Medicaid Managed Care	$48.90

NM THYROID METS IMA WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78018
Hospital Charge Code	4500902
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 THYROID METS IMA WHOLE BODY

Facility

$12,000.00

Service Code	HCPCS 78018
Hospital Charge Code	4500902
Hospital Revenue Code	341
Min. Negotiated Rate	$161.70
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	$161.70
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	$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-THYROID UPTAKE ONLY

Facility

$688.00

Service Code	HCPCS 78000
Hospital Charge Code	4508001
Hospital Revenue Code	341
Min. Negotiated Rate	$103.20
Max. Negotiated Rate	$103.20
Rate for Payer: Qualcare PPO/HMO/WC	$103.20

NM-THYROID UPTAKE ONLY

Facility

$688.00

Service Code	HCPCS 78000
Hospital Charge Code	4508001
Hospital Revenue Code	341
Min. Negotiated Rate	$19.54
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$261.44
Rate for Payer: Aetna Medicare Advantage	$206.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$175.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$175.44
Rate for Payer: Cigna Commercial	$344.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$178.88
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$103.20
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$21.74
Rate for Payer: Wellpoint Medicaid Managed Care	$19.54

NM TL201 (EA mCi)

Facility

$237.00

Hospital Charge Code	4500666
Hospital Revenue Code	343
Min. Negotiated Rate	$6.73
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$90.06
Rate for Payer: Aetna Medicare Advantage	$71.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.44
Rate for Payer: Cigna Commercial	$118.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.62
Rate for Payer: Qualcare PPO/HMO/WC	$35.55
Rate for Payer: UnitedHealthcare Community & State	$7.49
Rate for Payer: Wellpoint Medicaid Managed Care	$6.73

NM TL201 (EA mCi)

Facility

$237.00

Hospital Charge Code	4500666
Hospital Revenue Code	343
Min. Negotiated Rate	$35.55
Max. Negotiated Rate	$35.55
Rate for Payer: Qualcare PPO/HMO/WC	$35.55

NM TUMOR LCLZATN/WHLE BDY 2+DY

Facility

$2,820.00

Service Code	HCPCS 78804
Hospital Charge Code	4501013
Hospital Revenue Code	341
Min. Negotiated Rate	$423.00
Max. Negotiated Rate	$423.00
Rate for Payer: Qualcare PPO/HMO/WC	$423.00

NM TUMOR LCLZATN/WHLE BDY 2+DY

Facility

$2,820.00

Service Code	HCPCS 78804
Hospital Charge Code	4501013
Hospital Revenue Code	341
Min. Negotiated Rate	$80.09
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	$324.56
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	$733.20
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$423.00
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$89.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$645.06
Rate for Payer: Wellcare Medicare Advantage	$645.06
Rate for Payer: Wellpoint Medicaid Managed Care	$80.09

NM TUMOR LOCALIZATION LIMITED

Facility

$12,000.00

Service Code	HCPCS 78800
Hospital Charge Code	4500690
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

Know your out-of-pocket cost for care.

All Charges