Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TC99M MEDRONATE

Facility

$66.16

Service Code	HCPCS A9503
Hospital Charge Code	4507015
Hospital Revenue Code	343
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$105.60
Rate for Payer: Aetna Commercial	$25.14
Rate for Payer: Aetna Medicare Advantage	$19.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.87
Rate for Payer: Cigna Commercial	$33.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.92
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

TC99M PENTETATE UP TO 75MCI

Facility

$556.50

Service Code	HCPCS A9567
Hospital Charge Code	4509085
Hospital Revenue Code	343
Min. Negotiated Rate	$15.80
Max. Negotiated Rate	$278.25
Rate for Payer: Aetna Commercial	$211.47
Rate for Payer: Aetna Medicare Advantage	$166.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.91
Rate for Payer: Cigna Commercial	$278.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.69
Rate for Payer: Qualcare PPO/HMO/WC	$83.47
Rate for Payer: UnitedHealthcare Community & State	$17.59
Rate for Payer: Wellpoint Medicaid Managed Care	$15.80

TC99M PENTETATE UP TO 75MCI

Facility

$556.50

Service Code	HCPCS A9567
Hospital Charge Code	4509085
Hospital Revenue Code	343
Min. Negotiated Rate	$83.47
Max. Negotiated Rate	$83.47
Rate for Payer: Qualcare PPO/HMO/WC	$83.47

TC99M SESTAMIBI PER STUDY

Facility

$140.00

Service Code	HCPCS A9500
Hospital Charge Code	5309015
Hospital Revenue Code	343
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$88.89
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$42.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.70
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	$35.70
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.40
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

TC99M SESTAMIBI PER STUDY

Facility

$140.00

Service Code	HCPCS A9500
Hospital Charge Code	5309015
Hospital Revenue Code	343
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

TC99M SULFUR COLLOID =/< 20MCI

Facility

$1,030.84

Service Code	HCPCS A9541
Hospital Charge Code	4509089
Hospital Revenue Code	343
Min. Negotiated Rate	$154.63
Max. Negotiated Rate	$154.63
Rate for Payer: Qualcare PPO/HMO/WC	$154.63

TC99M SULFUR COLLOID =/< 20MCI

Facility

$1,030.84

Service Code	HCPCS A9541
Hospital Charge Code	4509089
Hospital Revenue Code	343
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$515.42
Rate for Payer: Aetna Commercial	$391.72
Rate for Payer: Aetna Medicare Advantage	$309.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.86
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	$262.86
Rate for Payer: Cigna Commercial	$515.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.63
Rate for Payer: UnitedHealthcare Community & State	$32.57
Rate for Payer: Wellpoint Medicaid Managed Care	$29.28

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	74115074
Hospital Revenue Code	343
Min. Negotiated Rate	$115.23
Max. Negotiated Rate	$115.23
Rate for Payer: Qualcare PPO/HMO/WC	$115.23

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	94053151
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

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	74117074
Hospital Revenue Code	343
Min. Negotiated Rate	$115.23
Max. Negotiated Rate	$115.23
Rate for Payer: Qualcare PPO/HMO/WC	$115.23

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	5309020
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

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	5309020
Hospital Revenue Code	343
Min. Negotiated Rate	$115.23
Max. Negotiated Rate	$115.23
Rate for Payer: Qualcare PPO/HMO/WC	$115.23

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	94053151
Hospital Revenue Code	343
Min. Negotiated Rate	$115.23
Max. Negotiated Rate	$115.23
Rate for Payer: Qualcare PPO/HMO/WC	$115.23

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	74117074
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

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	74116074
Hospital Revenue Code	343
Min. Negotiated Rate	$115.23
Max. Negotiated Rate	$115.23
Rate for Payer: Qualcare PPO/HMO/WC	$115.23

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	74116074
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

TC 99M TETROFOSMIN PER DS

Facility

$768.19

Service Code	HCPCS A9502
Hospital Charge Code	74115074
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

TC99 OXIDRONATE UP TO 30MCI

Facility

$97.78

Service Code	HCPCS A9561
Hospital Charge Code	4509084
Hospital Revenue Code	343
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$14.67
Rate for Payer: Qualcare PPO/HMO/WC	$14.67

TC99 OXIDRONATE UP TO 30MCI

Facility

$97.78

Service Code	HCPCS A9561
Hospital Charge Code	4509084
Hospital Revenue Code	343
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$72.60
Rate for Payer: Aetna Commercial	$37.16
Rate for Payer: Aetna Medicare Advantage	$29.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.93
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	$24.93
Rate for Payer: Cigna Commercial	$48.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.42
Rate for Payer: Qualcare PPO/HMO/WC	$14.67
Rate for Payer: UnitedHealthcare Community & State	$3.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

TC99 PERTECHNETATE PER MCI

Facility

$78.62

Service Code	HCPCS A9512
Hospital Charge Code	4509088
Hospital Revenue Code	343
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$11.79
Rate for Payer: Qualcare PPO/HMO/WC	$11.79

TC99 PERTECHNETATE PER MCI

Facility

$78.62

Service Code	HCPCS A9512
Hospital Charge Code	4509088
Hospital Revenue Code	343
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$39.31
Rate for Payer: Aetna Commercial	$29.88
Rate for Payer: Aetna Medicare Advantage	$23.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.05
Rate for Payer: Cigna Commercial	$39.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.44
Rate for Payer: Qualcare PPO/HMO/WC	$11.79
Rate for Payer: UnitedHealthcare Community & State	$2.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.23

TC99 PYROPHOSPHATE UP TO 25MCI

Facility

$125.48

Service Code	HCPCS A9538
Hospital Charge Code	4509086
Hospital Revenue Code	343
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$62.74
Rate for Payer: Aetna Commercial	$47.68
Rate for Payer: Aetna Medicare Advantage	$37.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.00
Rate for Payer: Cigna Commercial	$62.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.62
Rate for Payer: Qualcare PPO/HMO/WC	$18.82
Rate for Payer: UnitedHealthcare Community & State	$3.97
Rate for Payer: Wellpoint Medicaid Managed Care	$3.56

TC99 PYROPHOSPHATE UP TO 25MCI

Facility

$125.48

Service Code	HCPCS A9538
Hospital Charge Code	4509086
Hospital Revenue Code	343
Min. Negotiated Rate	$18.82
Max. Negotiated Rate	$18.82
Rate for Payer: Qualcare PPO/HMO/WC	$18.82

TCC CUTIMED OFF-LOADER

Facility

$391.90

Hospital Charge Code	270676385W
Hospital Revenue Code	272
Min. Negotiated Rate	$58.78
Max. Negotiated Rate	$58.78
Rate for Payer: Qualcare PPO/HMO/WC	$58.78

TCC CUTIMED OFF-LOADER

Facility

$391.90

Hospital Charge Code	270676385
Hospital Revenue Code	272
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$195.95
Rate for Payer: Aetna Commercial	$148.92
Rate for Payer: Aetna Medicare Advantage	$117.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.93
Rate for Payer: Cigna Commercial	$195.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.89
Rate for Payer: Oxford Commercial	$78.38
Rate for Payer: Qualcare PPO/HMO/WC	$58.78
Rate for Payer: UnitedHealthcare Commercial	$78.38
Rate for Payer: UnitedHealthcare Community & State	$12.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.13

Know your out-of-pocket cost for care.

All Charges