Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CARDIOVERSION (ELECTIVE)

Facility

$6,070.00

Service Code	HCPCS 92960
Hospital Charge Code	5100078
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

CARDIOVERSION (ELECTIVE)

Facility

$2,190.00

Service Code	HCPCS 92960
Hospital Charge Code	5309040
Hospital Revenue Code	480
Min. Negotiated Rate	$62.20
Max. Negotiated Rate	$2,848.39
Rate for Payer: Aetna Commercial	$2,135.80
Rate for Payer: Aetna Medicare Advantage	$2,544.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,848.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,848.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$785.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,848.39
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: Cigna Medicare Advantage	$785.22
Rate for Payer: Clover Medicare Advantage	$745.96
Rate for Payer: EmblemHealth Commercial	$2,355.66
Rate for Payer: Humana Medicare Advantage	$808.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$785.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$569.40
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$328.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$69.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$785.22
Rate for Payer: Wellcare Medicare Advantage	$785.22
Rate for Payer: Wellpoint Medicaid Managed Care	$62.20

CARDIOVERSION (ELECTIVE)

Facility

$6,070.00

Service Code	HCPCS 92960
Hospital Charge Code	5100078
Hospital Revenue Code	480
Min. Negotiated Rate	$172.39
Max. Negotiated Rate	$2,848.39
Rate for Payer: Aetna Commercial	$2,135.80
Rate for Payer: Aetna Medicare Advantage	$2,544.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,848.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,848.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$785.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,848.39
Rate for Payer: Cigna Commercial	$1,573.96
Rate for Payer: Cigna Medicare Advantage	$785.22
Rate for Payer: Clover Medicare Advantage	$745.96
Rate for Payer: EmblemHealth Commercial	$2,355.66
Rate for Payer: Humana Medicare Advantage	$808.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$785.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.20
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$191.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$785.22
Rate for Payer: Wellcare Medicare Advantage	$785.22
Rate for Payer: Wellpoint Medicaid Managed Care	$172.39

CARDIZEM/120MG/TAB

Facility

$19.30

Service Code	NDC 93032101
Hospital Charge Code	60632635
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

CARDIZEM/120MG/TAB

Facility

$19.30

Service Code	NDC 93032101
Hospital Charge Code	60632635
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

CARDIZEM/90MG/TAB

Facility

$14.34

Service Code	NDC 93032001
Hospital Charge Code	60632633
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.17
Rate for Payer: Aetna Commercial	$5.45
Rate for Payer: Aetna Medicare Advantage	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.66
Rate for Payer: Cigna Commercial	$7.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.73
Rate for Payer: Oxford Commercial	$2.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.15
Rate for Payer: UnitedHealthcare Commercial	$2.87
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

CARDIZEM/90MG/TAB

Facility

$14.34

Service Code	NDC 93032001
Hospital Charge Code	60632633
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$2.15

CARDIZEM SR/60MG/CAP

Facility

$21.24

Service Code	NDC 378606001
Hospital Charge Code	60632640
Hospital Revenue Code	250
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.19

CARDIZEM SR/60MG/CAP

Facility

$21.24

Service Code	NDC 378606001
Hospital Charge Code	60632640
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$10.62
Rate for Payer: Aetna Commercial	$8.07
Rate for Payer: Aetna Medicare Advantage	$6.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.42
Rate for Payer: Cigna Commercial	$10.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.52
Rate for Payer: Oxford Commercial	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.19
Rate for Payer: UnitedHealthcare Commercial	$4.25
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

CARD TOMOGRAPHIC MULT STUDIES

Facility

$6,315.40

Service Code	HCPCS 78452
Hospital Charge Code	36540005
Hospital Revenue Code	341
Min. Negotiated Rate	$179.36
Max. Negotiated Rate	$5,579.39
Rate for Payer: Aetna Commercial	$4,183.58
Rate for Payer: Aetna Medicare Advantage	$4,983.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,579.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,538.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,579.39
Rate for Payer: Cigna Commercial	$3,083.08
Rate for Payer: Cigna Medicare Advantage	$1,076.66
Rate for Payer: Clover Medicare Advantage	$1,461.18
Rate for Payer: EmblemHealth Commercial	$4,614.24
Rate for Payer: Humana Medicare Advantage	$1,584.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,538.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,642.00
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$947.31
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$199.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,538.08
Rate for Payer: Wellcare Medicare Advantage	$1,538.08
Rate for Payer: Wellpoint Medicaid Managed Care	$179.36

CARD TOMOGRAPHIC MULT STUDIES

Facility

$6,315.40

Service Code	HCPCS 78452
Hospital Charge Code	36540005
Hospital Revenue Code	341
Min. Negotiated Rate	$947.31
Max. Negotiated Rate	$947.31
Rate for Payer: Qualcare PPO/HMO/WC	$947.31

CARD US STRESS ECHO/CONTRAST

Facility

$3,311.10

Hospital Charge Code	5308010
Hospital Revenue Code	483
Min. Negotiated Rate	$496.67
Max. Negotiated Rate	$496.67
Rate for Payer: Qualcare PPO/HMO/WC	$496.67

CARD US STRESS ECHO/CONTRAST

Facility

$5,900.00

Hospital Charge Code	74117073
Hospital Revenue Code	483
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$2,950.00
Rate for Payer: Aetna Commercial	$2,242.00
Rate for Payer: Aetna Medicare Advantage	$1,770.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,504.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,504.50
Rate for Payer: Cigna Commercial	$2,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,534.00
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$186.44
Rate for Payer: Wellpoint Medicaid Managed Care	$167.56

CARD US STRESS ECHO/CONTRAST

Facility

$5,900.00

Hospital Charge Code	74117073
Hospital Revenue Code	483
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

CARD US STRESS ECHO/CONTRAST

Facility

$3,311.10

Hospital Charge Code	5308010
Hospital Revenue Code	483
Min. Negotiated Rate	$94.04
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$1,258.22
Rate for Payer: Aetna Medicare Advantage	$993.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$844.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$844.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$844.33
Rate for Payer: Cigna Commercial	$1,655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$860.89
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$496.67
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$104.63
Rate for Payer: Wellpoint Medicaid Managed Care	$94.04

CARD US TEE/CONTRAST

Facility

$3,311.10

Hospital Charge Code	5308005
Hospital Revenue Code	483
Min. Negotiated Rate	$94.04
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$1,258.22
Rate for Payer: Aetna Medicare Advantage	$993.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$844.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$844.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$844.33
Rate for Payer: Cigna Commercial	$1,655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$860.89
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$496.67
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$104.63
Rate for Payer: Wellpoint Medicaid Managed Care	$94.04

CARD US TEE/CONTRAST

Facility

$3,311.10

Hospital Charge Code	5308005
Hospital Revenue Code	483
Min. Negotiated Rate	$496.67
Max. Negotiated Rate	$496.67
Rate for Payer: Qualcare PPO/HMO/WC	$496.67

CAREVISION

Facility

$4,075.00

Hospital Charge Code	270339531
Hospital Revenue Code	272
Min. Negotiated Rate	$611.25
Max. Negotiated Rate	$611.25
Rate for Payer: Qualcare PPO/HMO/WC	$611.25

CAREVISION

Facility

$4,075.00

Hospital Charge Code	270339531
Hospital Revenue Code	272
Min. Negotiated Rate	$115.73
Max. Negotiated Rate	$2,037.50
Rate for Payer: Aetna Commercial	$1,548.50
Rate for Payer: Aetna Medicare Advantage	$1,222.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,039.12
Rate for Payer: Cigna Commercial	$2,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,059.50
Rate for Payer: Oxford Commercial	$815.00
Rate for Payer: Qualcare PPO/HMO/WC	$611.25
Rate for Payer: UnitedHealthcare Commercial	$815.00
Rate for Payer: UnitedHealthcare Community & State	$128.77
Rate for Payer: Wellpoint Medicaid Managed Care	$115.73

CARNITINE (FREE & TOTAL)

Facility

$646.00

Service Code	HCPCS 82379
Hospital Charge Code	38472923
Hospital Revenue Code	301
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$96.90
Rate for Payer: Qualcare PPO/HMO/WC	$96.90

CARNITINE (FREE & TOTAL)

Facility

$646.00

Service Code	HCPCS 82379
Hospital Charge Code	38472923
Hospital Revenue Code	301
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$323.00
Rate for Payer: Aetna Commercial	$45.89
Rate for Payer: Aetna Medicare Advantage	$54.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$323.00
Rate for Payer: Cigna Medicare Advantage	$16.87
Rate for Payer: Clover Medicare Advantage	$16.03
Rate for Payer: EmblemHealth Commercial	$50.61
Rate for Payer: Humana Medicare Advantage	$17.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.87
Rate for Payer: Wellcare Medicare Advantage	$16.87
Rate for Payer: Wellpoint Medicaid Managed Care	$18.35

CARNITOR 1GM LEVOCRNTNE 5ML VL

Facility

$19.30

Service Code	HCPCS J1955
Hospital Charge Code	6000382
Hospital Revenue Code	636
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

CARNITOR 1GM LEVOCRNTNE 5ML VL

Facility

$19.30

Service Code	HCPCS J1955
Hospital Charge Code	6000382
Hospital Revenue Code	636
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

CARNITOR 330MG TAB

Facility

$6.70

Service Code	NDC 54482014407
Hospital Charge Code	60635364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

CARNITOR 330MG TAB

Facility

$6.70

Service Code	NDC 54482014407
Hospital Charge Code	60635364
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

Know your out-of-pocket cost for care.

All Charges