Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AFB ID HPLC-FL and CONVENT

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39990164A
Hospital Revenue Code	309
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$12.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.91

AFB ID HPLC-FL and CONVENT

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39990164B
Hospital Revenue Code	309
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$34.05
Rate for Payer: Aetna Medicare Advantage	$40.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.42
Rate for Payer: Cigna Commercial	$43.05
Rate for Payer: Cigna Medicare Advantage	$12.52
Rate for Payer: Clover Medicare Advantage	$11.89
Rate for Payer: EmblemHealth Commercial	$37.56
Rate for Payer: Humana Medicare Advantage	$12.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.39
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.91
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.52
Rate for Payer: Wellcare Medicare Advantage	$12.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.45

AFB ID HPLC-FL & CONVENTI

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39900272
Hospital Revenue Code	309
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$34.05
Rate for Payer: Aetna Medicare Advantage	$40.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.42
Rate for Payer: Cigna Commercial	$43.05
Rate for Payer: Cigna Medicare Advantage	$12.52
Rate for Payer: Clover Medicare Advantage	$11.89
Rate for Payer: EmblemHealth Commercial	$37.56
Rate for Payer: Humana Medicare Advantage	$12.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.39
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.91
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.52
Rate for Payer: Wellcare Medicare Advantage	$12.52
Rate for Payer: Wellpoint Medicaid Managed Care	$2.45

AFB ID HPLC-FL & CONVENTI

Facility

$86.10

Service Code	HCPCS 87143
Hospital Charge Code	39900272
Hospital Revenue Code	309
Min. Negotiated Rate	$12.91
Max. Negotiated Rate	$12.91
Rate for Payer: Qualcare PPO/HMO/WC	$12.91

AFB SENSITIVITIES, I

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053A
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, I

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053A
Hospital Revenue Code	309
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

AFB SENSITIVITIES, II

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053B
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, II

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053B
Hospital Revenue Code	309
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

AFB SENSITIVITIES, III

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053C
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, III

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053C
Hospital Revenue Code	309
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

AFB SENSITIVITIES, IV

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053D
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITIES, IV

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053D
Hospital Revenue Code	309
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

AFB SENSITIVITIES, V

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053E
Hospital Revenue Code	309
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.76
Rate for Payer: Aetna Medicare Advantage	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.91
Rate for Payer: Cigna Commercial	$19.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.83
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

AFB SENSITIVITIES, V

Facility

$38.85

Service Code	HCPCS 8719091
Hospital Charge Code	39990053E
Hospital Revenue Code	309
Min. Negotiated Rate	$5.83
Max. Negotiated Rate	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.83

AFB SENSITIVITY

Facility

$79.00

Service Code	HCPCS 87190
Hospital Charge Code	38475083
Hospital Revenue Code	309
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare Advantage	$23.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: Cigna Medicare Advantage	$7.31
Rate for Payer: Clover Medicare Advantage	$6.94
Rate for Payer: EmblemHealth Commercial	$21.93
Rate for Payer: Humana Medicare Advantage	$7.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.31
Rate for Payer: Wellcare Medicare Advantage	$7.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

AFB SENSITIVITY

Facility

$79.00

Service Code	HCPCS 87190
Hospital Charge Code	38475083
Hospital Revenue Code	309
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479466
Hospital Revenue Code	309
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.55
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479466
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38475092
Hospital Revenue Code	309
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.55
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479498
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38475092
Hospital Revenue Code	309
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$22.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.80

AFB SMEAR

Facility

$152.00

Service Code	HCPCS 87206
Hospital Charge Code	38479498
Hospital Revenue Code	309
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.55
Rate for Payer: Cigna Commercial	$76.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$4.32

AFFIXUS CORTICAL BONE SCREW 4X

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704513
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

AFFIXUS CORTICAL BONE SCREW 4X

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704517
Hospital Revenue Code	278
Min. Negotiated Rate	$198.45
Max. Negotiated Rate	$320.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: Qualcare PPO/HMO/WC	$198.45

AFFIXUS CORTICAL BONE SCREW 4X

Facility

$1,323.00

Service Code	HCPCS C1713
Hospital Charge Code	270704513
Hospital Revenue Code	278
Min. Negotiated Rate	$37.57
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$502.74
Rate for Payer: Aetna Medicare Advantage	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$264.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.37
Rate for Payer: Cigna Commercial	$661.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.17
Rate for Payer: Qualcare PPO/HMO/WC	$198.45
Rate for Payer: UnitedHealthcare Community & State	$41.81
Rate for Payer: Wellpoint Medicaid Managed Care	$37.57

Know your out-of-pocket cost for care.

All Charges