Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES

Facility

$35,275.21

Service Code	APR-DRG 0923
Min. Negotiated Rate	$34,583.54
Max. Negotiated Rate	$35,275.21
Rate for Payer: UnitedHealthcare Community & State	$34,583.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,275.21
Rate for Payer: Wellpoint Medicaid Managed Care	$34,583.54

FACIAL BONES COMPL

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	94061005
Hospital Revenue Code	320
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$316.08
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

FACIAL BONES COMPL

Facility

$5,100.00

Service Code	HCPCS 70150
Hospital Charge Code	94061005
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FACTOR 8 PER VIAL

Facility

$9.00

Hospital Charge Code	38471089
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR 8 PER VIAL

Facility

$9.00

Hospital Charge Code	38471089
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

FACTOR 9 PER VIAL

Facility

$9.00

Hospital Charge Code	38471091
Hospital Revenue Code	636
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

FACTOR 9 PER VIAL

Facility

$9.00

Hospital Charge Code	38471091
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

FACTOR II

Facility

$214.00

Service Code	HCPCS 85210
Hospital Charge Code	38478032
Hospital Revenue Code	305
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.31
Rate for Payer: Aetna Medicare Advantage	$42.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.98
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	$47.08
Rate for Payer: Cigna Commercial	$107.00
Rate for Payer: Cigna Medicare Advantage	$12.98
Rate for Payer: Clover Medicare Advantage	$12.33
Rate for Payer: EmblemHealth Commercial	$38.94
Rate for Payer: Humana Medicare Advantage	$13.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.64
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.98
Rate for Payer: Wellcare Medicare Advantage	$12.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.08

FACTOR II

Facility

$214.00

Service Code	HCPCS 85210
Hospital Charge Code	38478032
Hospital Revenue Code	305
Min. Negotiated Rate	$32.10
Max. Negotiated Rate	$32.10
Rate for Payer: Qualcare PPO/HMO/WC	$32.10

FACTOR II ACTIVITY

Facility

$390.00

Service Code	HCPCS 85210
Hospital Charge Code	39900344
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR II ACTIVITY

Facility

$390.00

Service Code	HCPCS 85210
Hospital Charge Code	39900344
Hospital Revenue Code	305
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.31
Rate for Payer: Aetna Medicare Advantage	$42.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.98
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	$47.08
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.98
Rate for Payer: Clover Medicare Advantage	$12.33
Rate for Payer: EmblemHealth Commercial	$38.94
Rate for Payer: Humana Medicare Advantage	$13.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.98
Rate for Payer: Wellcare Medicare Advantage	$12.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR II,FUNCTIONAL

Facility

$89.25

Service Code	HCPCS 85210
Hospital Charge Code	39900155
Hospital Revenue Code	305
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$13.39
Rate for Payer: Qualcare PPO/HMO/WC	$13.39

FACTOR II,FUNCTIONAL

Facility

$89.25

Service Code	HCPCS 85210
Hospital Charge Code	39900155
Hospital Revenue Code	305
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.31
Rate for Payer: Aetna Medicare Advantage	$42.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.98
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	$47.08
Rate for Payer: Cigna Commercial	$44.62
Rate for Payer: Cigna Medicare Advantage	$12.98
Rate for Payer: Clover Medicare Advantage	$12.33
Rate for Payer: EmblemHealth Commercial	$38.94
Rate for Payer: Humana Medicare Advantage	$13.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.39
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.98
Rate for Payer: Wellcare Medicare Advantage	$12.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

FACTOR INHIBITOR TEST

Facility

$390.00

Service Code	HCPCS 85335
Hospital Charge Code	401085335
Hospital Revenue Code	305
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.69
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR INHIBITOR TEST

Facility

$91.00

Service Code	HCPCS 85335
Hospital Charge Code	38478077
Hospital Revenue Code	305
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

FACTOR INHIBITOR TEST

Facility

$390.00

Service Code	HCPCS 85335
Hospital Charge Code	401085335
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR INHIBITOR TEST

Facility

$91.00

Service Code	HCPCS 85335
Hospital Charge Code	38478077
Hospital Revenue Code	305
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.69
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$12.87
Rate for Payer: Clover Medicare Advantage	$12.23
Rate for Payer: EmblemHealth Commercial	$38.61
Rate for Payer: Humana Medicare Advantage	$13.26
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.87
Rate for Payer: Wellcare Medicare Advantage	$12.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

FACTOR IX

Facility

$503.00

Service Code	HCPCS 85250
Hospital Charge Code	38478041
Hospital Revenue Code	305
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$75.45
Rate for Payer: Qualcare PPO/HMO/WC	$75.45

FACTOR IX

Facility

$503.00

Service Code	HCPCS 85250
Hospital Charge Code	38478041
Hospital Revenue Code	305
Min. Negotiated Rate	$14.29
Max. Negotiated Rate	$251.50
Rate for Payer: Aetna Commercial	$51.79
Rate for Payer: Aetna Medicare Advantage	$61.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.07
Rate for Payer: Cigna Commercial	$251.50
Rate for Payer: Cigna Medicare Advantage	$19.04
Rate for Payer: Clover Medicare Advantage	$18.09
Rate for Payer: EmblemHealth Commercial	$57.12
Rate for Payer: Humana Medicare Advantage	$19.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.04
Rate for Payer: Wellcare Medicare Advantage	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$14.29

FACTOR IX ACTIVITY

Facility

$390.00

Service Code	HCPCS 85250
Hospital Charge Code	39900348
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR IX ACTIVITY

Facility

$390.00

Service Code	HCPCS 85250
Hospital Charge Code	39900348
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$51.79
Rate for Payer: Aetna Medicare Advantage	$61.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.07
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.04
Rate for Payer: Clover Medicare Advantage	$18.09
Rate for Payer: EmblemHealth Commercial	$57.12
Rate for Payer: Humana Medicare Advantage	$19.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.04
Rate for Payer: Wellcare Medicare Advantage	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR IX ANTIGEN

Facility

$1,000.35

Service Code	HCPCS 85250
Hospital Charge Code	401085250
Hospital Revenue Code	305
Min. Negotiated Rate	$150.05
Max. Negotiated Rate	$150.05
Rate for Payer: Qualcare PPO/HMO/WC	$150.05

FACTOR IX ANTIGEN

Facility

$1,000.35

Service Code	HCPCS 85250
Hospital Charge Code	401085250
Hospital Revenue Code	305
Min. Negotiated Rate	$15.23
Max. Negotiated Rate	$500.18
Rate for Payer: Aetna Commercial	$51.79
Rate for Payer: Aetna Medicare Advantage	$61.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.07
Rate for Payer: Cigna Commercial	$500.18
Rate for Payer: Cigna Medicare Advantage	$19.04
Rate for Payer: Clover Medicare Advantage	$18.09
Rate for Payer: EmblemHealth Commercial	$57.12
Rate for Payer: Humana Medicare Advantage	$19.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.09
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.04
Rate for Payer: Wellcare Medicare Advantage	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$28.41

FACTOR IX,FUNCTIONAL

Facility

$130.85

Service Code	HCPCS 85250
Hospital Charge Code	39900159
Hospital Revenue Code	305
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$51.79
Rate for Payer: Aetna Medicare Advantage	$61.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.07
Rate for Payer: Cigna Commercial	$65.42
Rate for Payer: Cigna Medicare Advantage	$19.04
Rate for Payer: Clover Medicare Advantage	$18.09
Rate for Payer: EmblemHealth Commercial	$57.12
Rate for Payer: Humana Medicare Advantage	$19.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.63
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.04
Rate for Payer: Wellcare Medicare Advantage	$19.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

FACTOR IX,FUNCTIONAL

Facility

$130.85

Service Code	HCPCS 85250
Hospital Charge Code	39900159
Hospital Revenue Code	305
Min. Negotiated Rate	$19.63
Max. Negotiated Rate	$19.63
Rate for Payer: Qualcare PPO/HMO/WC	$19.63

Know your out-of-pocket cost for care.

All Charges