Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FACTOR X ACTIVITY

Facility

$390.00

Service Code	HCPCS 85260
Hospital Charge Code	39900349
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR X,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85260
Hospital Charge Code	39900160
Hospital Revenue Code	305
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.46

FACTOR X,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85260
Hospital Charge Code	39900160
Hospital Revenue Code	305
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$61.52
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.99
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

FACTOR XI

Facility

$278.00

Service Code	HCPCS 85270
Hospital Charge Code	38478047
Hospital Revenue Code	305
Min. Negotiated Rate	$41.70
Max. Negotiated Rate	$41.70
Rate for Payer: Qualcare PPO/HMO/WC	$41.70

FACTOR XI

Facility

$278.00

Service Code	HCPCS 85270
Hospital Charge Code	38478047
Hospital Revenue Code	305
Min. Negotiated Rate	$7.90
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$139.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.28
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.90

FACTOR XI ACTIVITY

Facility

$390.00

Service Code	HCPCS 85270
Hospital Charge Code	39900350
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
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	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR XI ACTIVITY

Facility

$390.00

Service Code	HCPCS 85270
Hospital Charge Code	39900350
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR XI,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85270
Hospital Charge Code	39900161
Hospital Revenue Code	305
Min. Negotiated Rate	$3.49
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.69
Rate for Payer: Aetna Medicare Advantage	$58.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.93
Rate for Payer: Cigna Commercial	$61.52
Rate for Payer: Cigna Medicare Advantage	$17.90
Rate for Payer: Clover Medicare Advantage	$17.00
Rate for Payer: EmblemHealth Commercial	$53.70
Rate for Payer: Humana Medicare Advantage	$18.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.99
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.90
Rate for Payer: Wellcare Medicare Advantage	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$3.49

FACTOR XI,FUNCTIONAL

Facility

$123.05

Service Code	HCPCS 85270
Hospital Charge Code	39900161
Hospital Revenue Code	305
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$18.46

FACTOR XII

Facility

$299.00

Service Code	HCPCS 85280
Hospital Charge Code	38478050
Hospital Revenue Code	305
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$52.63
Rate for Payer: Aetna Medicare Advantage	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.19
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: Cigna Medicare Advantage	$19.35
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Medicare Advantage	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

FACTOR XII

Facility

$299.00

Service Code	HCPCS 85280
Hospital Charge Code	38478050
Hospital Revenue Code	305
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

FACTOR XII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85280
Hospital Charge Code	39900351
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$52.63
Rate for Payer: Aetna Medicare Advantage	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.19
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.35
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.35
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	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Medicare Advantage	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR XII ACTIVITY

Facility

$390.00

Service Code	HCPCS 85280
Hospital Charge Code	39900351
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FACTOR XII,FUNCTIONAL

Facility

$133.00

Service Code	HCPCS 85280
Hospital Charge Code	39900162
Hospital Revenue Code	305
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$19.95
Rate for Payer: Qualcare PPO/HMO/WC	$19.95

FACTOR XII,FUNCTIONAL

Facility

$133.00

Service Code	HCPCS 85280
Hospital Charge Code	39900162
Hospital Revenue Code	305
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$52.63
Rate for Payer: Aetna Medicare Advantage	$62.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.19
Rate for Payer: Cigna Commercial	$66.50
Rate for Payer: Cigna Medicare Advantage	$19.35
Rate for Payer: Clover Medicare Advantage	$18.38
Rate for Payer: EmblemHealth Commercial	$58.05
Rate for Payer: Humana Medicare Advantage	$19.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.58
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.35
Rate for Payer: Wellcare Medicare Advantage	$19.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.78

FACTOR XIII

Facility

$390.00

Service Code	HCPCS 85290
Hospital Charge Code	38478053
Hospital Revenue Code	305
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.44
Rate for Payer: Aetna Medicare Advantage	$52.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.34
Rate for Payer: Clover Medicare Advantage	$15.52
Rate for Payer: EmblemHealth Commercial	$49.02
Rate for Payer: Humana Medicare Advantage	$16.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.34
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	$13.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.34
Rate for Payer: Wellcare Medicare Advantage	$16.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

FACTOR XIII

Facility

$390.00

Service Code	HCPCS 85290
Hospital Charge Code	38478053
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

FALOPE RING BAND IMPLANT (GYN

Facility

$1,000.00

Hospital Charge Code	270653360
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

FALOPE RING BAND IMPLANT (GYN

Facility

$1,000.00

Hospital Charge Code	270653360
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

FAMCICLOVIR 250 MG TAB

Facility

$78.86

Service Code	NDC 78036715
Hospital Charge Code	60627337
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$39.43
Rate for Payer: Aetna Commercial	$29.97
Rate for Payer: Aetna Medicare Advantage	$23.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.11
Rate for Payer: Cigna Commercial	$39.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.50
Rate for Payer: Oxford Commercial	$15.77
Rate for Payer: Qualcare PPO/HMO/WC	$11.83
Rate for Payer: UnitedHealthcare Commercial	$15.77
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

FAMCICLOVIR 250 MG TAB

Facility

$78.86

Service Code	NDC 78036715
Hospital Charge Code	60627337
Hospital Revenue Code	250
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$11.83
Rate for Payer: Qualcare PPO/HMO/WC	$11.83

FAMCICLOVIR 500 MG TAB

Facility

$158.39

Service Code	NDC 78036815
Hospital Charge Code	6015036
Hospital Revenue Code	250
Min. Negotiated Rate	$23.76
Max. Negotiated Rate	$23.76
Rate for Payer: Qualcare PPO/HMO/WC	$23.76

FAMCICLOVIR 500 MG TAB

Facility

$158.39

Service Code	NDC 78036815
Hospital Charge Code	6015036
Hospital Revenue Code	250
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$79.19
Rate for Payer: Aetna Commercial	$60.19
Rate for Payer: Aetna Medicare Advantage	$47.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.39
Rate for Payer: Cigna Commercial	$79.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.18
Rate for Payer: Oxford Commercial	$31.68
Rate for Payer: Qualcare PPO/HMO/WC	$23.76
Rate for Payer: UnitedHealthcare Commercial	$31.68
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$4.50

FAMILY COUNSELING

Facility

$304.00

Service Code	HCPCS 90887
Hospital Charge Code	84504080
Hospital Revenue Code	900
Min. Negotiated Rate	$8.63
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$115.52
Rate for Payer: Aetna Medicare Advantage	$91.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.52
Rate for Payer: Cigna Commercial	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.04
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.60
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$9.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23.17
Rate for Payer: Wellpoint Medicaid Managed Care	$8.63

FAMILY COUNSELING

Facility

$304.00

Service Code	HCPCS 90887
Hospital Charge Code	84504080
Hospital Revenue Code	900
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$45.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.60

Know your out-of-pocket cost for care.

All Charges