Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	74308370
Hospital Revenue Code	402
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	74308370
Hospital Revenue Code	402
Min. Negotiated Rate	$24.37
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$326.04
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.08
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$24.37

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	74308340
Hospital Revenue Code	514
Min. Negotiated Rate	$42.03
Max. Negotiated Rate	$3,969.32
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,969.32
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$384.80
Rate for Payer: Qualcare PPO/HMO/WC	$222.00
Rate for Payer: UnitedHealthcare Community & State	$46.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$42.03

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	83653005
Hospital Revenue Code	720
Min. Negotiated Rate	$42.03
Max. Negotiated Rate	$4,601.00
Rate for Payer: Aetna Commercial	$2,976.31
Rate for Payer: Aetna Medicare Advantage	$3,545.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,969.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,094.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$80.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,969.32
Rate for Payer: Cigna Commercial	$2,193.38
Rate for Payer: Cigna Medicare Advantage	$1,094.23
Rate for Payer: Clover Medicare Advantage	$1,039.52
Rate for Payer: EmblemHealth Commercial	$3,282.69
Rate for Payer: Humana Medicare Advantage	$1,127.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,094.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$384.80
Rate for Payer: Oxford Commercial	$4,053.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00
Rate for Payer: UnitedHealthcare Commercial	$4,601.00
Rate for Payer: UnitedHealthcare Community & State	$46.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,094.23
Rate for Payer: Wellcare Medicare Advantage	$1,094.23
Rate for Payer: Wellpoint Medicaid Managed Care	$42.03

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	74308340
Hospital Revenue Code	514
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

AMNIOCENTISIS, EA ADDTL FETUS

Facility

$1,480.00

Service Code	HCPCS 59000
Hospital Charge Code	83653005
Hospital Revenue Code	720
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$222.00
Rate for Payer: Qualcare PPO/HMO/WC	$222.00

AMNIO EXCELL PLUS 3.0 x 4.0 CM

Facility

$13,635.00

Service Code	HCPCS Q4137
Hospital Charge Code	270687808
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

AMNIO EXCELL PLUS 3.0 x 4.0 CM

Facility

$13,635.00

Service Code	HCPCS Q4137
Hospital Charge Code	270687808
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,299.67
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25
Rate for Payer: UnitedHealthcare Community & State	$430.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$387.23

AMNIOFIX 7CM X 6CM

Facility

$12,666.50

Hospital Charge Code	270702726
Hospital Revenue Code	278
Min. Negotiated Rate	$1,899.97
Max. Negotiated Rate	$3,065.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,533.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,065.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.97

AMNIOFIX 7CM X 6CM

Facility

$12,666.50

Hospital Charge Code	270702726
Hospital Revenue Code	278
Min. Negotiated Rate	$359.73
Max. Negotiated Rate	$6,333.25
Rate for Payer: Aetna Commercial	$4,813.27
Rate for Payer: Aetna Medicare Advantage	$3,799.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,229.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,229.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,533.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,229.96
Rate for Payer: Cigna Commercial	$6,333.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,065.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,899.97
Rate for Payer: UnitedHealthcare Community & State	$400.26
Rate for Payer: Wellpoint Medicaid Managed Care	$359.73

AMNIOFIX INJECTABLE 100MG

Facility

$9,170.00

Hospital Charge Code	270660769
Hospital Revenue Code	270
Min. Negotiated Rate	$260.43
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,384.20
Rate for Payer: Oxford Commercial	$1,834.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Commercial	$1,834.00
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: Wellpoint Medicaid Managed Care	$260.43

AMNIOFIX INJECTABLE 100MG

Facility

$9,170.00

Hospital Charge Code	270660769
Hospital Revenue Code	270
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$1,375.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMNIOFIX INJECTABLE 20MG

Facility

$1,652.50

Service Code	HCPCS Q4139
Hospital Charge Code	270679818
Hospital Revenue Code	636
Min. Negotiated Rate	$247.88
Max. Negotiated Rate	$399.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.90
Rate for Payer: Qualcare PPO/HMO/WC	$247.88

AMNIOFIX INJECTABLE 20MG

Facility

$1,652.50

Service Code	HCPCS Q4139
Hospital Charge Code	270679818
Hospital Revenue Code	636
Min. Negotiated Rate	$46.93
Max. Negotiated Rate	$826.25
Rate for Payer: Aetna Commercial	$627.95
Rate for Payer: Aetna Medicare Advantage	$495.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$421.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$421.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$421.39
Rate for Payer: Cigna Commercial	$826.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$399.90
Rate for Payer: Qualcare PPO/HMO/WC	$247.88
Rate for Payer: UnitedHealthcare Community & State	$52.22
Rate for Payer: Wellpoint Medicaid Managed Care	$46.93

AMNIO MATRIX 1 ML

Facility

$5,250.00

Service Code	HCPCS Q4139
Hospital Charge Code	270681918
Hospital Revenue Code	636
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

AMNIO MATRIX 1 ML

Facility

$5,250.00

Service Code	HCPCS Q4139
Hospital Charge Code	270681918
Hospital Revenue Code	636
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

AMNIO MAXX ACELLULAR 2.0ML

Facility

$9,475.00

Service Code	HCPCS C1762
Hospital Charge Code	270691770
Hospital Revenue Code	278
Min. Negotiated Rate	$269.09
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$299.41
Rate for Payer: Wellpoint Medicaid Managed Care	$269.09

AMNIO MAXX ACELLULAR 2.0ML

Facility

$9,475.00

Service Code	HCPCS C1762
Hospital Charge Code	270691770
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

AMNION MATRIX CORD 3CMX4CM

Facility

$14,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703707
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

AMNION MATRIX CORD 3CMX4CM

Facility

$14,000.00

Service Code	HCPCS C1765
Hospital Charge Code	270703707
Hospital Revenue Code	278
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$442.40
Rate for Payer: Wellpoint Medicaid Managed Care	$397.60

AMNION VIASHIELD DL LAY 4X4CM

Facility

$18,335.00

Service Code	HCPCS Q4211
Hospital Charge Code	270695511
Hospital Revenue Code	278
Min. Negotiated Rate	$2,750.25
Max. Negotiated Rate	$4,437.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,667.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,437.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,750.25

AMNION VIASHIELD DL LAY 4X4CM

Facility

$18,335.00

Service Code	HCPCS Q4211
Hospital Charge Code	270695511
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,437.07
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,667.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,437.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,750.25
Rate for Payer: UnitedHealthcare Community & State	$579.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$520.71

AMNION WOUND MATRIX 2cmx2cm

Facility

$3,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270679824
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$961.95
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

AMNION WOUND MATRIX 2cmx2cm

Facility

$3,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270679824
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

AMNIOTIC FLUID TRI

Facility

$9,170.00

Hospital Charge Code	270680608
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

Know your out-of-pocket cost for care.

All Charges