Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HIVAC 7 SINGLE/DOUBLE CEM INJ

Facility

$1,175.00

Hospital Charge Code	270678234
Hospital Revenue Code	272
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$176.25
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

HIVAC 7 SINGLE/DOUBLE CEM INJ

Facility

$1,175.00

Hospital Charge Code	270678234
Hospital Revenue Code	272
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.50
Rate for Payer: Oxford Commercial	$235.00
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Commercial	$235.00
Rate for Payer: UnitedHealthcare Community & State	$37.13
Rate for Payer: Wellpoint Medicaid Managed Care	$33.37

HIV - ENZYME IMMUNOASSAY

Facility

$1,066.43

Service Code	HCPCS 87390
Hospital Charge Code	3000818
Hospital Revenue Code	306
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$533.22
Rate for Payer: Aetna Commercial	$65.44
Rate for Payer: Aetna Medicare Advantage	$77.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.06
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	$87.28
Rate for Payer: Cigna Commercial	$533.22
Rate for Payer: Cigna Medicare Advantage	$24.06
Rate for Payer: Clover Medicare Advantage	$22.86
Rate for Payer: EmblemHealth Commercial	$72.18
Rate for Payer: Humana Medicare Advantage	$24.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.27
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$159.96
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.06
Rate for Payer: Wellcare Medicare Advantage	$24.06
Rate for Payer: Wellpoint Medicaid Managed Care	$30.29

HIV - ENZYME IMMUNOASSAY

Facility

$1,066.43

Service Code	HCPCS 87390
Hospital Charge Code	3000818
Hospital Revenue Code	306
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$159.96
Rate for Payer: Qualcare PPO/HMO/WC	$159.96

HIV GENOTYPING,OTHER

Facility

$906.00

Service Code	HCPCS 87906
Hospital Charge Code	38477210
Hospital Revenue Code	306
Min. Negotiated Rate	$25.73
Max. Negotiated Rate	$466.97
Rate for Payer: Aetna Commercial	$350.15
Rate for Payer: Aetna Medicare Advantage	$417.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$466.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$466.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$128.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$466.97
Rate for Payer: Cigna Commercial	$453.00
Rate for Payer: Cigna Medicare Advantage	$128.73
Rate for Payer: Clover Medicare Advantage	$122.29
Rate for Payer: EmblemHealth Commercial	$386.19
Rate for Payer: Humana Medicare Advantage	$132.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$128.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$135.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$102.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$128.73
Rate for Payer: Wellcare Medicare Advantage	$128.73
Rate for Payer: Wellpoint Medicaid Managed Care	$25.73

HIV GENOTYPING,OTHER

Facility

$906.00

Service Code	HCPCS 87906
Hospital Charge Code	38477210
Hospital Revenue Code	306
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$135.90
Rate for Payer: Qualcare PPO/HMO/WC	$135.90

HIV SOURCE PATIENT

Facility

$522.00

Service Code	HCPCS 86701
Hospital Charge Code	38479062
Hospital Revenue Code	302
Min. Negotiated Rate	$78.30
Max. Negotiated Rate	$78.30
Rate for Payer: Qualcare PPO/HMO/WC	$78.30

HIV SOURCE PATIENT

Facility

$522.00

Service Code	HCPCS 86701
Hospital Charge Code	38479062
Hospital Revenue Code	302
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna Commercial	$24.18
Rate for Payer: Aetna Medicare Advantage	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.25
Rate for Payer: Cigna Commercial	$261.00
Rate for Payer: Cigna Medicare Advantage	$8.89
Rate for Payer: Clover Medicare Advantage	$8.45
Rate for Payer: EmblemHealth Commercial	$26.67
Rate for Payer: Humana Medicare Advantage	$9.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$78.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.89
Rate for Payer: Wellcare Medicare Advantage	$8.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.82

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$212,858.29

Service Code	MSDRG 969
Min. Negotiated Rate	$64,812.62
Max. Negotiated Rate	$212,858.29
Rate for Payer: Aetna Commercial	$153,458.65
Rate for Payer: Aetna Medicare Advantage	$212,858.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190,333.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190,333.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$68,223.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190,333.35
Rate for Payer: Cigna Commercial	$136,462.14
Rate for Payer: Cigna Medicare Advantage	$68,223.81
Rate for Payer: Clover Medicare Advantage	$64,812.62
Rate for Payer: EmblemHealth Commercial	$204,671.43
Rate for Payer: Humana Medicare Advantage	$70,270.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$68,223.81
Rate for Payer: Oxford Commercial	$107,857.31
Rate for Payer: UnitedHealthcare Commercial	$144,370.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$68,223.81
Rate for Payer: Wellcare Medicare Advantage	$68,223.81

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$102,789.49

Service Code	MSDRG 970
Min. Negotiated Rate	$31,298.08
Max. Negotiated Rate	$102,789.49
Rate for Payer: Aetna Commercial	$75,066.36
Rate for Payer: Aetna Medicare Advantage	$102,789.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77,019.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77,019.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$32,945.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77,019.90
Rate for Payer: Cigna Commercial	$58,795.56
Rate for Payer: Cigna Medicare Advantage	$32,945.35
Rate for Payer: Clover Medicare Advantage	$31,298.08
Rate for Payer: EmblemHealth Commercial	$98,836.05
Rate for Payer: Humana Medicare Advantage	$33,933.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$32,945.35
Rate for Payer: Oxford Commercial	$46,470.99
Rate for Payer: UnitedHealthcare Commercial	$62,203.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$32,945.35
Rate for Payer: Wellcare Medicare Advantage	$32,945.35

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$9,822.22

Service Code	APR-DRG 8921
Min. Negotiated Rate	$9,629.63
Max. Negotiated Rate	$9,822.22
Rate for Payer: UnitedHealthcare Community & State	$9,629.63
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,822.22
Rate for Payer: Wellpoint Medicaid Managed Care	$9,629.63

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$23,572.53

Service Code	APR-DRG 8924
Min. Negotiated Rate	$23,110.32
Max. Negotiated Rate	$23,572.53
Rate for Payer: UnitedHealthcare Community & State	$23,110.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$23,572.53
Rate for Payer: Wellpoint Medicaid Managed Care	$23,110.32

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$10,339.08

Service Code	APR-DRG 8922
Min. Negotiated Rate	$10,136.35
Max. Negotiated Rate	$10,339.08
Rate for Payer: UnitedHealthcare Community & State	$10,136.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,339.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10,136.35

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$14,185.62

Service Code	APR-DRG 8923
Min. Negotiated Rate	$13,907.47
Max. Negotiated Rate	$14,185.62
Rate for Payer: UnitedHealthcare Community & State	$13,907.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,185.62
Rate for Payer: Wellpoint Medicaid Managed Care	$13,907.47

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$60,378.36

Service Code	MSDRG 975
Min. Negotiated Rate	$18,384.44
Max. Negotiated Rate	$60,378.36
Rate for Payer: Aetna Commercial	$44,860.66
Rate for Payer: Aetna Medicare Advantage	$60,378.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37,678.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37,678.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,352.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37,678.80
Rate for Payer: Cigna Commercial	$28,869.44
Rate for Payer: Cigna Medicare Advantage	$19,352.04
Rate for Payer: Clover Medicare Advantage	$18,384.44
Rate for Payer: EmblemHealth Commercial	$58,056.12
Rate for Payer: Humana Medicare Advantage	$19,932.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,352.04
Rate for Payer: Oxford Commercial	$22,817.90
Rate for Payer: UnitedHealthcare Commercial	$30,542.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,352.04
Rate for Payer: Wellcare Medicare Advantage	$19,352.04

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$110,643.69

Service Code	MSDRG 974
Min. Negotiated Rate	$33,689.58
Max. Negotiated Rate	$110,643.69
Rate for Payer: Aetna Commercial	$80,660.21
Rate for Payer: Aetna Medicare Advantage	$110,643.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80,898.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80,898.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35,462.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80,898.60
Rate for Payer: Cigna Commercial	$64,337.60
Rate for Payer: Cigna Medicare Advantage	$35,462.72
Rate for Payer: Clover Medicare Advantage	$33,689.58
Rate for Payer: EmblemHealth Commercial	$106,388.16
Rate for Payer: Humana Medicare Advantage	$36,526.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35,462.72
Rate for Payer: Oxford Commercial	$50,851.32
Rate for Payer: UnitedHealthcare Commercial	$68,066.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$35,462.72
Rate for Payer: Wellcare Medicare Advantage	$35,462.72

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$47,984.20

Service Code	MSDRG 976
Min. Negotiated Rate	$14,610.57
Max. Negotiated Rate	$47,984.20
Rate for Payer: Aetna Commercial	$36,033.40
Rate for Payer: Aetna Medicare Advantage	$47,984.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,549.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,549.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,379.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,549.25
Rate for Payer: Cigna Commercial	$19,941.09
Rate for Payer: Cigna Medicare Advantage	$15,379.55
Rate for Payer: Clover Medicare Advantage	$14,610.57
Rate for Payer: EmblemHealth Commercial	$46,138.65
Rate for Payer: Humana Medicare Advantage	$15,840.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,379.55
Rate for Payer: Oxford Commercial	$15,761.09
Rate for Payer: UnitedHealthcare Commercial	$21,096.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,379.55
Rate for Payer: Wellcare Medicare Advantage	$15,379.55

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$10,438.73

Service Code	APR-DRG 8901
Min. Negotiated Rate	$10,234.05
Max. Negotiated Rate	$10,438.73
Rate for Payer: UnitedHealthcare Community & State	$10,234.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,438.73
Rate for Payer: Wellpoint Medicaid Managed Care	$10,234.05

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$34,478.97

Service Code	APR-DRG 8904
Min. Negotiated Rate	$33,802.91
Max. Negotiated Rate	$34,478.97
Rate for Payer: UnitedHealthcare Community & State	$33,802.91
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,478.97
Rate for Payer: Wellpoint Medicaid Managed Care	$33,802.91

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$10,989.29

Service Code	APR-DRG 8902
Min. Negotiated Rate	$10,773.81
Max. Negotiated Rate	$10,989.29
Rate for Payer: UnitedHealthcare Community & State	$10,773.81
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,989.29
Rate for Payer: Wellpoint Medicaid Managed Care	$10,773.81

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$17,643.22

Service Code	APR-DRG 8903
Min. Negotiated Rate	$17,297.27
Max. Negotiated Rate	$17,643.22
Rate for Payer: UnitedHealthcare Community & State	$17,297.27
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$17,643.22
Rate for Payer: Wellpoint Medicaid Managed Care	$17,297.27

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$15,516.98

Service Code	APR-DRG 8933
Min. Negotiated Rate	$15,212.73
Max. Negotiated Rate	$15,516.98
Rate for Payer: UnitedHealthcare Community & State	$15,212.73
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,516.98
Rate for Payer: Wellpoint Medicaid Managed Care	$15,212.73

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$22,197.62

Service Code	APR-DRG 8934
Min. Negotiated Rate	$21,762.37
Max. Negotiated Rate	$22,197.62
Rate for Payer: UnitedHealthcare Community & State	$21,762.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$22,197.62
Rate for Payer: Wellpoint Medicaid Managed Care	$21,762.37

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$11,157.81

Service Code	APR-DRG 8932
Min. Negotiated Rate	$10,939.03
Max. Negotiated Rate	$11,157.81
Rate for Payer: UnitedHealthcare Community & State	$10,939.03
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,157.81
Rate for Payer: Wellpoint Medicaid Managed Care	$10,939.03

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$10,319.42

Service Code	APR-DRG 8931
Min. Negotiated Rate	$10,117.08
Max. Negotiated Rate	$10,319.42
Rate for Payer: UnitedHealthcare Community & State	$10,117.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,319.42
Rate for Payer: Wellpoint Medicaid Managed Care	$10,117.08

Know your out-of-pocket cost for care.

All Charges