Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

H.PYLORI (IGG,IGA,IGM) I

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

H.PYLORI (IGG,IGA,IGM) II

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H.PYLORI (IGG,IGA,IGM) II

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

H.PYLORI (IGG,IGA,IGM) III

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

H.PYLORI (IGG,IGA,IGM) III

Facility

$390.00

Service Code	HCPCS 8667791
Hospital Charge Code	39990099C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

H-PYLORI STOOL

Facility

$70.00

Service Code	HCPCS 87338
Hospital Charge Code	38470105
Hospital Revenue Code	306
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

H-PYLORI STOOL

Facility

$70.00

Service Code	HCPCS 87338
Hospital Charge Code	38470105
Hospital Revenue Code	306
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$39.11
Rate for Payer: Aetna Medicare Advantage	$46.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.16
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: Cigna Medicare Advantage	$14.38
Rate for Payer: Clover Medicare Advantage	$13.66
Rate for Payer: EmblemHealth Commercial	$43.14
Rate for Payer: Humana Medicare Advantage	$14.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.38
Rate for Payer: Wellcare Medicare Advantage	$14.38
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

H PYLORI TISSUE SCREEN

Facility

$458.65

Service Code	HCPCS 87081
Hospital Charge Code	397041255
Hospital Revenue Code	309
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$229.32
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.05
Rate for Payer: Cigna Commercial	$229.32
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.25
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$13.03

H PYLORI TISSUE SCREEN

Facility

$458.65

Service Code	HCPCS 87081
Hospital Charge Code	397041255
Hospital Revenue Code	309
Min. Negotiated Rate	$68.80
Max. Negotiated Rate	$68.80
Rate for Payer: Qualcare PPO/HMO/WC	$68.80

H PYLORI UBIT

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39990237
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$244.35
Rate for Payer: Aetna Commercial	$183.22
Rate for Payer: Aetna Medicare Advantage	$218.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$244.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$244.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$67.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$244.35
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$67.36
Rate for Payer: Clover Medicare Advantage	$63.99
Rate for Payer: EmblemHealth Commercial	$202.08
Rate for Payer: Humana Medicare Advantage	$69.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$67.36
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	$53.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.36
Rate for Payer: Wellcare Medicare Advantage	$67.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

H PYLORI UBIT

Facility

$390.00

Service Code	HCPCS 83013
Hospital Charge Code	39990237
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HRDTRY BRST CA-RLAT DISORDERS1

Facility

$744.90

Service Code	HCPCS 81432
Hospital Charge Code	401181432C
Hospital Revenue Code	310
Min. Negotiated Rate	$111.73
Max. Negotiated Rate	$111.73
Rate for Payer: Qualcare PPO/HMO/WC	$111.73

HRDTRY BRST CA-RLAT DISORDERS1

Facility

$744.90

Service Code	HCPCS 81432
Hospital Charge Code	401181432C
Hospital Revenue Code	310
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$4,730.08
Rate for Payer: Aetna Commercial	$3,546.74
Rate for Payer: Aetna Medicare Advantage	$4,224.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,730.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,730.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,303.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,730.08
Rate for Payer: Cigna Commercial	$372.45
Rate for Payer: Cigna Medicare Advantage	$1,303.95
Rate for Payer: Clover Medicare Advantage	$1,238.75
Rate for Payer: EmblemHealth Commercial	$3,911.85
Rate for Payer: Humana Medicare Advantage	$1,343.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,303.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.67
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.73
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$543.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,303.95
Rate for Payer: Wellcare Medicare Advantage	$1,303.95
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

HRDTRY BRST CA-RLAT DISORDERS2

Facility

$744.90

Service Code	HCPCS 81433
Hospital Charge Code	401181433D
Hospital Revenue Code	310
Min. Negotiated Rate	$21.16
Max. Negotiated Rate	$372.45
Rate for Payer: Aetna Commercial	$283.06
Rate for Payer: Aetna Medicare Advantage	$223.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.95
Rate for Payer: Cigna Commercial	$372.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.67
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.73
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.16

HRDTRY BRST CA-RLAT DISORDERS2

Facility

$744.90

Service Code	HCPCS 81433
Hospital Charge Code	401181433D
Hospital Revenue Code	310
Min. Negotiated Rate	$111.73
Max. Negotiated Rate	$111.73
Rate for Payer: Qualcare PPO/HMO/WC	$111.73

H REFLEX AMP & LATENCY

Facility

$5,700.00

Hospital Charge Code	9109100
Hospital Revenue Code	922
Min. Negotiated Rate	$161.88
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.00
Rate for Payer: Oxford Commercial	$2,277.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,585.00
Rate for Payer: UnitedHealthcare Community & State	$180.12
Rate for Payer: Wellpoint Medicaid Managed Care	$161.88

H REFLEX AMP & LATENCY

Facility

$5,700.00

Hospital Charge Code	9109100
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

HSP DISCH> 30 MIN

Facility

$174.00

Service Code	HCPCS 99239
Hospital Charge Code	87502370
Hospital Revenue Code	510
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.24
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.94

HSP DISCH> 30 MIN

Facility

$174.00

Service Code	HCPCS 99239
Hospital Charge Code	87502370
Hospital Revenue Code	510
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

HSTART PRENATAL DEVELOPMENT

Facility

$280.00

Service Code	HCPCS 99241
Hospital Charge Code	83652435
Hospital Revenue Code	514
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Community & State	$8.85
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

HSTART PRENATAL DEVELOPMENT

Facility

$280.00

Service Code	HCPCS 99241
Hospital Charge Code	83652435
Hospital Revenue Code	514
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

HSTART SUBSQNT PLAN 3RD TRIMTR

Facility

$153.00

Service Code	HCPCS 9924122
Hospital Charge Code	83652515
Hospital Revenue Code	514
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

HSTART SUBSQNT PLAN 3RD TRIMTR

Facility

$153.00

Service Code	HCPCS 9924122
Hospital Charge Code	83652515
Hospital Revenue Code	514
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$58.14
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.78
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

HSV 1/ 2 IGG HERPESELECT I

Facility

$390.00

Service Code	HCPCS 86695
Hospital Charge Code	39990101A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

HSV 1/ 2 IGG HERPESELECT I

Facility

$390.00

Service Code	HCPCS 86695
Hospital Charge Code	39990101A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges