Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ANTIBODY SCREEN (INDIRECT COOM

Facility

$455.00

Service Code	HCPCS 86850
Hospital Charge Code	38471004
Hospital Revenue Code	302
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$68.25

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100658
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100534
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100658
Hospital Revenue Code	302
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ANTIBODY TITER

Facility

$390.00

Service Code	HCPCS 86886
Hospital Charge Code	3100534
Hospital Revenue Code	300
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ANTIBODY TITRATION

Facility

$135.00

Service Code	HCPCS 86886
Hospital Charge Code	38471016
Hospital Revenue Code	300
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$20.25
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

ANTIBODY TITRATION

Facility

$135.00

Service Code	HCPCS 86886
Hospital Charge Code	38471016
Hospital Revenue Code	300
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$405.73
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.83

ANTIBODY TOXOPLASMA

Facility

$157.47

Hospital Charge Code	3000377A
Hospital Revenue Code	306
Min. Negotiated Rate	$23.62
Max. Negotiated Rate	$23.62
Rate for Payer: Qualcare PPO/HMO/WC	$23.62

ANTIBODY TOXOPLASMA

Facility

$157.47

Hospital Charge Code	3000377A
Hospital Revenue Code	306
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$59.84
Rate for Payer: Aetna Medicare Advantage	$47.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.15
Rate for Payer: Cigna Commercial	$78.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.62
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.98
Rate for Payer: Wellpoint Medicaid Managed Care	$4.47

ANTIBODY TOXOPLASMA IGM

Facility

$146.38

Hospital Charge Code	3000377B
Hospital Revenue Code	306
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$55.62
Rate for Payer: Aetna Medicare Advantage	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.33
Rate for Payer: Cigna Commercial	$73.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.96
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.63
Rate for Payer: Wellpoint Medicaid Managed Care	$4.16

ANTIBODY TOXOPLASMA IGM

Facility

$146.38

Hospital Charge Code	3000377B
Hospital Revenue Code	306
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$21.96
Rate for Payer: Qualcare PPO/HMO/WC	$21.96

ANTIBODY VIRUS NOS

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	401386790A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTIBODY VIRUS NOS

Facility

$390.00

Service Code	HCPCS 86790
Hospital Charge Code	401386790A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$391.36
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
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	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ANTIBODY VIRUS,NOT SPECIFIED 1

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476270
Hospital Revenue Code	302
Min. Negotiated Rate	$29.55
Max. Negotiated Rate	$29.55
Rate for Payer: Qualcare PPO/HMO/WC	$29.55

ANTIBODY VIRUS,NOT SPECIFIED 1

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476270
Hospital Revenue Code	302
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$391.36
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$98.50
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.22
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

ANTIBODY VIRUS,NOT SPECIFIED 2

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476271
Hospital Revenue Code	302
Min. Negotiated Rate	$29.55
Max. Negotiated Rate	$29.55
Rate for Payer: Qualcare PPO/HMO/WC	$29.55

ANTIBODY VIRUS,NOT SPECIFIED 2

Facility

$197.00

Service Code	HCPCS 86790
Hospital Charge Code	38476271
Hospital Revenue Code	302
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$391.36
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$391.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$98.50
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.22
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

ANTI-CARDIOLIPIN IGG

Facility

$390.00

Service Code	HCPCS 86147
Hospital Charge Code	39900194
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare Advantage	$82.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.32
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.45
Rate for Payer: Clover Medicare Advantage	$24.18
Rate for Payer: EmblemHealth Commercial	$76.35
Rate for Payer: Humana Medicare Advantage	$26.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.45
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	$20.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.45
Rate for Payer: Wellcare Medicare Advantage	$25.45
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ANTI-CARDIOLIPIN IGG

Facility

$390.00

Service Code	HCPCS 86147
Hospital Charge Code	39900194
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTI-CYTOPLASMIC ANTIBODY

Facility

$302.00

Service Code	HCPCS 86021
Hospital Charge Code	38476228
Hospital Revenue Code	302
Min. Negotiated Rate	$8.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$151.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$8.58

ANTI-CYTOPLASMIC ANTIBODY

Facility

$302.00

Service Code	HCPCS 86021
Hospital Charge Code	38476228
Hospital Revenue Code	302
Min. Negotiated Rate	$45.30
Max. Negotiated Rate	$45.30
Rate for Payer: Qualcare PPO/HMO/WC	$45.30

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	3039016
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	3039016
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	38430016
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	38430016
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

Know your out-of-pocket cost for care.

All Charges