Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	3039022
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	38430022
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80342
Hospital Charge Code	39990222
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	38430023
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	39990223
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	39990223
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	3039023
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	3039023
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80343
Hospital Charge Code	38430023
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	39990224
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	3039024
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	38430024
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	38430024
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	39990224
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIPSYCHOTICS NOS 7/MORE

Facility

$190.45

Service Code	HCPCS 80344
Hospital Charge Code	3039024
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIROTATION SCREW 85MM

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270687017
Hospital Revenue Code	278
Min. Negotiated Rate	$52.11
Max. Negotiated Rate	$917.50
Rate for Payer: Aetna Commercial	$697.30
Rate for Payer: Aetna Medicare Advantage	$550.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$467.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$467.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$467.93
Rate for Payer: Cigna Commercial	$917.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.07
Rate for Payer: Qualcare PPO/HMO/WC	$275.25
Rate for Payer: UnitedHealthcare Community & State	$57.99
Rate for Payer: Wellpoint Medicaid Managed Care	$52.11

ANTIROTATION SCREW 85MM

Facility

$1,835.00

Service Code	HCPCS C1713
Hospital Charge Code	270687017
Hospital Revenue Code	278
Min. Negotiated Rate	$275.25
Max. Negotiated Rate	$444.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$367.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.07
Rate for Payer: Qualcare PPO/HMO/WC	$275.25

ANTIROT SCR FEM NECK 90MMSTER

Facility

$1,077.10

Service Code	HCPCS C1713
Hospital Charge Code	270686944
Hospital Revenue Code	278
Min. Negotiated Rate	$161.56
Max. Negotiated Rate	$260.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.66
Rate for Payer: Qualcare PPO/HMO/WC	$161.56

ANTIROT SCR FEM NECK 90MMSTER

Facility

$1,077.10

Service Code	HCPCS C1713
Hospital Charge Code	270686944
Hospital Revenue Code	278
Min. Negotiated Rate	$30.59
Max. Negotiated Rate	$538.55
Rate for Payer: Aetna Commercial	$409.30
Rate for Payer: Aetna Medicare Advantage	$323.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.66
Rate for Payer: Cigna Commercial	$538.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.66
Rate for Payer: Qualcare PPO/HMO/WC	$161.56
Rate for Payer: UnitedHealthcare Community & State	$34.04
Rate for Payer: Wellpoint Medicaid Managed Care	$30.59

ANTI-SARS-COV2-IGG QUALIT

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679A
Hospital Revenue Code	302
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

ANTI-SARS-COV2-IGG QUALIT

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679A
Hospital Revenue Code	302
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$114.59
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.83
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: Cigna Medicare Advantage	$42.13
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Medicare Advantage	$42.13
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

ANTI-SARS-COV2-TOTAL (IGG-IGM)

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679B
Hospital Revenue Code	302
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$114.59
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.83
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: Cigna Medicare Advantage	$42.13
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Medicare Advantage	$42.13
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

ANTI-SARS-COV2-TOTAL (IGG-IGM)

Facility

$169.00

Service Code	HCPCS 86769
Hospital Charge Code	40138679B
Hospital Revenue Code	302
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

ANTI STREPTOLYSIN O

Facility

$292.00

Service Code	HCPCS 86063
Hospital Charge Code	38476006
Hospital Revenue Code	302
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.69
Rate for Payer: Aetna Medicare Advantage	$18.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.93
Rate for Payer: Cigna Commercial	$146.00
Rate for Payer: Cigna Medicare Advantage	$5.77
Rate for Payer: Clover Medicare Advantage	$5.48
Rate for Payer: EmblemHealth Commercial	$17.31
Rate for Payer: Humana Medicare Advantage	$5.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.77
Rate for Payer: Wellcare Medicare Advantage	$5.77
Rate for Payer: Wellpoint Medicaid Managed Care	$8.29

ANTI STREPTOLYSIN O

Facility

$292.00

Service Code	HCPCS 86063
Hospital Charge Code	38476006
Hospital Revenue Code	302
Min. Negotiated Rate	$43.80
Max. Negotiated Rate	$43.80
Rate for Payer: Qualcare PPO/HMO/WC	$43.80

Know your out-of-pocket cost for care.

All Charges