Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LEGIONELLA AB PANEL IFA, I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990045A
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

LEGIONELLA AB PANEL IFA, I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990045A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA AB PANEL IFA, II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990045B
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

LEGIONELLA AB PANEL IFA, II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990045B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA AG DETECT DFA STOOL

Facility

$390.00

Service Code	HCPCS 87278
Hospital Charge Code	397071539
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA AG DETECT DFA STOOL

Facility

$390.00

Service Code	HCPCS 87278
Hospital Charge Code	401387278
Hospital Revenue Code	306
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$42.43
Rate for Payer: Aetna Medicare Advantage	$50.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.59
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.60
Rate for Payer: Clover Medicare Advantage	$14.82
Rate for Payer: EmblemHealth Commercial	$46.80
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.60
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	$12.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.60
Rate for Payer: Wellcare Medicare Advantage	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LEGIONELLA AG DETECT DFA STOOL

Facility

$390.00

Service Code	HCPCS 87278
Hospital Charge Code	401387278
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA AG DETECT DFA STOOL

Facility

$390.00

Service Code	HCPCS 87278
Hospital Charge Code	397071539
Hospital Revenue Code	306
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$42.43
Rate for Payer: Aetna Medicare Advantage	$50.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.59
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.60
Rate for Payer: Clover Medicare Advantage	$14.82
Rate for Payer: EmblemHealth Commercial	$46.80
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.60
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	$12.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.60
Rate for Payer: Wellcare Medicare Advantage	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LEGIONELLA AG EIA

Facility

$77.00

Service Code	HCPCS 87449
Hospital Charge Code	38478080
Hospital Revenue Code	306
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$38.50
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

LEGIONELLA AG EIA

Facility

$77.00

Service Code	HCPCS 87449
Hospital Charge Code	38478080
Hospital Revenue Code	306
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

LEGIONELLA AG,EIA,URINE

Facility

$390.00

Service Code	HCPCS 87449
Hospital Charge Code	39900290
Hospital Revenue Code	306
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
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	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

LEGIONELLA AG,EIA,URINE

Facility

$390.00

Service Code	HCPCS 87449
Hospital Charge Code	39900290
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA AG,UR IMMUNO

Facility

$77.00

Service Code	HCPCS 87449
Hospital Charge Code	38479118
Hospital Revenue Code	306
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$11.55
Rate for Payer: Qualcare PPO/HMO/WC	$11.55

LEGIONELLA AG,UR IMMUNO

Facility

$77.00

Service Code	HCPCS 87449
Hospital Charge Code	38479118
Hospital Revenue Code	306
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$38.50
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.19

LEGIONELLA ANTIGEN, URINE

Facility

$667.59

Service Code	HCPCS 87449
Hospital Charge Code	3032265
Hospital Revenue Code	306
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

LEGIONELLA ANTIGEN, URINE

Facility

$667.59

Service Code	HCPCS 87449
Hospital Charge Code	3032265
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

LEGIONELLA CULTURE

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475006
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

LEGIONELLA CULTURE

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475006
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$174.50
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
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	$31.27
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

LEGIONELLA IGG,IGM 1-6, I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, I

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044A
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

LEGIONELLA IGG,IGM 1-6, II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, II

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044B
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

LEGIONELLA IGG,IGM 1-6, III

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044C
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

LEGIONELLA IGG,IGM 1-6, III

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

LEGIONELLA IGG,IGM 1-6, IV

Facility

$390.00

Service Code	HCPCS 8671391
Hospital Charge Code	39990044D
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

Know your out-of-pocket cost for care.

All Charges