Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

M.PNEUMONIAE AB (IGG),EIA

Facility

$667.59

Service Code	HCPCS 86738
Hospital Charge Code	39900250
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M.PNEUMONIAE AB (IGG),EIA

Facility

$667.59

Service Code	HCPCS 86738
Hospital Charge Code	39900250
Hospital Revenue Code	302
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.03
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
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	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

M.PNEUMONIAE AB (IGG,M),E I

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046A
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M.PNEUMONIAE AB (IGG,M),E I

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046A
Hospital Revenue Code	302
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
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	$21.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

M.PNEUMONIAE AB (IGG,M),E II

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046B
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

M.PNEUMONIAE AB (IGG,M),E II

Facility

$667.59

Service Code	HCPCS 8673891
Hospital Charge Code	39990046B
Hospital Revenue Code	302
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
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	$21.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

M. PNEUMONIAE ANTIBODY AI

Facility

$79.19

Service Code	HCPCS 86738
Hospital Charge Code	39900533
Hospital Revenue Code	302
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Qualcare PPO/HMO/WC	$11.88

M. PNEUMONIAE ANTIBODY AI

Facility

$79.19

Service Code	HCPCS 86738
Hospital Charge Code	39900533
Hospital Revenue Code	302
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.03
Rate for Payer: Cigna Commercial	$39.59
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.59
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.88
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.25

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900489
Hospital Revenue Code	309
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.83
Rate for Payer: Cigna Commercial	$52.88
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.86
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900489
Hospital Revenue Code	309
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$15.86

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900269
Hospital Revenue Code	309
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.83
Rate for Payer: Cigna Commercial	$52.88
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.86
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

M.PNEUMONIAE CULTURE

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900269
Hospital Revenue Code	309
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$15.86

MPOX VIR DNA QUAL RT PCR

Facility

$100.00

Service Code	HCPCS 87593
Hospital Charge Code	401312084
Hospital Revenue Code	306
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

MPOX VIR DNA QUAL RT PCR

Facility

$100.00

Service Code	HCPCS 87593
Hospital Charge Code	401312084
Hospital Revenue Code	306
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$186.13
Rate for Payer: Aetna Commercial	$139.56
Rate for Payer: Aetna Medicare Advantage	$166.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$186.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$186.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$51.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$84.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$186.13
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: Cigna Medicare Advantage	$51.31
Rate for Payer: Clover Medicare Advantage	$48.74
Rate for Payer: EmblemHealth Commercial	$153.93
Rate for Payer: Humana Medicare Advantage	$52.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$51.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.31
Rate for Payer: Wellcare Medicare Advantage	$51.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

MRA-CHEST WO/W CONTRAST

Facility

$3,538.00

Service Code	HCPCS 71555
Hospital Charge Code	2408001
Hospital Revenue Code	618
Min. Negotiated Rate	$100.48
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,344.44
Rate for Payer: Aetna Medicare Advantage	$1,061.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$902.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$902.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$418.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$902.19
Rate for Payer: Cigna Commercial	$1,769.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$919.88
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$530.70
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$111.80
Rate for Payer: Wellpoint Medicaid Managed Care	$100.48

MRA-CHEST WO/W CONTRAST

Facility

$3,538.00

Service Code	HCPCS 71555
Hospital Charge Code	2408001
Hospital Revenue Code	618
Min. Negotiated Rate	$530.70
Max. Negotiated Rate	$530.70
Rate for Payer: Qualcare PPO/HMO/WC	$530.70

MRA HEAD W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70544
Hospital Charge Code	94061027
Hospital Revenue Code	615
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

MRA HEAD W/O CONT

Facility

$13,500.00

Service Code	HCPCS 70544
Hospital Charge Code	94061027
Hospital Revenue Code	615
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA-LOWER EXTREM WO/W CONT-RT

Facility

$2,895.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2407001
Hospital Revenue Code	616
Min. Negotiated Rate	$434.25
Max. Negotiated Rate	$434.25
Rate for Payer: Qualcare PPO/HMO/WC	$434.25

MRA-LOWER EXTREM WO/W CONT-RT

Facility

$2,895.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2407001
Hospital Revenue Code	616
Min. Negotiated Rate	$82.22
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$1,100.10
Rate for Payer: Aetna Medicare Advantage	$868.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$738.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$738.23
Rate for Payer: Cigna Commercial	$1,447.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.70
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$434.25
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$91.48
Rate for Payer: Wellpoint Medicaid Managed Care	$82.22

MRA LOW EXTR W/ OR W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2400300
Hospital Revenue Code	616
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

MRA LOW EXTR W/ OR W/O CONT RT

Facility

$13,500.00

Service Code	HCPCS 73725RT
Hospital Charge Code	2400300
Hospital Revenue Code	616
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

MRA LOWR EXTR W/OR W/O CO LT

Facility

$1,994.00

Service Code	HCPCS 73725LT
Hospital Charge Code	2400299
Hospital Revenue Code	616
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$757.72
Rate for Payer: Aetna Medicare Advantage	$598.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$508.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$508.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$508.47
Rate for Payer: Cigna Commercial	$997.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$518.44
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$299.10
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$63.01
Rate for Payer: Wellpoint Medicaid Managed Care	$56.63

MRA LOWR EXTR W/OR W/O CO LT

Facility

$1,994.00

Service Code	HCPCS 73725LT
Hospital Charge Code	2400299
Hospital Revenue Code	616
Min. Negotiated Rate	$299.10
Max. Negotiated Rate	$299.10
Rate for Payer: Qualcare PPO/HMO/WC	$299.10

MRA LOWR EXTR W & W/O CON BIL

Facility

$13,500.00

Service Code	HCPCS 7372550
Hospital Charge Code	2400097
Hospital Revenue Code	616
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,510.00
Rate for Payer: Oxford Commercial	$5,427.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Commercial	$6,130.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

Know your out-of-pocket cost for care.

All Charges