Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MR UPP EXT ANY JT UP RT W/ C

Facility

$13,500.00

Service Code	HCPCS 73222RT
Hospital Charge Code	2400259
Hospital Revenue Code	614
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$2,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

M.S. CONTIN/60MG/TAB

Facility

$35.64

Service Code	NDC 406838023
Hospital Charge Code	60634411
Hospital Revenue Code	250
Min. Negotiated Rate	$5.35
Max. Negotiated Rate	$5.35
Rate for Payer: Qualcare PPO/HMO/WC	$5.35

M.S. CONTIN/60MG/TAB

Facility

$35.64

Service Code	NDC 406838023
Hospital Charge Code	60634411
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$17.82
Rate for Payer: Aetna Commercial	$13.54
Rate for Payer: Aetna Medicare Advantage	$10.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.09
Rate for Payer: Cigna Commercial	$17.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.27
Rate for Payer: Oxford Commercial	$7.13
Rate for Payer: Qualcare PPO/HMO/WC	$5.35
Rate for Payer: UnitedHealthcare Commercial	$7.13
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

MSLT OR MWT

Facility

$40,000.00

Service Code	HCPCS 95805
Hospital Charge Code	90000015
Hospital Revenue Code	920
Min. Negotiated Rate	$969.20
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,348.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,700.81
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

MSLT OR MWT

Facility

$40,000.00

Service Code	HCPCS 95805
Hospital Charge Code	90000015
Hospital Revenue Code	920
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

MS,MS/MS.ANALYTE QUAL EA SPECI

Facility

$127.00

Service Code	HCPCS 83789
Hospital Charge Code	38477150
Hospital Revenue Code	301
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.46
Rate for Payer: Cigna Commercial	$63.50
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

MS,MS/MS.ANALYTE QUAL EA SPECI

Facility

$127.00

Service Code	HCPCS 83789
Hospital Charge Code	38477150
Hospital Revenue Code	301
Min. Negotiated Rate	$19.05
Max. Negotiated Rate	$19.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.05

MS PANEL I

Facility

$390.00

Service Code	HCPCS 82040
Hospital Charge Code	39990130A
Hospital Revenue Code	307
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.46
Rate for Payer: Aetna Medicare Advantage	$16.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.96
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.95
Rate for Payer: Clover Medicare Advantage	$4.70
Rate for Payer: EmblemHealth Commercial	$14.85
Rate for Payer: Humana Medicare Advantage	$5.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.95
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	$3.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.95
Rate for Payer: Wellcare Medicare Advantage	$4.95
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MS PANEL I

Facility

$390.00

Service Code	HCPCS 82040
Hospital Charge Code	39990130A
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MS PANEL II

Facility

$390.00

Service Code	HCPCS 82042
Hospital Charge Code	39990130B
Hospital Revenue Code	307
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare Advantage	$25.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.22
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$7.78
Rate for Payer: Clover Medicare Advantage	$7.39
Rate for Payer: EmblemHealth Commercial	$23.34
Rate for Payer: Humana Medicare Advantage	$8.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.78
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	$6.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.78
Rate for Payer: Wellcare Medicare Advantage	$7.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MS PANEL II

Facility

$390.00

Service Code	HCPCS 82042
Hospital Charge Code	39990130B
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MS PANEL III

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39990130C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MS PANEL III

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39990130C
Hospital Revenue Code	301
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.74
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
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	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MS PANEL IV

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39990130D
Hospital Revenue Code	301
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna Medicare Advantage	$30.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.74
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.30
Rate for Payer: Clover Medicare Advantage	$8.84
Rate for Payer: EmblemHealth Commercial	$27.90
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.30
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	$7.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.30
Rate for Payer: Wellcare Medicare Advantage	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MS PANEL IV

Facility

$390.00

Service Code	HCPCS 82784
Hospital Charge Code	39990130D
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MS PANEL V

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	39990130E
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$74.50
Rate for Payer: Aetna Medicare Advantage	$88.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$27.39
Rate for Payer: Clover Medicare Advantage	$26.02
Rate for Payer: EmblemHealth Commercial	$82.17
Rate for Payer: Humana Medicare Advantage	$28.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.39
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	$21.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.39
Rate for Payer: Wellcare Medicare Advantage	$27.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MS PANEL V

Facility

$390.00

Service Code	HCPCS 83916
Hospital Charge Code	39990130E
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MTA3U0 22.5D

Facility

$725.00

Hospital Charge Code	270667855
Hospital Revenue Code	278
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$22.91
Rate for Payer: Wellpoint Medicaid Managed Care	$20.59

MTA3U0 22.5D

Facility

$725.00

Hospital Charge Code	270667855
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

MTF-AUTOLOGUS PLATELET SYSTEM

Facility

$775.00

Hospital Charge Code	270339453
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

MTF-AUTOLOGUS PLATELET SYSTEM

Facility

$775.00

Hospital Charge Code	270339453
Hospital Revenue Code	272
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$22.01

MTHFR,DNA M

Facility

$389.40

Service Code	HCPCS 81291
Hospital Charge Code	39900022
Hospital Revenue Code	310
Min. Negotiated Rate	$58.41
Max. Negotiated Rate	$58.41
Rate for Payer: Qualcare PPO/HMO/WC	$58.41

MTHFR,DNA M

Facility

$389.40

Service Code	HCPCS 81291
Hospital Charge Code	39900022
Hospital Revenue Code	310
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$237.02
Rate for Payer: Aetna Commercial	$177.72
Rate for Payer: Aetna Medicare Advantage	$211.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$65.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.02
Rate for Payer: Cigna Commercial	$194.70
Rate for Payer: Cigna Medicare Advantage	$65.34
Rate for Payer: Clover Medicare Advantage	$62.07
Rate for Payer: EmblemHealth Commercial	$196.02
Rate for Payer: Humana Medicare Advantage	$67.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$65.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.41
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$52.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.34
Rate for Payer: Wellcare Medicare Advantage	$65.34
Rate for Payer: Wellpoint Medicaid Managed Care	$11.06

MT MULTIPL FOR CAVUS FOOT

Facility

$6,573.95

Service Code	HCPCS 28309
Hospital Charge Code	16000724
Hospital Revenue Code	360
Min. Negotiated Rate	$986.09
Max. Negotiated Rate	$986.09
Rate for Payer: Qualcare PPO/HMO/WC	$986.09

MT MULTIPL FOR CAVUS FOOT

Facility

$6,573.95

Service Code	HCPCS 28309
Hospital Charge Code	16000724
Hospital Revenue Code	360
Min. Negotiated Rate	$186.70
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,709.23
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$986.09
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$207.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$186.70

Know your out-of-pocket cost for care.

All Charges