Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ASF VIVACIT PS 12 MM SZ 6-9

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686545
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

ASF VIVACIT PS 12 MM SZ 6-9

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270686545
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

ASMBLD PROTEAN FRAGMNT PLATE Y

Facility

$5,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270668299
Hospital Revenue Code	278
Min. Negotiated Rate	$783.75
Max. Negotiated Rate	$1,264.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: Qualcare PPO/HMO/WC	$783.75

ASMBLD PROTEAN FRAGMNT PLATE Y

Facility

$5,225.00

Service Code	HCPCS C1713
Hospital Charge Code	270668299
Hospital Revenue Code	278
Min. Negotiated Rate	$148.39
Max. Negotiated Rate	$2,612.50
Rate for Payer: Aetna Commercial	$1,985.50
Rate for Payer: Aetna Medicare Advantage	$1,567.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,332.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,045.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,332.38
Rate for Payer: Cigna Commercial	$2,612.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,264.45
Rate for Payer: Qualcare PPO/HMO/WC	$783.75
Rate for Payer: UnitedHealthcare Community & State	$165.11
Rate for Payer: Wellpoint Medicaid Managed Care	$148.39

ASNIS 6.5/105MM

Facility

$2,020.00

Hospital Charge Code	270664933
Hospital Revenue Code	270
Min. Negotiated Rate	$57.37
Max. Negotiated Rate	$1,010.00
Rate for Payer: Aetna Commercial	$767.60
Rate for Payer: Aetna Medicare Advantage	$606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$515.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$515.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$515.10
Rate for Payer: Cigna Commercial	$1,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$525.20
Rate for Payer: Oxford Commercial	$404.00
Rate for Payer: Qualcare PPO/HMO/WC	$303.00
Rate for Payer: UnitedHealthcare Commercial	$404.00
Rate for Payer: UnitedHealthcare Community & State	$63.83
Rate for Payer: Wellpoint Medicaid Managed Care	$57.37

ASNIS 6.5/105MM

Facility

$2,020.00

Hospital Charge Code	270664933
Hospital Revenue Code	270
Min. Negotiated Rate	$303.00
Max. Negotiated Rate	$303.00
Rate for Payer: Qualcare PPO/HMO/WC	$303.00

ASO AB

Facility

$390.00

Service Code	HCPCS 86060
Hospital Charge Code	39990022EX
Hospital Revenue Code	302
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$19.86
Rate for Payer: Aetna Medicare Advantage	$23.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.48
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$7.30
Rate for Payer: Clover Medicare Advantage	$6.93
Rate for Payer: EmblemHealth Commercial	$21.90
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.30
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	$5.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.30
Rate for Payer: Wellcare Medicare Advantage	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ASO AB

Facility

$390.00

Service Code	HCPCS 86060
Hospital Charge Code	39990022EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASO AB I

Facility

$50.15

Service Code	HCPCS 86060
Hospital Charge Code	39990022A
Hospital Revenue Code	306
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$7.52
Rate for Payer: Qualcare PPO/HMO/WC	$7.52

ASO AB I

Facility

$50.15

Service Code	HCPCS 86060
Hospital Charge Code	39990022A
Hospital Revenue Code	306
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$19.86
Rate for Payer: Aetna Medicare Advantage	$23.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.48
Rate for Payer: Cigna Commercial	$25.07
Rate for Payer: Cigna Medicare Advantage	$7.30
Rate for Payer: Clover Medicare Advantage	$6.93
Rate for Payer: EmblemHealth Commercial	$21.90
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.04
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.52
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.30
Rate for Payer: Wellcare Medicare Advantage	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

ASO AB II

Facility

$39.65

Service Code	HCPCS 86063
Hospital Charge Code	39990022B
Hospital Revenue Code	306
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

ASO AB II

Facility

$39.65

Service Code	HCPCS 86063
Hospital Charge Code	39990022B
Hospital Revenue Code	306
Min. Negotiated Rate	$1.13
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	$19.82
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	$10.31
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
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	$1.13

ASO TITER

Facility

$453.00

Service Code	HCPCS 86060
Hospital Charge Code	38476047
Hospital Revenue Code	302
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

ASO TITER

Facility

$453.00

Service Code	HCPCS 86060
Hospital Charge Code	38476047
Hospital Revenue Code	302
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$226.50
Rate for Payer: Aetna Commercial	$19.86
Rate for Payer: Aetna Medicare Advantage	$23.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.48
Rate for Payer: Cigna Commercial	$226.50
Rate for Payer: Cigna Medicare Advantage	$7.30
Rate for Payer: Clover Medicare Advantage	$6.93
Rate for Payer: EmblemHealth Commercial	$21.90
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.30
Rate for Payer: Wellcare Medicare Advantage	$7.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.87

ASPARTATE AMINOTRANSFERASE-AST

Facility

$313.00

Service Code	HCPCS 84450
Hospital Charge Code	38472128
Hospital Revenue Code	301
Min. Negotiated Rate	$46.95
Max. Negotiated Rate	$46.95
Rate for Payer: Qualcare PPO/HMO/WC	$46.95

ASPARTATE AMINOTRANSFERASE-AST

Facility

$313.00

Service Code	HCPCS 84450
Hospital Charge Code	38472128
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$156.50
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	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$156.50
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	$81.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.95
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	$8.89

ASP BLADDER W INS SUPRAPUB

Facility

$9,671.92

Service Code	HCPCS 51102
Hospital Charge Code	2309104
Hospital Revenue Code	361
Min. Negotiated Rate	$274.68
Max. Negotiated Rate	$9,008.64
Rate for Payer: Aetna Commercial	$6,754.93
Rate for Payer: Aetna Medicare Advantage	$8,046.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,008.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,483.43
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	$9,008.64
Rate for Payer: Cigna Commercial	$4,978.04
Rate for Payer: Cigna Medicare Advantage	$2,483.43
Rate for Payer: Clover Medicare Advantage	$2,359.26
Rate for Payer: EmblemHealth Commercial	$7,450.29
Rate for Payer: Humana Medicare Advantage	$2,557.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,483.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,514.70
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.79
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$305.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,483.43
Rate for Payer: Wellcare Medicare Advantage	$2,483.43
Rate for Payer: Wellpoint Medicaid Managed Care	$274.68

ASP BLADDER W INS SUPRAPUB

Facility

$9,671.92

Service Code	HCPCS 51102
Hospital Charge Code	2309104
Hospital Revenue Code	361
Min. Negotiated Rate	$1,450.79
Max. Negotiated Rate	$1,450.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,450.79

ASPERGILLIN ANTIBODIES

Facility

$131.00

Service Code	HCPCS 86606
Hospital Charge Code	38476188
Hospital Revenue Code	302
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

ASPERGILLIN ANTIBODIES

Facility

$131.00

Service Code	HCPCS 86606
Hospital Charge Code	38476188
Hospital Revenue Code	302
Min. Negotiated Rate	$3.72
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	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$65.50
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	$34.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
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	$3.72

ASPERGILLUS AB, ID, I

Facility

$390.00

Service Code	HCPCS 8660691
Hospital Charge Code	39990032A
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

ASPERGILLUS AB, ID, I

Facility

$390.00

Service Code	HCPCS 8660691
Hospital Charge Code	39990032A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASPERGILLUS AB, ID, II

Facility

$390.00

Service Code	HCPCS 8660691
Hospital Charge Code	39990032B
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

ASPERGILLUS AB, ID, II

Facility

$390.00

Service Code	HCPCS 8660691
Hospital Charge Code	39990032B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ASPERGILLUS AB, ID, III

Facility

$390.00

Service Code	HCPCS 8660691
Hospital Charge Code	39990032C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges