Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PART THROMBOPLASTIN TIME (PTT)

Facility

$659.96

Service Code	HCPCS 85730
Hospital Charge Code	3002037
Hospital Revenue Code	305
Min. Negotiated Rate	$4.81
Max. Negotiated Rate	$329.98
Rate for Payer: Aetna Commercial	$16.35
Rate for Payer: Aetna Medicare Advantage	$19.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.01
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	$21.80
Rate for Payer: Cigna Commercial	$329.98
Rate for Payer: Cigna Medicare Advantage	$6.01
Rate for Payer: Clover Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$18.03
Rate for Payer: Humana Medicare Advantage	$6.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.59
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.99
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.01
Rate for Payer: Wellcare Medicare Advantage	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$18.74

PART THROMBOPLASTIN TIME (PTT)

Facility

$659.96

Service Code	HCPCS 85730
Hospital Charge Code	3002037
Hospital Revenue Code	305
Min. Negotiated Rate	$98.99
Max. Negotiated Rate	$98.99
Rate for Payer: Qualcare PPO/HMO/WC	$98.99

PARVOVIRUS ANTIBODY (HPV)

Facility

$581.00

Service Code	HCPCS 86747
Hospital Charge Code	38472902
Hospital Revenue Code	302
Min. Negotiated Rate	$87.15
Max. Negotiated Rate	$87.15
Rate for Payer: Qualcare PPO/HMO/WC	$87.15

PARVOVIRUS ANTIBODY (HPV)

Facility

$581.00

Service Code	HCPCS 86747
Hospital Charge Code	38472902
Hospital Revenue Code	302
Min. Negotiated Rate	$12.02
Max. Negotiated Rate	$290.50
Rate for Payer: Aetna Commercial	$40.88
Rate for Payer: Aetna Medicare Advantage	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.03
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	$54.52
Rate for Payer: Cigna Commercial	$290.50
Rate for Payer: Cigna Medicare Advantage	$15.03
Rate for Payer: Clover Medicare Advantage	$14.28
Rate for Payer: EmblemHealth Commercial	$45.09
Rate for Payer: Humana Medicare Advantage	$15.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.03
Rate for Payer: Wellcare Medicare Advantage	$15.03
Rate for Payer: Wellpoint Medicaid Managed Care	$16.50

PARVOVIRUS B19 AB (IGG,M) I

Facility

$390.00

Service Code	HCPCS 86747
Hospital Charge Code	39990047A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PARVOVIRUS B19 AB (IGG,M) I

Facility

$390.00

Service Code	HCPCS 86747
Hospital Charge Code	39990047A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.88
Rate for Payer: Aetna Medicare Advantage	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.03
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	$54.52
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.03
Rate for Payer: Clover Medicare Advantage	$14.28
Rate for Payer: EmblemHealth Commercial	$45.09
Rate for Payer: Humana Medicare Advantage	$15.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.03
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	$12.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.03
Rate for Payer: Wellcare Medicare Advantage	$15.03
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PARVOVIRUS B19 AB (IGG,M) II

Facility

$390.00

Service Code	HCPCS 86747
Hospital Charge Code	39990047B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PARVOVIRUS B19 AB (IGG,M) II

Facility

$390.00

Service Code	HCPCS 86747
Hospital Charge Code	39990047B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.88
Rate for Payer: Aetna Medicare Advantage	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.03
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	$54.52
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.03
Rate for Payer: Clover Medicare Advantage	$14.28
Rate for Payer: EmblemHealth Commercial	$45.09
Rate for Payer: Humana Medicare Advantage	$15.48
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.03
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	$12.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.03
Rate for Payer: Wellcare Medicare Advantage	$15.03
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PARVOVIRUS B19 DNA,QL,PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900402
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PARVOVIRUS B19 DNA,QL,PCR

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39900402
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PASSER CATHETER 60cm S/C DISP

Facility

$888.00

Service Code	HCPCS C1729
Hospital Charge Code	270612675
Hospital Revenue Code	278
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$444.00
Rate for Payer: Aetna Commercial	$337.44
Rate for Payer: Aetna Medicare Advantage	$266.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.44
Rate for Payer: Cigna Commercial	$444.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.90
Rate for Payer: Qualcare PPO/HMO/WC	$133.20
Rate for Payer: UnitedHealthcare Community & State	$28.06
Rate for Payer: Wellpoint Medicaid Managed Care	$25.22

PASSER CATHETER 60cm S/C DISP

Facility

$888.00

Service Code	HCPCS C1729
Hospital Charge Code	270612675
Hospital Revenue Code	278
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$214.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.90
Rate for Payer: Qualcare PPO/HMO/WC	$133.20

PASSER SUTURE HEWSON

Facility

$822.50

Hospital Charge Code	270620933
Hospital Revenue Code	272
Min. Negotiated Rate	$23.36
Max. Negotiated Rate	$411.25
Rate for Payer: Aetna Commercial	$312.55
Rate for Payer: Aetna Medicare Advantage	$246.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.74
Rate for Payer: Cigna Commercial	$411.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.85
Rate for Payer: Oxford Commercial	$164.50
Rate for Payer: Qualcare PPO/HMO/WC	$123.38
Rate for Payer: UnitedHealthcare Commercial	$164.50
Rate for Payer: UnitedHealthcare Community & State	$25.99
Rate for Payer: Wellpoint Medicaid Managed Care	$23.36

PASSER SUTURE HEWSON

Facility

$822.50

Hospital Charge Code	270620933
Hospital Revenue Code	272
Min. Negotiated Rate	$123.38
Max. Negotiated Rate	$123.38
Rate for Payer: Qualcare PPO/HMO/WC	$123.38

PASSER SUTURE STRAIGHT

Facility

$1,655.00

Hospital Charge Code	270613181
Hospital Revenue Code	272
Min. Negotiated Rate	$248.25
Max. Negotiated Rate	$248.25
Rate for Payer: Qualcare PPO/HMO/WC	$248.25

PASSER SUTURE STRAIGHT

Facility

$1,655.00

Hospital Charge Code	270613181
Hospital Revenue Code	272
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$827.50
Rate for Payer: Aetna Commercial	$628.90
Rate for Payer: Aetna Medicare Advantage	$496.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.02
Rate for Payer: Cigna Commercial	$827.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$430.30
Rate for Payer: Oxford Commercial	$331.00
Rate for Payer: Qualcare PPO/HMO/WC	$248.25
Rate for Payer: UnitedHealthcare Commercial	$331.00
Rate for Payer: UnitedHealthcare Community & State	$52.30
Rate for Payer: Wellpoint Medicaid Managed Care	$47.00

PASSPORT 8MM X 4

Facility

$160.00

Hospital Charge Code	270667982
Hospital Revenue Code	270
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$32.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

PASSPORT 8MM X 4

Facility

$160.00

Hospital Charge Code	270667982
Hospital Revenue Code	270
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

PASSPORT BUTTON CANNULA

Facility

$160.00

Hospital Charge Code	270684275
Hospital Revenue Code	272
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$32.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

PASSPORT BUTTON CANNULA

Facility

$160.00

Hospital Charge Code	270684275
Hospital Revenue Code	272
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

PASS ZIM WIRE 1.5 19MM 5091248

Facility

$328.85

Hospital Charge Code	270601269
Hospital Revenue Code	272
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$164.43
Rate for Payer: Aetna Commercial	$124.96
Rate for Payer: Aetna Medicare Advantage	$98.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.86
Rate for Payer: Cigna Commercial	$164.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.50
Rate for Payer: Oxford Commercial	$65.77
Rate for Payer: Qualcare PPO/HMO/WC	$49.33
Rate for Payer: UnitedHealthcare Commercial	$65.77
Rate for Payer: UnitedHealthcare Community & State	$10.39
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

PASS ZIM WIRE 1.5 19MM 5091248

Facility

$328.85

Hospital Charge Code	270601269
Hospital Revenue Code	272
Min. Negotiated Rate	$49.33
Max. Negotiated Rate	$49.33
Rate for Payer: Qualcare PPO/HMO/WC	$49.33

PASTE PROTECTANT CALAZIME 4oz

Facility

$21.68

Hospital Charge Code	270650073
Hospital Revenue Code	270
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$8.24
Rate for Payer: Aetna Medicare Advantage	$6.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.53
Rate for Payer: Cigna Commercial	$10.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.64
Rate for Payer: Oxford Commercial	$4.34
Rate for Payer: Qualcare PPO/HMO/WC	$3.25
Rate for Payer: UnitedHealthcare Commercial	$4.34
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

PASTE PROTECTANT CALAZIME 4oz

Facility

$21.68

Hospital Charge Code	270650073
Hospital Revenue Code	270
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$3.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.25

PASTE REME CALAZ 4OZ MSC094544

Facility

$25.00

Hospital Charge Code	270640977W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

Know your out-of-pocket cost for care.

All Charges