Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BACTERIAL ANTIGENS

Facility

$247.00

Service Code	HCPCS 87899
Hospital Charge Code	38475032
Hospital Revenue Code	306
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

BACTERIAL VAGINOSIS PANEL I

Facility

$390.00

Service Code	HCPCS 87480
Hospital Charge Code	39990112A
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.73
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
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	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BACTERIAL VAGINOSIS PANEL I

Facility

$390.00

Service Code	HCPCS 87480
Hospital Charge Code	39990112A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL VAGINOSIS PANEL II

Facility

$390.00

Service Code	HCPCS 87510
Hospital Charge Code	39990112B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL VAGINOSIS PANEL II

Facility

$390.00

Service Code	HCPCS 87510
Hospital Charge Code	39990112B
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.73
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
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	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BACTERIAL VAGINOSIS PANEL III

Facility

$390.00

Service Code	HCPCS 87660
Hospital Charge Code	39990112C
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.73
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
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	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BACTERIAL VAGINOSIS PANEL III

Facility

$390.00

Service Code	HCPCS 87660
Hospital Charge Code	39990112C
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIOSTATIC SALINE

Facility

$6.77

Service Code	NDC 409196607
Hospital Charge Code	60628544
Hospital Revenue Code	270
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

BACTERIOSTATIC SALINE

Facility

$6.77

Service Code	NDC 409196607
Hospital Charge Code	60628544
Hospital Revenue Code	270
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.73
Rate for Payer: Cigna Commercial	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Oxford Commercial	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

BACTERIOSTATIC WATER INJ 30ML

Facility

$4.00

Service Code	NDC 409397703
Hospital Charge Code	60628556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BACTERIOSTATIC WATER INJ 30ML

Facility

$4.00

Service Code	NDC 409397703
Hospital Charge Code	60628556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACTISURE WOUND LAVAGE WW

Facility

$3,750.00

Hospital Charge Code	270693604
Hospital Revenue Code	272
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

BACTISURE WOUND LAVAGE WW

Facility

$3,750.00

Hospital Charge Code	270693604
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

BACTROBAN 2% CREAM 15 GM

Facility

$251.00

Hospital Charge Code	60628763W
Hospital Revenue Code	250
Min. Negotiated Rate	$7.13
Max. Negotiated Rate	$125.50
Rate for Payer: Aetna Commercial	$95.38
Rate for Payer: Aetna Medicare Advantage	$75.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.00
Rate for Payer: Cigna Commercial	$125.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.26
Rate for Payer: Oxford Commercial	$50.20
Rate for Payer: Qualcare PPO/HMO/WC	$37.65
Rate for Payer: UnitedHealthcare Commercial	$50.20
Rate for Payer: UnitedHealthcare Community & State	$7.93
Rate for Payer: Wellpoint Medicaid Managed Care	$7.13

BACTROBAN 2% CREAM 15 GM

Facility

$251.00

Hospital Charge Code	60628763W
Hospital Revenue Code	250
Min. Negotiated Rate	$37.65
Max. Negotiated Rate	$37.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.65

BACTROBAN 2 % OINTMENT (NASAL)

Facility

$4.00

Service Code	NDC 45802011222
Hospital Charge Code	606350983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BACTROBAN 2 % OINTMENT (NASAL)

Facility

$4.00

Service Code	NDC 45802011222
Hospital Charge Code	606350983
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BAER EVOKED POTENTIAL AUDITORY

Facility

$1,287.50

Service Code	HCPCS 92585
Hospital Charge Code	5400098
Hospital Revenue Code	471
Min. Negotiated Rate	$193.12
Max. Negotiated Rate	$193.12
Rate for Payer: Qualcare PPO/HMO/WC	$193.12

BAER EVOKED POTENTIAL AUDITORY

Facility

$1,287.50

Service Code	HCPCS 92585
Hospital Charge Code	5400098
Hospital Revenue Code	471
Min. Negotiated Rate	$36.56
Max. Negotiated Rate	$1,823.00
Rate for Payer: Aetna Commercial	$489.25
Rate for Payer: Aetna Medicare Advantage	$386.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.31
Rate for Payer: Cigna Commercial	$643.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.75
Rate for Payer: Oxford Commercial	$1,606.00
Rate for Payer: Qualcare PPO/HMO/WC	$193.12
Rate for Payer: UnitedHealthcare Commercial	$1,823.00
Rate for Payer: UnitedHealthcare Community & State	$40.69
Rate for Payer: Wellpoint Medicaid Managed Care	$36.56

BAERVEIDT GLAUCOMA IMPLANT

Facility

$1,685.00

Hospital Charge Code	270335538
Hospital Revenue Code	278
Min. Negotiated Rate	$47.85
Max. Negotiated Rate	$842.50
Rate for Payer: Aetna Commercial	$640.30
Rate for Payer: Aetna Medicare Advantage	$505.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$429.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$429.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$337.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$429.68
Rate for Payer: Cigna Commercial	$842.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.77
Rate for Payer: Qualcare PPO/HMO/WC	$252.75
Rate for Payer: UnitedHealthcare Community & State	$53.25
Rate for Payer: Wellpoint Medicaid Managed Care	$47.85

BAERVEIDT GLAUCOMA IMPLANT

Facility

$1,685.00

Hospital Charge Code	270335538
Hospital Revenue Code	278
Min. Negotiated Rate	$252.75
Max. Negotiated Rate	$407.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$337.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$407.77
Rate for Payer: Qualcare PPO/HMO/WC	$252.75

BAERVELDT BG IMPLANT 250MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692773
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

BAERVELDT BG IMPLANT 250MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692773
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

BAERVELDT BG IMPLANT 350MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692774
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

BAERVELDT BG IMPLANT 350MM

Facility

$3,000.00

Service Code	HCPCS L8612
Hospital Charge Code	270692774
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

Know your out-of-pocket cost for care.

All Charges