Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RESP ALLERGY PROF REG I XX

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069Z
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP ALLERGY PROF REG I XX

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069V
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP ALLERGY PROF REG I XX

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069U
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

RESP ALLERGY PROF REG I XX

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069T
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP ALLERGY PROF REG I XX

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069T
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

RESP ALLERGY PROF REG I XX

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069V
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

RESP ALLERGY PROF REG I XX

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069U
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP ALLERGY PROF REG I XXI

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069X
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP ALLERGY PROF REG I XXI

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069X
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

RESP ALLERGY PROF REG I XXI

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069W
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP ALLERGY PROF REG I XXI

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069W
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

RESP ALLERGY PROF REG I XXV

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069Y
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

RESP ALLERGY PROF REG I XXV

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39990069Y
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RESP INDUCED SPUTUM

Facility

$667.59

Service Code	HCPCS 89220
Hospital Charge Code	9508001
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

RESP INDUCED SPUTUM

Facility

$667.59

Service Code	HCPCS 89220
Hospital Charge Code	9508001
Hospital Revenue Code	309
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
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	$15.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

RESPIRATORY FAILURE

Facility

$5,156.88

Service Code	APR-DRG 1331
Min. Negotiated Rate	$5,055.76
Max. Negotiated Rate	$5,156.88
Rate for Payer: UnitedHealthcare Community & State	$5,055.76
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,156.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5,055.76

RESPIRATORY FAILURE

Facility

$14,696.86

Service Code	APR-DRG 1333
Min. Negotiated Rate	$14,408.69
Max. Negotiated Rate	$14,696.86
Rate for Payer: UnitedHealthcare Community & State	$14,408.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,696.86
Rate for Payer: Wellpoint Medicaid Managed Care	$14,408.69

RESPIRATORY FAILURE

Facility

$24,308.42

Service Code	APR-DRG 1334
Min. Negotiated Rate	$23,831.78
Max. Negotiated Rate	$24,308.42
Rate for Payer: UnitedHealthcare Community & State	$23,831.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,308.42
Rate for Payer: Wellpoint Medicaid Managed Care	$23,831.78

RESPIRATORY FAILURE

Facility

$9,759.03

Service Code	APR-DRG 1332
Min. Negotiated Rate	$9,567.68
Max. Negotiated Rate	$9,759.03
Rate for Payer: UnitedHealthcare Community & State	$9,567.68
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,759.03
Rate for Payer: Wellpoint Medicaid Managed Care	$9,567.68

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$50,299.95

Service Code	MSDRG 178
Min. Negotiated Rate	$15,315.69
Max. Negotiated Rate	$50,299.95
Rate for Payer: Aetna Commercial	$37,682.72
Rate for Payer: Aetna Medicare Advantage	$50,299.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,427.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,427.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,121.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,427.95
Rate for Payer: Cigna Commercial	$21,757.97
Rate for Payer: Cigna Medicare Advantage	$16,121.78
Rate for Payer: Clover Medicare Advantage	$15,315.69
Rate for Payer: EmblemHealth Commercial	$48,365.34
Rate for Payer: Humana Medicare Advantage	$16,605.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,121.78
Rate for Payer: Oxford Commercial	$17,197.12
Rate for Payer: UnitedHealthcare Commercial	$23,018.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,121.78
Rate for Payer: Wellcare Medicare Advantage	$16,121.78

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$68,835.97

Service Code	MSDRG 177
Min. Negotiated Rate	$20,959.67
Max. Negotiated Rate	$68,835.97
Rate for Payer: Aetna Commercial	$50,884.27
Rate for Payer: Aetna Medicare Advantage	$68,835.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47,098.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22,062.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47,098.50
Rate for Payer: Cigna Commercial	$34,837.27
Rate for Payer: Cigna Medicare Advantage	$22,062.81
Rate for Payer: Clover Medicare Advantage	$20,959.67
Rate for Payer: EmblemHealth Commercial	$66,188.43
Rate for Payer: Humana Medicare Advantage	$22,724.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22,062.81
Rate for Payer: Oxford Commercial	$27,534.77
Rate for Payer: UnitedHealthcare Commercial	$36,856.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$22,062.81
Rate for Payer: Wellcare Medicare Advantage	$22,062.81

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$43,317.71

Service Code	MSDRG 179
Min. Negotiated Rate	$13,189.69
Max. Negotiated Rate	$43,317.71
Rate for Payer: Aetna Commercial	$32,709.90
Rate for Payer: Aetna Medicare Advantage	$43,317.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,055.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,055.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,883.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,055.80
Rate for Payer: Cigna Commercial	$16,831.22
Rate for Payer: Cigna Medicare Advantage	$13,883.88
Rate for Payer: Clover Medicare Advantage	$13,189.69
Rate for Payer: EmblemHealth Commercial	$41,651.64
Rate for Payer: Humana Medicare Advantage	$14,300.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,883.88
Rate for Payer: Oxford Commercial	$13,303.10
Rate for Payer: UnitedHealthcare Commercial	$17,806.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,883.88
Rate for Payer: Wellcare Medicare Advantage	$13,883.88

RESPIRATORY MALIGNANCY

Facility

$8,450.17

Service Code	APR-DRG 1361
Min. Negotiated Rate	$8,284.48
Max. Negotiated Rate	$8,450.17
Rate for Payer: UnitedHealthcare Community & State	$8,284.48
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,450.17
Rate for Payer: Wellpoint Medicaid Managed Care	$8,284.48

RESPIRATORY MALIGNANCY

Facility

$24,537.36

Service Code	APR-DRG 1364
Min. Negotiated Rate	$24,056.24
Max. Negotiated Rate	$24,537.36
Rate for Payer: UnitedHealthcare Community & State	$24,056.24
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,537.36
Rate for Payer: Wellpoint Medicaid Managed Care	$24,056.24

RESPIRATORY MALIGNANCY

Facility

$11,520.11

Service Code	APR-DRG 1362
Min. Negotiated Rate	$11,294.23
Max. Negotiated Rate	$11,520.11
Rate for Payer: UnitedHealthcare Community & State	$11,294.23
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,520.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11,294.23

Know your out-of-pocket cost for care.

All Charges