Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SENSORY NEUROPATHY ANTIBODY IV

Facility

$82.85

Service Code	HCPCS 86255
Hospital Charge Code	39990148D
Hospital Revenue Code	302
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$41.42
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

SENSORY NEUROPATHY ANTIBODY IV

Facility

$82.85

Service Code	HCPCS 86255
Hospital Charge Code	39990148D
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

SENSORY NEUROPATHY ANTIBODY V

Facility

$82.85

Service Code	HCPCS 86255
Hospital Charge Code	39990148E
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

SENSORY NEUROPATHY ANTIBODY V

Facility

$82.85

Service Code	HCPCS 86255
Hospital Charge Code	39990148E
Hospital Revenue Code	302
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$41.42
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148F
Hospital Revenue Code	302
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$41.42
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148G
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148G
Hospital Revenue Code	302
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$41.42
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

SENSORY NEUROPATHY ANTIBODY VI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39990148F
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

SENSOSTRIP LCD TEMP INDICATOR

Facility

$2.53

Hospital Charge Code	270642527
Hospital Revenue Code	270
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$0.38
Rate for Payer: Qualcare PPO/HMO/WC	$0.38

SENSOSTRIP LCD TEMP INDICATOR

Facility

$2.53

Hospital Charge Code	270642527
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.26
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare Advantage	$0.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.65
Rate for Payer: Cigna Commercial	$1.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.66
Rate for Payer: Oxford Commercial	$0.51
Rate for Payer: Qualcare PPO/HMO/WC	$0.38
Rate for Payer: UnitedHealthcare Commercial	$0.51
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

SEPARATION &ID HIGH RES TECH

Facility

$118.00

Service Code	HCPCS 83909
Hospital Charge Code	38472806
Hospital Revenue Code	301
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

SEPARATION &ID HIGH RES TECH

Facility

$118.00

Service Code	HCPCS 83909
Hospital Charge Code	38472806
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.35

SEPARATION &ID HIGH RES TECH

Facility

$118.00

Service Code	HCPCS 83909
Hospital Charge Code	38479424
Hospital Revenue Code	301
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

SEPARATION &ID HIGH RES TECH

Facility

$118.00

Service Code	HCPCS 83909
Hospital Charge Code	38479424
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.35

SEPARATION &ID HIGH RES TECH

Facility

$118.00

Service Code	HCPCS 83909
Hospital Charge Code	38479453
Hospital Revenue Code	301
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.84
Rate for Payer: Aetna Medicare Advantage	$35.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.09
Rate for Payer: Cigna Commercial	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.35

SEPARATION &ID HIGH RES TECH

Facility

$118.00

Service Code	HCPCS 83909
Hospital Charge Code	38479453
Hospital Revenue Code	301
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$17.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.70

Separator 4

Facility

$44,400.00

Hospital Charge Code	270685894N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,260.96
Max. Negotiated Rate	$22,200.00
Rate for Payer: Aetna Commercial	$16,872.00
Rate for Payer: Aetna Medicare Advantage	$13,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,322.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,322.00
Rate for Payer: Cigna Commercial	$22,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,544.00
Rate for Payer: Oxford Commercial	$8,880.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,660.00
Rate for Payer: UnitedHealthcare Commercial	$8,880.00
Rate for Payer: UnitedHealthcare Community & State	$1,403.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,260.96

Separator 4

Facility

$4,400.00

Hospital Charge Code	270685894
Hospital Revenue Code	272
Min. Negotiated Rate	$124.96
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,672.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.00
Rate for Payer: Oxford Commercial	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Commercial	$880.00
Rate for Payer: UnitedHealthcare Community & State	$139.04
Rate for Payer: Wellpoint Medicaid Managed Care	$124.96

Separator 4

Facility

$44,400.00

Hospital Charge Code	270685894N
Hospital Revenue Code	272
Min. Negotiated Rate	$6,660.00
Max. Negotiated Rate	$6,660.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,660.00

Separator 4

Facility

$4,400.00

Hospital Charge Code	270685894
Hospital Revenue Code	272
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

SEPARATOR 4

Facility

$4,400.00

Hospital Charge Code	270685894S
Hospital Revenue Code	272
Min. Negotiated Rate	$124.96
Max. Negotiated Rate	$2,200.00
Rate for Payer: Aetna Commercial	$1,672.00
Rate for Payer: Aetna Medicare Advantage	$1,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.00
Rate for Payer: Cigna Commercial	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,144.00
Rate for Payer: Oxford Commercial	$880.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00
Rate for Payer: UnitedHealthcare Commercial	$880.00
Rate for Payer: UnitedHealthcare Community & State	$139.04
Rate for Payer: Wellpoint Medicaid Managed Care	$124.96

SEPARATOR 4

Facility

$4,400.00

Hospital Charge Code	270685894S
Hospital Revenue Code	272
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$660.00
Rate for Payer: Qualcare PPO/HMO/WC	$660.00

SEPARATOR 8 150CM

Facility

$9,400.00

Hospital Charge Code	270683397
Hospital Revenue Code	272
Min. Negotiated Rate	$266.96
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$3,572.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,444.00
Rate for Payer: Oxford Commercial	$1,880.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00
Rate for Payer: UnitedHealthcare Commercial	$1,880.00
Rate for Payer: UnitedHealthcare Community & State	$297.04
Rate for Payer: Wellpoint Medicaid Managed Care	$266.96

SEPARATOR 8 150CM

Facility

$9,400.00

Hospital Charge Code	270683397N
Hospital Revenue Code	272
Min. Negotiated Rate	$266.96
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$3,572.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,444.00
Rate for Payer: Oxford Commercial	$1,880.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00
Rate for Payer: UnitedHealthcare Commercial	$1,880.00
Rate for Payer: UnitedHealthcare Community & State	$297.04
Rate for Payer: Wellpoint Medicaid Managed Care	$266.96

SEPARATOR 8 150CM

Facility

$9,400.00

Hospital Charge Code	270683397N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$1,410.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

Know your out-of-pocket cost for care.

All Charges