Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TOXOPLASMA GONDII IGG CSF

Facility

$390.00

Service Code	HCPCS 86777
Hospital Charge Code	39900255
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
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	$52.20
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
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	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TOXOPLASMA GONDII IGG CSF

Facility

$390.00

Service Code	HCPCS 86777
Hospital Charge Code	39900255
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TOXOPLASMA GONDII PCR CSF

Facility

$482.51

Service Code	HCPCS 87799
Hospital Charge Code	401387799B
Hospital Revenue Code	306
Min. Negotiated Rate	$72.38
Max. Negotiated Rate	$72.38
Rate for Payer: Qualcare PPO/HMO/WC	$72.38

TOXOPLASMA GONDII PCR CSF

Facility

$482.51

Service Code	HCPCS 87799
Hospital Charge Code	401387799B
Hospital Revenue Code	306
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$241.25
Rate for Payer: Aetna Commercial	$116.52
Rate for Payer: Aetna Medicare Advantage	$138.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.40
Rate for Payer: Cigna Commercial	$241.25
Rate for Payer: Cigna Medicare Advantage	$42.84
Rate for Payer: Clover Medicare Advantage	$40.70
Rate for Payer: EmblemHealth Commercial	$128.52
Rate for Payer: Humana Medicare Advantage	$44.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$72.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$34.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84
Rate for Payer: Wellcare Medicare Advantage	$42.84
Rate for Payer: Wellpoint Medicaid Managed Care	$13.70

TOXOPLASMA IGG,IGM I

Facility

$390.00

Service Code	HCPCS 86777
Hospital Charge Code	39980146A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TOXOPLASMA IGG,IGM I

Facility

$390.00

Service Code	HCPCS 86777
Hospital Charge Code	39980146A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$46.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.39
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	$52.20
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.39
Rate for Payer: Clover Medicare Advantage	$13.67
Rate for Payer: EmblemHealth Commercial	$43.17
Rate for Payer: Humana Medicare Advantage	$14.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.39
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	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.39
Rate for Payer: Wellcare Medicare Advantage	$14.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TOXOPLASMA IGG,IGM II

Facility

$390.00

Service Code	HCPCS 86778
Hospital Charge Code	39990146B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.20
Rate for Payer: Aetna Medicare Advantage	$46.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.41
Rate for Payer: Clover Medicare Advantage	$13.69
Rate for Payer: EmblemHealth Commercial	$43.23
Rate for Payer: Humana Medicare Advantage	$14.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.41
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	$11.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.41
Rate for Payer: Wellcare Medicare Advantage	$14.41
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TOXOPLASMA IGG,IGM II

Facility

$390.00

Service Code	HCPCS 86778
Hospital Charge Code	39990146B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

T-PLATE 1.5MM 3HOLE/8HOLE

Facility

$967.15

Service Code	HCPCS C1713
Hospital Charge Code	270654815
Hospital Revenue Code	278
Min. Negotiated Rate	$145.07
Max. Negotiated Rate	$234.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.05
Rate for Payer: Qualcare PPO/HMO/WC	$145.07

T-PLATE 1.5MM 3HOLE/8HOLE

Facility

$967.15

Service Code	HCPCS C1713
Hospital Charge Code	270654815
Hospital Revenue Code	278
Min. Negotiated Rate	$27.47
Max. Negotiated Rate	$483.57
Rate for Payer: Aetna Commercial	$367.52
Rate for Payer: Aetna Medicare Advantage	$290.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.62
Rate for Payer: Cigna Commercial	$483.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.05
Rate for Payer: Qualcare PPO/HMO/WC	$145.07
Rate for Payer: UnitedHealthcare Community & State	$30.56
Rate for Payer: Wellpoint Medicaid Managed Care	$27.47

T-PLATE 1.5MM 4HOLE/8HOLE

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654816
Hospital Revenue Code	278
Min. Negotiated Rate	$28.61
Max. Negotiated Rate	$503.68
Rate for Payer: Aetna Commercial	$382.79
Rate for Payer: Aetna Medicare Advantage	$302.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.87
Rate for Payer: Cigna Commercial	$503.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10
Rate for Payer: UnitedHealthcare Community & State	$31.83
Rate for Payer: Wellpoint Medicaid Managed Care	$28.61

T-PLATE 1.5MM 4HOLE/8HOLE

Facility

$1,007.35

Service Code	HCPCS C1713
Hospital Charge Code	270654816
Hospital Revenue Code	278
Min. Negotiated Rate	$151.10
Max. Negotiated Rate	$243.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.78
Rate for Payer: Qualcare PPO/HMO/WC	$151.10

T-PLATE 2.0MM 2HOLE/8HOLE

Facility

$1,037.55

Service Code	HCPCS C1713
Hospital Charge Code	270654826
Hospital Revenue Code	278
Min. Negotiated Rate	$155.63
Max. Negotiated Rate	$251.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.09
Rate for Payer: Qualcare PPO/HMO/WC	$155.63

T-PLATE 2.0MM 2HOLE/8HOLE

Facility

$1,037.55

Service Code	HCPCS C1713
Hospital Charge Code	270654826
Hospital Revenue Code	278
Min. Negotiated Rate	$29.47
Max. Negotiated Rate	$518.77
Rate for Payer: Aetna Commercial	$394.27
Rate for Payer: Aetna Medicare Advantage	$311.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$264.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$264.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$264.58
Rate for Payer: Cigna Commercial	$518.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.09
Rate for Payer: Qualcare PPO/HMO/WC	$155.63
Rate for Payer: UnitedHealthcare Community & State	$32.79
Rate for Payer: Wellpoint Medicaid Managed Care	$29.47

T-PLATE 2.0MM 3HOLE/8HOLE

Facility

$1,096.95

Service Code	HCPCS C1713
Hospital Charge Code	270654827
Hospital Revenue Code	278
Min. Negotiated Rate	$31.15
Max. Negotiated Rate	$548.48
Rate for Payer: Aetna Commercial	$416.84
Rate for Payer: Aetna Medicare Advantage	$329.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.72
Rate for Payer: Cigna Commercial	$548.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.46
Rate for Payer: Qualcare PPO/HMO/WC	$164.54
Rate for Payer: UnitedHealthcare Community & State	$34.66
Rate for Payer: Wellpoint Medicaid Managed Care	$31.15

T-PLATE 2.0MM 3HOLE/8HOLE

Facility

$1,096.95

Service Code	HCPCS C1713
Hospital Charge Code	270654827
Hospital Revenue Code	278
Min. Negotiated Rate	$164.54
Max. Negotiated Rate	$265.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$219.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.46
Rate for Payer: Qualcare PPO/HMO/WC	$164.54

T-PLATE 2.0x18MM 2HOLE 18MM

Facility

$234.85

Service Code	HCPCS C1713
Hospital Charge Code	270604348
Hospital Revenue Code	278
Min. Negotiated Rate	$35.23
Max. Negotiated Rate	$56.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.83
Rate for Payer: Qualcare PPO/HMO/WC	$35.23

T-PLATE 2.0x18MM 2HOLE 18MM

Facility

$234.85

Service Code	HCPCS C1713
Hospital Charge Code	270604348
Hospital Revenue Code	278
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$117.42
Rate for Payer: Aetna Commercial	$89.24
Rate for Payer: Aetna Medicare Advantage	$70.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$46.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.89
Rate for Payer: Cigna Commercial	$117.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.83
Rate for Payer: Qualcare PPO/HMO/WC	$35.23
Rate for Payer: UnitedHealthcare Community & State	$7.42
Rate for Payer: Wellpoint Medicaid Managed Care	$6.67

T-PLATE 2.4MM 2HOLE/8HOLE

Facility

$1,103.15

Service Code	HCPCS C1713
Hospital Charge Code	270654860
Hospital Revenue Code	278
Min. Negotiated Rate	$165.47
Max. Negotiated Rate	$266.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.96
Rate for Payer: Qualcare PPO/HMO/WC	$165.47

T-PLATE 2.4MM 2HOLE/8HOLE

Facility

$1,103.15

Service Code	HCPCS C1713
Hospital Charge Code	270654860
Hospital Revenue Code	278
Min. Negotiated Rate	$31.33
Max. Negotiated Rate	$551.58
Rate for Payer: Aetna Commercial	$419.20
Rate for Payer: Aetna Medicare Advantage	$330.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.30
Rate for Payer: Cigna Commercial	$551.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.96
Rate for Payer: Qualcare PPO/HMO/WC	$165.47
Rate for Payer: UnitedHealthcare Community & State	$34.86
Rate for Payer: Wellpoint Medicaid Managed Care	$31.33

T-PLATE 2.4MM 3HOLE/8HOLE

Facility

$1,174.20

Service Code	HCPCS C1713
Hospital Charge Code	270654861
Hospital Revenue Code	278
Min. Negotiated Rate	$176.13
Max. Negotiated Rate	$284.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$234.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.16
Rate for Payer: Qualcare PPO/HMO/WC	$176.13

T-PLATE 2.4MM 3HOLE/8HOLE

Facility

$1,174.20

Service Code	HCPCS C1713
Hospital Charge Code	270654861
Hospital Revenue Code	278
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$587.10
Rate for Payer: Aetna Commercial	$446.20
Rate for Payer: Aetna Medicare Advantage	$352.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$234.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.42
Rate for Payer: Cigna Commercial	$587.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.16
Rate for Payer: Qualcare PPO/HMO/WC	$176.13
Rate for Payer: UnitedHealthcare Community & State	$37.10
Rate for Payer: Wellpoint Medicaid Managed Care	$33.35

T-PLATE 2.4MM 6 HOLE

Facility

$4,306.25

Service Code	HCPCS C1713
Hospital Charge Code	270700108
Hospital Revenue Code	278
Min. Negotiated Rate	$122.30
Max. Negotiated Rate	$2,153.12
Rate for Payer: Aetna Commercial	$1,636.38
Rate for Payer: Aetna Medicare Advantage	$1,291.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,098.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,098.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$861.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,098.09
Rate for Payer: Cigna Commercial	$2,153.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.11
Rate for Payer: Qualcare PPO/HMO/WC	$645.94
Rate for Payer: UnitedHealthcare Community & State	$136.08
Rate for Payer: Wellpoint Medicaid Managed Care	$122.30

T-PLATE 2.4MM 6 HOLE

Facility

$4,306.25

Service Code	HCPCS C1713
Hospital Charge Code	270700108
Hospital Revenue Code	278
Min. Negotiated Rate	$645.94
Max. Negotiated Rate	$1,042.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$861.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.11
Rate for Payer: Qualcare PPO/HMO/WC	$645.94

T-PLATE 2.4MM 6 HOLE

Facility

$4,306.25

Service Code	HCPCS C1713
Hospital Charge Code	270700083
Hospital Revenue Code	278
Min. Negotiated Rate	$645.94
Max. Negotiated Rate	$1,042.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$861.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,042.11
Rate for Payer: Qualcare PPO/HMO/WC	$645.94

Know your out-of-pocket cost for care.

All Charges