Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TSH

Facility

$115.50

Service Code	HCPCS 84443
Hospital Charge Code	39900141
Hospital Revenue Code	301
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$17.32
Rate for Payer: Qualcare PPO/HMO/WC	$17.32

TSH RECEPTOR AB

Facility

$1,204.00

Service Code	HCPCS 84235
Hospital Charge Code	38472036
Hospital Revenue Code	301
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$602.00
Rate for Payer: Aetna Commercial	$193.75
Rate for Payer: Aetna Medicare Advantage	$230.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$71.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.39
Rate for Payer: Cigna Commercial	$602.00
Rate for Payer: Cigna Medicare Advantage	$71.23
Rate for Payer: Clover Medicare Advantage	$67.67
Rate for Payer: EmblemHealth Commercial	$213.69
Rate for Payer: Humana Medicare Advantage	$73.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$71.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.04
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$56.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.23
Rate for Payer: Wellcare Medicare Advantage	$71.23
Rate for Payer: Wellpoint Medicaid Managed Care	$34.19

TSH RECEPTOR AB

Facility

$1,204.00

Service Code	HCPCS 84235
Hospital Charge Code	38472036
Hospital Revenue Code	301
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$180.60
Rate for Payer: Qualcare PPO/HMO/WC	$180.60

TSI

Facility

$390.00

Service Code	HCPCS 84445
Hospital Charge Code	39900142
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TSI

Facility

$390.00

Service Code	HCPCS 84445
Hospital Charge Code	39900142
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna Medicare Advantage	$164.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$50.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$50.86
Rate for Payer: Clover Medicare Advantage	$48.32
Rate for Payer: EmblemHealth Commercial	$152.58
Rate for Payer: Humana Medicare Advantage	$52.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$50.86
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	$40.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.86
Rate for Payer: Wellcare Medicare Advantage	$50.86
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

T-SPOT TB TEST

Facility

$855.89

Service Code	HCPCS 86481
Hospital Charge Code	401186481
Hospital Revenue Code	302
Min. Negotiated Rate	$24.31
Max. Negotiated Rate	$427.94
Rate for Payer: Aetna Commercial	$272.00
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.75
Rate for Payer: Cigna Commercial	$427.94
Rate for Payer: Cigna Medicare Advantage	$100.00
Rate for Payer: Clover Medicare Advantage	$95.00
Rate for Payer: EmblemHealth Commercial	$300.00
Rate for Payer: Humana Medicare Advantage	$103.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$222.53
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$80.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$100.00
Rate for Payer: Wellcare Medicare Advantage	$100.00
Rate for Payer: Wellpoint Medicaid Managed Care	$24.31

T-SPOT TB TEST

Facility

$855.89

Service Code	HCPCS 86481
Hospital Charge Code	401186481
Hospital Revenue Code	302
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$128.38
Rate for Payer: Qualcare PPO/HMO/WC	$128.38

TSS PRESS FIT STEM SZ 13

Facility

$7,914.75

Service Code	HCPCS C1776
Hospital Charge Code	270690411
Hospital Revenue Code	278
Min. Negotiated Rate	$224.78
Max. Negotiated Rate	$3,957.38
Rate for Payer: Aetna Commercial	$3,007.61
Rate for Payer: Aetna Medicare Advantage	$2,374.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,018.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,018.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,018.26
Rate for Payer: Cigna Commercial	$3,957.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.21
Rate for Payer: UnitedHealthcare Community & State	$250.11
Rate for Payer: Wellpoint Medicaid Managed Care	$224.78

TSS PRESS FIT STEM SZ 13

Facility

$7,914.75

Service Code	HCPCS C1776
Hospital Charge Code	270690411
Hospital Revenue Code	278
Min. Negotiated Rate	$1,187.21
Max. Negotiated Rate	$1,915.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,582.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,187.21

TSS PRESS FIT STEM SZ 13

Facility

$9,535.50

Service Code	HCPCS C1776
Hospital Charge Code	270688779
Hospital Revenue Code	278
Min. Negotiated Rate	$1,430.33
Max. Negotiated Rate	$2,307.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,907.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,307.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,430.33

TSS PRESS FIT STEM SZ 13

Facility

$9,535.50

Service Code	HCPCS C1776
Hospital Charge Code	270688779
Hospital Revenue Code	278
Min. Negotiated Rate	$270.81
Max. Negotiated Rate	$4,767.75
Rate for Payer: Aetna Commercial	$3,623.49
Rate for Payer: Aetna Medicare Advantage	$2,860.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,431.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,431.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,907.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,431.55
Rate for Payer: Cigna Commercial	$4,767.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,307.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,430.33
Rate for Payer: UnitedHealthcare Community & State	$301.32
Rate for Payer: Wellpoint Medicaid Managed Care	$270.81

TSS PRESS FIT STEM SZ 6

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704897
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

TSS PRESS FIT STEM SZ 6

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704897
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

TSS PRESS FIT STEM SZ 7

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704896
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

TSS PRESS FIT STEM SZ 7

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704896
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

TTE FOLLOW-UP OR LIMITED

Facility

$1,615.00

Service Code	HCPCS 93308
Hospital Charge Code	395093308
Hospital Revenue Code	480
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.90
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$51.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$45.87

TTE FOLLOW-UP OR LIMITED

Facility

$1,615.00

Service Code	HCPCS 93308
Hospital Charge Code	395093308
Hospital Revenue Code	480
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$242.25
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	74117080
Hospital Revenue Code	483
Min. Negotiated Rate	$613.18
Max. Negotiated Rate	$613.18
Rate for Payer: Qualcare PPO/HMO/WC	$613.18

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	5309045
Hospital Revenue Code	483
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$1,553.40
Rate for Payer: Aetna Medicare Advantage	$1,226.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.41
Rate for Payer: Cigna Commercial	$2,043.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,062.85
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.18
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$129.18
Rate for Payer: Wellpoint Medicaid Managed Care	$116.10

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	44053305
Hospital Revenue Code	483
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$1,553.40
Rate for Payer: Aetna Medicare Advantage	$1,226.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.41
Rate for Payer: Cigna Commercial	$2,043.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,062.85
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.18
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$129.18
Rate for Payer: Wellpoint Medicaid Managed Care	$116.10

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	5309045
Hospital Revenue Code	483
Min. Negotiated Rate	$613.18
Max. Negotiated Rate	$613.18
Rate for Payer: Qualcare PPO/HMO/WC	$613.18

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	74115080
Hospital Revenue Code	483
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$1,553.40
Rate for Payer: Aetna Medicare Advantage	$1,226.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.41
Rate for Payer: Cigna Commercial	$2,043.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,062.85
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.18
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$129.18
Rate for Payer: Wellpoint Medicaid Managed Care	$116.10

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	44053305
Hospital Revenue Code	483
Min. Negotiated Rate	$613.18
Max. Negotiated Rate	$613.18
Rate for Payer: Qualcare PPO/HMO/WC	$613.18

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	74116080
Hospital Revenue Code	483
Min. Negotiated Rate	$116.10
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$1,553.40
Rate for Payer: Aetna Medicare Advantage	$1,226.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,042.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,042.41
Rate for Payer: Cigna Commercial	$2,043.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,062.85
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$613.18
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$129.18
Rate for Payer: Wellpoint Medicaid Managed Care	$116.10

TTE W CONTRAST OR W/O & W COMP

Facility

$4,087.90

Hospital Charge Code	74116080
Hospital Revenue Code	483
Min. Negotiated Rate	$613.18
Max. Negotiated Rate	$613.18
Rate for Payer: Qualcare PPO/HMO/WC	$613.18

Know your out-of-pocket cost for care.

All Charges