Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VIROLOGY

Facility

$90.65

Service Code	HCPCS 86695
Hospital Charge Code	39900241
Hospital Revenue Code	302
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

VIROLOGY

Facility

$90.65

Service Code	HCPCS 86695
Hospital Charge Code	39900241
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.60

VIRTU LORDOTIC 14X12X7MM

Facility

$12,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270685321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

VIRTU LORDOTIC 14X12X7MM

Facility

$12,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270685321
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

VIRUS ISOLATION CENTRIFUGE W I

Facility

$138.00

Service Code	HCPCS 87254
Hospital Charge Code	38477156
Hospital Revenue Code	309
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$53.20
Rate for Payer: Aetna Medicare Advantage	$63.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.95
Rate for Payer: Cigna Commercial	$69.00
Rate for Payer: Cigna Medicare Advantage	$19.56
Rate for Payer: Clover Medicare Advantage	$18.58
Rate for Payer: EmblemHealth Commercial	$58.68
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.56
Rate for Payer: Wellcare Medicare Advantage	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.92

VIRUS ISOLATION CENTRIFUGE W I

Facility

$138.00

Service Code	HCPCS 87254
Hospital Charge Code	38477156
Hospital Revenue Code	309
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$20.70

VIRUS ISOL/OTHER THAN BY CYTO

Facility

$238.00

Service Code	HCPCS 87255
Hospital Charge Code	38477188
Hospital Revenue Code	309
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$35.70
Rate for Payer: Qualcare PPO/HMO/WC	$35.70

VIRUS ISOL/OTHER THAN BY CYTO

Facility

$238.00

Service Code	HCPCS 87255
Hospital Charge Code	38477188
Hospital Revenue Code	309
Min. Negotiated Rate	$6.76
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$92.10
Rate for Payer: Aetna Medicare Advantage	$109.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.83
Rate for Payer: Cigna Commercial	$119.00
Rate for Payer: Cigna Medicare Advantage	$33.86
Rate for Payer: Clover Medicare Advantage	$32.17
Rate for Payer: EmblemHealth Commercial	$101.58
Rate for Payer: Humana Medicare Advantage	$34.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$27.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.86
Rate for Payer: Wellcare Medicare Advantage	$33.86
Rate for Payer: Wellpoint Medicaid Managed Care	$6.76

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	2691875
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	2691875
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	411075726L
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	321075726L
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	366875726L
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	366875726L
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	411075726L
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCERAL SELECTIVE-LT

Facility

$25,628.45

Service Code	HCPCS 75726LT
Hospital Charge Code	321075726L
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	321075726R
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	411075726R
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	321075726R
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	411075726R
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	2691880
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	2691880
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	366875726R
Hospital Revenue Code	323
Min. Negotiated Rate	$3,844.27
Max. Negotiated Rate	$3,844.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27

VISCERAL SELECTIVE-RT

Facility

$25,628.45

Service Code	HCPCS 75726RT
Hospital Charge Code	366875726R
Hospital Revenue Code	323
Min. Negotiated Rate	$727.85
Max. Negotiated Rate	$12,814.23
Rate for Payer: Aetna Commercial	$9,738.81
Rate for Payer: Aetna Medicare Advantage	$7,688.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,535.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,535.25
Rate for Payer: Cigna Commercial	$12,814.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,663.40
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,844.27
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$809.86
Rate for Payer: Wellpoint Medicaid Managed Care	$727.85

VISCOAT .05ML SYRINGE (STF)

Facility

$455.00

Hospital Charge Code	270330681
Hospital Revenue Code	250
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$68.25
Rate for Payer: Qualcare PPO/HMO/WC	$68.25

Know your out-of-pocket cost for care.

All Charges