Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VMA,URINE II

Facility

$390.00

Service Code	HCPCS 84585
Hospital Charge Code	39990067B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$42.16
Rate for Payer: Aetna Medicare Advantage	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.50
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	$56.23
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.50
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.50
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.50
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	$12.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.50
Rate for Payer: Wellcare Medicare Advantage	$15.50
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VMA,URINE II

Facility

$390.00

Service Code	HCPCS 84585
Hospital Charge Code	39990067B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VNGD AAK PSC 14 MM 79/83

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

VNGD AAK PSC 14 MM 79/83

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270692922
Hospital Revenue Code	278
Min. Negotiated Rate	$337.39
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$375.41
Rate for Payer: Wellpoint Medicaid Managed Care	$337.39

VNGD DIST FEM AUG 70X5 LL/RM

Facility

$6,090.00

Service Code	HCPCS C1713
Hospital Charge Code	270685004
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

VNGD DIST FEM AUG 70X5 LL/RM

Facility

$6,090.00

Service Code	HCPCS C1713
Hospital Charge Code	270685004
Hospital Revenue Code	278
Min. Negotiated Rate	$172.96
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$2,314.20
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50
Rate for Payer: UnitedHealthcare Community & State	$192.44
Rate for Payer: Wellpoint Medicaid Managed Care	$172.96

VNGD POST FEM AUG 80X5 RL/LM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687723
Hospital Revenue Code	278
Min. Negotiated Rate	$172.96
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$2,314.20
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50
Rate for Payer: UnitedHealthcare Community & State	$192.44
Rate for Payer: Wellpoint Medicaid Managed Care	$172.96

VNGD POST FEM AUG 80X5 RL/LM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687723
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

VNGD POST FEM AUG 80X5 RL/LM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687722
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

VNGD POST FEM AUG 80X5 RL/LM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270687722
Hospital Revenue Code	278
Min. Negotiated Rate	$172.96
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$2,314.20
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50
Rate for Payer: UnitedHealthcare Community & State	$192.44
Rate for Payer: Wellpoint Medicaid Managed Care	$172.96

VNGD PS OPEN POR FMRL LT 70

Facility

$25,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270681306
Hospital Revenue Code	278
Min. Negotiated Rate	$725.90
Max. Negotiated Rate	$12,780.00
Rate for Payer: Aetna Commercial	$9,712.80
Rate for Payer: Aetna Medicare Advantage	$7,668.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,517.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,517.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,517.80
Rate for Payer: Cigna Commercial	$12,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,834.00
Rate for Payer: UnitedHealthcare Community & State	$807.70
Rate for Payer: Wellpoint Medicaid Managed Care	$725.90

VNGD PS OPEN POR FMRL LT 70

Facility

$25,560.00

Service Code	HCPCS C1776
Hospital Charge Code	270681306
Hospital Revenue Code	278
Min. Negotiated Rate	$3,834.00
Max. Negotiated Rate	$6,185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,834.00

VNGD PS+TIB BRG 20X63/67MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270684055
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

VNGD PS+TIB BRG 20X63/67MM

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270684055
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

VNGD SSK 360 R FEM 65MM

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270687528
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$8,784.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

VNGD SSK 360 R FEM 65MM

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270687528
Hospital Revenue Code	278
Min. Negotiated Rate	$1,030.92
Max. Negotiated Rate	$18,150.00
Rate for Payer: Aetna Commercial	$13,794.00
Rate for Payer: Aetna Medicare Advantage	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,256.50
Rate for Payer: Cigna Commercial	$18,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00
Rate for Payer: UnitedHealthcare Community & State	$1,147.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,030.92

VNGD SSK INTLK FMRL 80 RT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270684871
Hospital Revenue Code	278
Min. Negotiated Rate	$5,445.00
Max. Negotiated Rate	$8,784.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00

VNGD SSK INTLK FMRL 80 RT

Facility

$36,300.00

Service Code	HCPCS C1776
Hospital Charge Code	270684871
Hospital Revenue Code	278
Min. Negotiated Rate	$1,030.92
Max. Negotiated Rate	$18,150.00
Rate for Payer: Aetna Commercial	$13,794.00
Rate for Payer: Aetna Medicare Advantage	$10,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,256.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,256.50
Rate for Payer: Cigna Commercial	$18,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,784.60
Rate for Payer: Qualcare PPO/HMO/WC	$5,445.00
Rate for Payer: UnitedHealthcare Community & State	$1,147.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,030.92

VNGD SSK PSC TIB BRG 10X79/83

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270684870
Hospital Revenue Code	278
Min. Negotiated Rate	$337.39
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$375.41
Rate for Payer: Wellpoint Medicaid Managed Care	$337.39

VNGD SSK PSC TIB BRG 10X79/83

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270684870
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

VNGD SSK PSC TIB BRG 12X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270680592
Hospital Revenue Code	278
Min. Negotiated Rate	$1,782.00
Max. Negotiated Rate	$2,874.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00

VNGD SSK PSC TIB BRG 12X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270680592
Hospital Revenue Code	278
Min. Negotiated Rate	$337.39
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$375.41
Rate for Payer: Wellpoint Medicaid Managed Care	$337.39

VNGD SSK PSC TIB BRG 14X71/75

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685143
Hospital Revenue Code	278
Min. Negotiated Rate	$1,562.50
Max. Negotiated Rate	$2,520.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50

VNGD SSK PSC TIB BRG 14X71/75

Facility

$10,416.65

Service Code	HCPCS C1776
Hospital Charge Code	270685143
Hospital Revenue Code	278
Min. Negotiated Rate	$295.83
Max. Negotiated Rate	$5,208.32
Rate for Payer: Aetna Commercial	$3,958.33
Rate for Payer: Aetna Medicare Advantage	$3,124.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,656.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,083.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,656.25
Rate for Payer: Cigna Commercial	$5,208.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,520.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,562.50
Rate for Payer: UnitedHealthcare Community & State	$329.17
Rate for Payer: Wellpoint Medicaid Managed Care	$295.83

VNGD SSK PSC TIB BRG 20X63/67

Facility

$11,880.00

Service Code	HCPCS C1776
Hospital Charge Code	270684888
Hospital Revenue Code	278
Min. Negotiated Rate	$337.39
Max. Negotiated Rate	$5,940.00
Rate for Payer: Aetna Commercial	$4,514.40
Rate for Payer: Aetna Medicare Advantage	$3,564.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,029.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,376.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,029.40
Rate for Payer: Cigna Commercial	$5,940.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,874.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,782.00
Rate for Payer: UnitedHealthcare Community & State	$375.41
Rate for Payer: Wellpoint Medicaid Managed Care	$337.39

Know your out-of-pocket cost for care.

All Charges