Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BX SKIN, SQ TISSUE, MUC MEMB

Facility

$1,720.85

Service Code	HCPCS 11100
Hospital Charge Code	2250455
Hospital Revenue Code	361
Min. Negotiated Rate	$258.13
Max. Negotiated Rate	$258.13
Rate for Payer: Qualcare PPO/HMO/WC	$258.13

BYSTOLIC 20MG TABLE

Facility

$21.44

Service Code	NDC 456142030
Hospital Charge Code	60635788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$8.15
Rate for Payer: Aetna Medicare Advantage	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.47
Rate for Payer: Cigna Commercial	$10.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Oxford Commercial	$4.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.22
Rate for Payer: UnitedHealthcare Commercial	$4.29
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

BYSTOLIC 20MG TABLE

Facility

$21.44

Service Code	NDC 456142030
Hospital Charge Code	60635788
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

BYSTOLIC 5MG TABLE

Facility

$22.91

Service Code	NDC 456140530
Hospital Charge Code	60635787
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

BYSTOLIC 5MG TABLE

Facility

$22.91

Service Code	NDC 456140530
Hospital Charge Code	60635787
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.46
Rate for Payer: Aetna Commercial	$8.71
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.84
Rate for Payer: Cigna Commercial	$11.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$4.58
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$4.58
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

C1 ESTERASE INHIBITOR

Facility

$341.00

Service Code	HCPCS 86160
Hospital Charge Code	38476209
Hospital Revenue Code	302
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$51.15
Rate for Payer: Qualcare PPO/HMO/WC	$51.15

C1 ESTERASE INHIBITOR

Facility

$341.00

Service Code	HCPCS 86160
Hospital Charge Code	38476209
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$170.50
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$170.50
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$9.68

C1 ESTERASE INHIBITOR,FUN

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990024EX
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

C1 ESTERASE INHIBITOR,FUN

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990024EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C1 ESTERASE INHIBITOR,FUN I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990024A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

C1 ESTERASE INHIBITOR,FUN I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990024A
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,FUN II

Facility

$82.50

Service Code	HCPCS 86161
Hospital Charge Code	39990024B
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,FUN II

Facility

$82.50

Service Code	HCPCS 86161
Hospital Charge Code	39990024B
Hospital Revenue Code	306
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

C1 ESTERASE INHIBITOR,TOT

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990025EX
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

C1 ESTERASE INHIBITOR,TOT

Facility

$390.00

Service Code	HCPCS 86161
Hospital Charge Code	39990025EX
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C1 ESTERASE INHIBITOR,TOT I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990025A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

C1 ESTERASE INHIBITOR,TOT I

Facility

$82.50

Service Code	HCPCS 86160
Hospital Charge Code	39990025A
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,TOT II

Facility

$82.50

Hospital Charge Code	39990025B
Hospital Revenue Code	306
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

C1 ESTERASE INHIBITOR,TOT II

Facility

$82.50

Hospital Charge Code	39990025B
Hospital Revenue Code	306
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.04
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

C1Q IMMUNE COMPLEX DETECTION

Facility

$387.00

Service Code	HCPCS 86332
Hospital Charge Code	38476218
Hospital Revenue Code	302
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$66.29
Rate for Payer: Aetna Medicare Advantage	$78.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.40
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: Cigna Medicare Advantage	$24.37
Rate for Payer: Clover Medicare Advantage	$23.15
Rate for Payer: EmblemHealth Commercial	$73.11
Rate for Payer: Humana Medicare Advantage	$25.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.37
Rate for Payer: Wellcare Medicare Advantage	$24.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.99

C1Q IMMUNE COMPLEX DETECTION

Facility

$387.00

Service Code	HCPCS 86332
Hospital Charge Code	38476218
Hospital Revenue Code	302
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

C1Q,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900360
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C1Q,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900360
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

C2,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900196
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

C2,SERUM

Facility

$390.00

Service Code	HCPCS 86160
Hospital Charge Code	39900196
Hospital Revenue Code	302
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.64
Rate for Payer: Aetna Medicare Advantage	$38.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.00
Rate for Payer: Clover Medicare Advantage	$11.40
Rate for Payer: EmblemHealth Commercial	$36.00
Rate for Payer: Humana Medicare Advantage	$12.36
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.00
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	$9.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.00
Rate for Payer: Wellcare Medicare Advantage	$12.00
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Know your out-of-pocket cost for care.

All Charges