Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CH CYTOLOGY, BRONCH BRUSH

Facility

$425.00

Service Code	HCPCS 8810491
Hospital Charge Code	397061045
Hospital Revenue Code	311
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

CH CYTOLOGY, BRONCH WASH

Facility

$425.00

Service Code	HCPCS 8810491
Hospital Charge Code	397061044
Hospital Revenue Code	311
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

CH CYTOLOGY, BRONCH WASH

Facility

$425.00

Service Code	HCPCS 8810491
Hospital Charge Code	397061044
Hospital Revenue Code	311
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

CH CYTOLOGY, CSF

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061041
Hospital Revenue Code	311
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

CH CYTOLOGY, CSF

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061041
Hospital Revenue Code	311
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

CH CYTOLOGY, FLUID

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061004
Hospital Revenue Code	311
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

CH CYTOLOGY, FLUID

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061004
Hospital Revenue Code	311
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

CH CYTOLOGY, SEMEN

Facility

$390.00

Service Code	HCPCS 88160
Hospital Charge Code	397061047
Hospital Revenue Code	311
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
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	$64.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CH CYTOLOGY, SEMEN

Facility

$390.00

Service Code	HCPCS 88160
Hospital Charge Code	397061047
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH CYTOLOGY, SPUTUM

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061043
Hospital Revenue Code	311
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

CH CYTOLOGY, SPUTUM

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061043
Hospital Revenue Code	311
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

CH CYTOLOGY, URINE

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061042
Hospital Revenue Code	311
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

CH CYTOLOGY, URINE

Facility

$425.00

Service Code	HCPCS 88104
Hospital Charge Code	397061042
Hospital Revenue Code	311
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$61.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

CH D DIMER

Facility

$667.59

Service Code	HCPCS 85378
Hospital Charge Code	397021080
Hospital Revenue Code	305
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$26.44
Rate for Payer: Aetna Medicare Advantage	$31.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.26
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$9.72
Rate for Payer: Clover Medicare Advantage	$9.23
Rate for Payer: EmblemHealth Commercial	$29.16
Rate for Payer: Humana Medicare Advantage	$10.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72
Rate for Payer: Wellcare Medicare Advantage	$9.72
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

CH D DIMER

Facility

$667.59

Service Code	HCPCS 85378
Hospital Charge Code	397021080
Hospital Revenue Code	305
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CH DIFFERENTIAL AUTO

Facility

$390.00

Service Code	HCPCS 85004
Hospital Charge Code	397021026
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$17.60
Rate for Payer: Aetna Medicare Advantage	$20.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.47
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.47
Rate for Payer: Clover Medicare Advantage	$6.15
Rate for Payer: EmblemHealth Commercial	$19.41
Rate for Payer: Humana Medicare Advantage	$6.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.47
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	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.47
Rate for Payer: Wellcare Medicare Advantage	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CH DIFFERENTIAL AUTO

Facility

$390.00

Service Code	HCPCS 85004
Hospital Charge Code	397021026
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH DRVVT SCREEN W/REFLEX

Facility

$390.00

Service Code	HCPCS 85613
Hospital Charge Code	397071543
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CH DRVVT SCREEN W/REFLEX

Facility

$390.00

Service Code	HCPCS 85613
Hospital Charge Code	397071543
Hospital Revenue Code	305
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$26.06
Rate for Payer: Aetna Medicare Advantage	$31.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.75
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$9.58
Rate for Payer: Clover Medicare Advantage	$9.10
Rate for Payer: EmblemHealth Commercial	$28.74
Rate for Payer: Humana Medicare Advantage	$9.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.58
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	$7.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.58
Rate for Payer: Wellcare Medicare Advantage	$9.58
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CHECK FLO ACCESSORY ADAPTOR

Facility

$66.15

Hospital Charge Code	270636700
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$33.08
Rate for Payer: Aetna Commercial	$25.14
Rate for Payer: Aetna Medicare Advantage	$19.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.87
Rate for Payer: Cigna Commercial	$33.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.20
Rate for Payer: Oxford Commercial	$13.23
Rate for Payer: Qualcare PPO/HMO/WC	$9.92
Rate for Payer: UnitedHealthcare Commercial	$13.23
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

CHECK FLO ACCESSORY ADAPTOR

Facility

$66.15

Hospital Charge Code	270636700
Hospital Revenue Code	272
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$9.92
Rate for Payer: Qualcare PPO/HMO/WC	$9.92

CHECKPOINT 3.5MM HEX IMPACTION

Facility

$610.00

Hospital Charge Code	270668099
Hospital Revenue Code	272
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

CHECKPOINT 3.5MM HEX IMPACTION

Facility

$610.00

Hospital Charge Code	270668099
Hospital Revenue Code	272
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.60
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$17.32

CHECKPOINT HEX 3.5MMX15MM

Facility

$610.00

Hospital Charge Code	270668613
Hospital Revenue Code	272
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

CHECKPOINT HEX 3.5MMX15MM

Facility

$610.00

Hospital Charge Code	270668613
Hospital Revenue Code	272
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.60
Rate for Payer: Oxford Commercial	$122.00
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Commercial	$122.00
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$17.32

Know your out-of-pocket cost for care.

All Charges