Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ADALIMUMAB ANTIDRUG AB FOR IBD

Facility

$250.00

Service Code	HCPCS 83520
Hospital Charge Code	401183520G
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ADALIMUMAB ANTIDRUG AB FOR IBD

Facility

$250.00

Service Code	HCPCS 83520
Hospital Charge Code	401183520G
Hospital Revenue Code	301
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

ADALIMUMAB LEVEL FOR IBD

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401180145
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ADALIMUMAB LEVEL FOR IBD

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401180145
Hospital Revenue Code	301
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$104.91
Rate for Payer: Aetna Medicare Advantage	$124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.91
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$38.57
Rate for Payer: Clover Medicare Advantage	$36.64
Rate for Payer: EmblemHealth Commercial	$115.71
Rate for Payer: Humana Medicare Advantage	$39.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$30.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.57
Rate for Payer: Wellcare Medicare Advantage	$38.57
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

ADALIMUMAB LEVEL FOR IBD SERUM

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401380145
Hospital Revenue Code	301
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$104.91
Rate for Payer: Aetna Medicare Advantage	$124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.91
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: Cigna Medicare Advantage	$38.57
Rate for Payer: Clover Medicare Advantage	$36.64
Rate for Payer: EmblemHealth Commercial	$115.71
Rate for Payer: Humana Medicare Advantage	$39.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$30.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.57
Rate for Payer: Wellcare Medicare Advantage	$38.57
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

ADALIMUMAB LEVEL FOR IBD SERUM

Facility

$250.00

Service Code	HCPCS 80145
Hospital Charge Code	401380145
Hospital Revenue Code	301
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

ADAMS TS13 ACT W REFLEX INHIB

Facility

$390.00

Service Code	HCPCS 85397
Hospital Charge Code	39900520
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$83.94
Rate for Payer: Aetna Medicare Advantage	$99.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$30.86
Rate for Payer: Clover Medicare Advantage	$29.32
Rate for Payer: EmblemHealth Commercial	$92.58
Rate for Payer: Humana Medicare Advantage	$31.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.86
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	$24.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.86
Rate for Payer: Wellcare Medicare Advantage	$30.86
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ADAMS TS13 ACT W REFLEX INHIB

Facility

$390.00

Service Code	HCPCS 85397
Hospital Charge Code	39900520
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ADAPTER 45 DEGREE AS B/F

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683031
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

ADAPTER 45 DEGREE AS B/F

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270683031
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

ADAPTER BIOLOX +0MM 12/14

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270678673
Hospital Revenue Code	278
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$226.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

ADAPTER BIOLOX +0MM 12/14

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270678673
Hospital Revenue Code	278
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Community & State	$29.55
Rate for Payer: Wellpoint Medicaid Managed Care	$26.55

ADAPTER BIOPSY VALVE

Facility

$48.85

Hospital Charge Code	270677982
Hospital Revenue Code	272
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$7.33
Rate for Payer: Qualcare PPO/HMO/WC	$7.33

ADAPTER BIOPSY VALVE

Facility

$48.85

Hospital Charge Code	270677982
Hospital Revenue Code	272
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$24.43
Rate for Payer: Aetna Commercial	$18.56
Rate for Payer: Aetna Medicare Advantage	$14.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.46
Rate for Payer: Cigna Commercial	$24.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.70
Rate for Payer: Oxford Commercial	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$7.33
Rate for Payer: UnitedHealthcare Commercial	$9.77
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

ADAPTER BIPOLAR 3.5MM

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270689638
Hospital Revenue Code	278
Min. Negotiated Rate	$140.25
Max. Negotiated Rate	$226.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: Qualcare PPO/HMO/WC	$140.25

ADAPTER BIPOLAR 3.5MM

Facility

$935.00

Service Code	HCPCS C1776
Hospital Charge Code	270689638
Hospital Revenue Code	278
Min. Negotiated Rate	$26.55
Max. Negotiated Rate	$467.50
Rate for Payer: Aetna Commercial	$355.30
Rate for Payer: Aetna Medicare Advantage	$280.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.43
Rate for Payer: Cigna Commercial	$467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$226.27
Rate for Payer: Qualcare PPO/HMO/WC	$140.25
Rate for Payer: UnitedHealthcare Community & State	$29.55
Rate for Payer: Wellpoint Medicaid Managed Care	$26.55

ADAPTER BMT DRLL 4.3 471843

Facility

$930.00

Hospital Charge Code	270617541
Hospital Revenue Code	272
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$353.40
Rate for Payer: Aetna Medicare Advantage	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$237.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$237.15
Rate for Payer: Cigna Commercial	$465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.80
Rate for Payer: Oxford Commercial	$186.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.50
Rate for Payer: UnitedHealthcare Commercial	$186.00
Rate for Payer: UnitedHealthcare Community & State	$29.39
Rate for Payer: Wellpoint Medicaid Managed Care	$26.41

ADAPTER BMT DRLL 4.3 471843

Facility

$930.00

Hospital Charge Code	270617541
Hospital Revenue Code	272
Min. Negotiated Rate	$139.50
Max. Negotiated Rate	$139.50
Rate for Payer: Qualcare PPO/HMO/WC	$139.50

ADAPTER CELL MERLIN TRANSMIT

Facility

$2,250.00

Hospital Charge Code	270676937V
Hospital Revenue Code	271
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

ADAPTER CELL MERLIN TRANSMIT

Facility

$2,250.00

Hospital Charge Code	270676937V
Hospital Revenue Code	271
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$450.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

ADAPTER DUAL IRRIG 250070419

Facility

$59.31

Hospital Charge Code	270621072
Hospital Revenue Code	272
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna Commercial	$22.54
Rate for Payer: Aetna Medicare Advantage	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.12
Rate for Payer: Cigna Commercial	$29.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.42
Rate for Payer: Oxford Commercial	$11.86
Rate for Payer: Qualcare PPO/HMO/WC	$8.90
Rate for Payer: UnitedHealthcare Commercial	$11.86
Rate for Payer: UnitedHealthcare Community & State	$1.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

ADAPTER DUAL IRRIG 250070419

Facility

$59.31

Hospital Charge Code	270621072
Hospital Revenue Code	272
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$8.90
Rate for Payer: Qualcare PPO/HMO/WC	$8.90

ADAPTER G2 SLIM 65W HP ACCESSO

Facility

$345.00

Hospital Charge Code	270684748
Hospital Revenue Code	272
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$131.10
Rate for Payer: Aetna Medicare Advantage	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.70
Rate for Payer: Oxford Commercial	$69.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Commercial	$69.00
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

ADAPTER G2 SLIM 65W HP ACCESSO

Facility

$345.00

Hospital Charge Code	270684748
Hospital Revenue Code	272
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

ADAPTER HEMOSTASIS VALVE 8FR

Facility

$100.00

Hospital Charge Code	270645891
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

Know your out-of-pocket cost for care.

All Charges