Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DIPYRIDAMOLE/ASPIRIN 200/25 MG

Facility

$51.52

Service Code	NDC 597000160
Hospital Charge Code	60628983
Hospital Revenue Code	250
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$7.73
Rate for Payer: Qualcare PPO/HMO/WC	$7.73

DIPYRIDAMOLE/ASPIRIN 200/25 MG

Facility

$51.52

Service Code	NDC 597000160
Hospital Charge Code	60628983
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$25.76
Rate for Payer: Aetna Commercial	$19.58
Rate for Payer: Aetna Medicare Advantage	$15.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.14
Rate for Payer: Cigna Commercial	$25.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.40
Rate for Payer: Oxford Commercial	$10.30
Rate for Payer: Qualcare PPO/HMO/WC	$7.73
Rate for Payer: UnitedHealthcare Commercial	$10.30
Rate for Payer: UnitedHealthcare Community & State	$1.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

Dipyridamole Vial 50mg/10ml

Facility

$52.41

Service Code	HCPCS J1245
Hospital Charge Code	4509071
Hospital Revenue Code	636
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$26.20
Rate for Payer: Aetna Commercial	$19.92
Rate for Payer: Aetna Medicare Advantage	$15.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.36
Rate for Payer: Cigna Commercial	$26.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.86
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.49

Dipyridamole Vial 50mg/10ml

Facility

$52.41

Service Code	HCPCS J1245
Hospital Charge Code	4509071
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$12.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.86

DIR-ARTGRM CAROTID CERV UNIL

Facility

$12,031.00

Service Code	HCPCS 75676
Hospital Charge Code	2680330
Hospital Revenue Code	323
Min. Negotiated Rate	$341.68
Max. Negotiated Rate	$6,015.50
Rate for Payer: Aetna Commercial	$4,571.78
Rate for Payer: Aetna Medicare Advantage	$3,609.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,067.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,067.91
Rate for Payer: Cigna Commercial	$6,015.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,128.06
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$380.18
Rate for Payer: Wellpoint Medicaid Managed Care	$341.68

DIR-ARTGRM CAROTID CERV UNIL

Facility

$12,031.00

Service Code	HCPCS 75676
Hospital Charge Code	2680330
Hospital Revenue Code	323
Min. Negotiated Rate	$1,804.65
Max. Negotiated Rate	$1,804.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,804.65

DIRECT COOMBS

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471013
Hospital Revenue Code	302
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
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	$19.55
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

DIRECT COOMBS

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471013
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECT COOMBS, C3D

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471085
Hospital Revenue Code	302
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
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	$19.55
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

DIRECT COOMBS, C3D

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471085
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECT COOMBS, IG

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471086
Hospital Revenue Code	302
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
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	$19.55
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

DIRECT COOMBS, IG

Facility

$48.00

Service Code	HCPCS 86880
Hospital Charge Code	38471086
Hospital Revenue Code	302
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

DIRECTED BLOOD, EACH UNIT

Facility

$1,204.00

Service Code	HCPCS P9010
Hospital Charge Code	38471087
Hospital Revenue Code	382
Min. Negotiated Rate	$34.19
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$600.44
Rate for Payer: Aetna Medicare Advantage	$715.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$220.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.77
Rate for Payer: Cigna Commercial	$442.50
Rate for Payer: Cigna Medicare Advantage	$220.75
Rate for Payer: Clover Medicare Advantage	$209.71
Rate for Payer: EmblemHealth Commercial	$662.25
Rate for Payer: Humana Medicare Advantage	$227.37
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$220.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$313.04
Rate for Payer: Oxford Commercial	$1,028.00
Rate for Payer: Qualcare PPO/HMO/WC	$180.60
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$38.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.75
Rate for Payer: Wellcare Medicare Advantage	$220.75
Rate for Payer: Wellpoint Medicaid Managed Care	$34.19

DIRECTED BLOOD, EACH UNIT

Facility

$1,204.00

Service Code	HCPCS P9010
Hospital Charge Code	38471087
Hospital Revenue Code	382
Min. Negotiated Rate	$180.60
Max. Negotiated Rate	$180.60
Rate for Payer: Qualcare PPO/HMO/WC	$180.60

DIRECTIGEN RSV TEST BD

Facility

$1,462.50

Hospital Charge Code	270651994
Hospital Revenue Code	272
Min. Negotiated Rate	$41.53
Max. Negotiated Rate	$731.25
Rate for Payer: Aetna Commercial	$555.75
Rate for Payer: Aetna Medicare Advantage	$438.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$372.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$372.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$372.94
Rate for Payer: Cigna Commercial	$731.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$380.25
Rate for Payer: Oxford Commercial	$292.50
Rate for Payer: Qualcare PPO/HMO/WC	$219.38
Rate for Payer: UnitedHealthcare Commercial	$292.50
Rate for Payer: UnitedHealthcare Community & State	$46.22
Rate for Payer: Wellpoint Medicaid Managed Care	$41.53

DIRECTIGEN RSV TEST BD

Facility

$1,462.50

Hospital Charge Code	270651994
Hospital Revenue Code	272
Min. Negotiated Rate	$219.38
Max. Negotiated Rate	$219.38
Rate for Payer: Qualcare PPO/HMO/WC	$219.38

DIRECT LDL SERUM

Facility

$52.00

Service Code	HCPCS 83721
Hospital Charge Code	401183721
Hospital Revenue Code	300
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

DIRECT LDL SERUM

Facility

$52.00

Service Code	HCPCS 83721
Hospital Charge Code	401183721
Hospital Revenue Code	300
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: Aetna Medicare Advantage	$34.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.50
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	$38.09
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: Cigna Medicare Advantage	$10.50
Rate for Payer: Clover Medicare Advantage	$9.97
Rate for Payer: EmblemHealth Commercial	$31.50
Rate for Payer: Humana Medicare Advantage	$10.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.50
Rate for Payer: Wellcare Medicare Advantage	$10.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

DIR-PERC TRANSHEP CHOLANG

Facility

$3,012.00

Hospital Charge Code	2007035
Hospital Revenue Code	320
Min. Negotiated Rate	$85.54
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$1,144.56
Rate for Payer: Aetna Medicare Advantage	$903.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.06
Rate for Payer: Cigna Commercial	$1,506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.12
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$451.80
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$95.18
Rate for Payer: Wellpoint Medicaid Managed Care	$85.54

DIR-PERC TRANSHEP CHOLANG

Facility

$3,012.00

Hospital Charge Code	2007035
Hospital Revenue Code	320
Min. Negotiated Rate	$451.80
Max. Negotiated Rate	$451.80
Rate for Payer: Qualcare PPO/HMO/WC	$451.80

DISC 10X22X11MM 5DEG CAGE PC

Facility

$8,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692593
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

DISC 10X22X11MM 5DEG CAGE PC

Facility

$8,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692593
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

DISC 10 X 22 X 12 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692722
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

DISC 10 X 22 X 12 5 DEG

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270692722
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

DISC 12X27X13MM 5 DEG CAGE PC

Facility

$16,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270692588
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

Know your out-of-pocket cost for care.

All Charges