Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DRVVT SCR W/RFL PHOS NEUT

Facility

$65.80

Service Code	HCPCS 85613
Hospital Charge Code	39900181
Hospital Revenue Code	305
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$156.00
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	$32.90
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	$17.11
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.87
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	$1.87

DRY SEAL FLEX SHEATH

Facility

$3,020.00

Hospital Charge Code	270682807
Hospital Revenue Code	272
Min. Negotiated Rate	$85.77
Max. Negotiated Rate	$1,510.00
Rate for Payer: Aetna Commercial	$1,147.60
Rate for Payer: Aetna Medicare Advantage	$906.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$770.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$770.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$770.10
Rate for Payer: Cigna Commercial	$1,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$785.20
Rate for Payer: Oxford Commercial	$604.00
Rate for Payer: Qualcare PPO/HMO/WC	$453.00
Rate for Payer: UnitedHealthcare Commercial	$604.00
Rate for Payer: UnitedHealthcare Community & State	$95.43
Rate for Payer: Wellpoint Medicaid Managed Care	$85.77

DRY SEAL FLEX SHEATH

Facility

$3,020.00

Hospital Charge Code	270682807
Hospital Revenue Code	272
Min. Negotiated Rate	$453.00
Max. Negotiated Rate	$453.00
Rate for Payer: Qualcare PPO/HMO/WC	$453.00

DRY SEAL FLEX SHEATH

Facility

$2,235.00

Hospital Charge Code	270682806
Hospital Revenue Code	272
Min. Negotiated Rate	$63.47
Max. Negotiated Rate	$1,117.50
Rate for Payer: Aetna Commercial	$849.30
Rate for Payer: Aetna Medicare Advantage	$670.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$569.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$569.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$569.92
Rate for Payer: Cigna Commercial	$1,117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$581.10
Rate for Payer: Oxford Commercial	$447.00
Rate for Payer: Qualcare PPO/HMO/WC	$335.25
Rate for Payer: UnitedHealthcare Commercial	$447.00
Rate for Payer: UnitedHealthcare Community & State	$70.63
Rate for Payer: Wellpoint Medicaid Managed Care	$63.47

DRY SEAL FLEX SHEATH

Facility

$2,235.00

Hospital Charge Code	270682806
Hospital Revenue Code	272
Min. Negotiated Rate	$335.25
Max. Negotiated Rate	$335.25
Rate for Payer: Qualcare PPO/HMO/WC	$335.25

DSAEK/DSEK PRE CUT

Facility

$21,500.00

Hospital Charge Code	270683330
Hospital Revenue Code	278
Min. Negotiated Rate	$610.60
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$679.40
Rate for Payer: Wellpoint Medicaid Managed Care	$610.60

DSAEK/DSEK PRE CUT

Facility

$21,500.00

Hospital Charge Code	270683330
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

DSMT GROUP COUNSELING-EDUC

Facility

$131.00

Service Code	HCPCS 99078
Hospital Charge Code	9200080
Hospital Revenue Code	942
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$1,203.00
Rate for Payer: Aetna Commercial	$49.78
Rate for Payer: Aetna Medicare Advantage	$39.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.41
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.06
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

DSMT GROUP COUNSELING-EDUC

Facility

$131.00

Service Code	HCPCS 99078
Hospital Charge Code	9200080
Hospital Revenue Code	942
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

DST BY NEURO AGT LMB/SAC, SL J

Facility

$5,232.00

Service Code	HCPCS 64635
Hospital Charge Code	84506055
Hospital Revenue Code	361
Min. Negotiated Rate	$784.80
Max. Negotiated Rate	$784.80
Rate for Payer: Qualcare PPO/HMO/WC	$784.80

DST BY NEURO AGT LMB/SAC, SL J

Facility

$5,232.00

Service Code	HCPCS 64635
Hospital Charge Code	84506055
Hospital Revenue Code	361
Min. Negotiated Rate	$148.59
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,360.32
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$784.80
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$165.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$148.59

DST BY NEURO LMB/SAC, EA ADD J

Facility

$3,103.00

Service Code	HCPCS 64636
Hospital Charge Code	84506060
Hospital Revenue Code	361
Min. Negotiated Rate	$465.45
Max. Negotiated Rate	$465.45
Rate for Payer: Qualcare PPO/HMO/WC	$465.45

DST BY NEURO LMB/SAC, EA ADD J

Facility

$3,103.00

Service Code	HCPCS 64636
Hospital Charge Code	84506060
Hospital Revenue Code	361
Min. Negotiated Rate	$88.13
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,179.14
Rate for Payer: Aetna Medicare Advantage	$930.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$791.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$791.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$791.26
Rate for Payer: Cigna Commercial	$1,551.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$806.78
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$465.45
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$98.05
Rate for Payer: Wellpoint Medicaid Managed Care	$88.13

DSTR NULYT AGT CNCLR NRV

Facility

$8,060.04

Service Code	HCPCS 64624
Hospital Charge Code	1600000342
Hospital Revenue Code	360
Min. Negotiated Rate	$228.91
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,095.61
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,209.01
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$254.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$228.91

DSTR NULYT AGT CNCLR NRV

Facility

$8,060.04

Service Code	HCPCS 64624
Hospital Charge Code	1600000342
Hospital Revenue Code	360
Min. Negotiated Rate	$1,209.01
Max. Negotiated Rate	$1,209.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,209.01

DTAP < 7 YRS

Facility

$174.60

Service Code	HCPCS 90700
Hospital Charge Code	83652319
Hospital Revenue Code	250
Min. Negotiated Rate	$26.19
Max. Negotiated Rate	$26.19
Rate for Payer: Qualcare PPO/HMO/WC	$26.19

DTAP < 7 YRS

Facility

$174.60

Service Code	HCPCS 90700
Hospital Charge Code	83652319
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$87.30
Rate for Payer: Aetna Commercial	$66.35
Rate for Payer: Aetna Medicare Advantage	$52.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.52
Rate for Payer: Cigna Commercial	$87.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.40
Rate for Payer: Oxford Commercial	$34.92
Rate for Payer: Qualcare PPO/HMO/WC	$26.19
Rate for Payer: UnitedHealthcare Commercial	$34.92
Rate for Payer: UnitedHealthcare Community & State	$5.52
Rate for Payer: Wellpoint Medicaid Managed Care	$4.96

DTAP DIPH PERUSS EX

Facility

$165.49

Service Code	NDC 58160081011
Hospital Charge Code	606351020X
Hospital Revenue Code	259
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$82.75
Rate for Payer: Aetna Commercial	$62.89
Rate for Payer: Aetna Medicare Advantage	$49.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.20
Rate for Payer: Cigna Commercial	$82.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.03
Rate for Payer: Oxford Commercial	$33.10
Rate for Payer: Qualcare PPO/HMO/WC	$24.82
Rate for Payer: UnitedHealthcare Commercial	$33.10
Rate for Payer: UnitedHealthcare Community & State	$5.23
Rate for Payer: Wellpoint Medicaid Managed Care	$4.70

DTAP DIPH PERUSS EX

Facility

$165.49

Service Code	NDC 58160081011
Hospital Charge Code	606351020X
Hospital Revenue Code	259
Min. Negotiated Rate	$24.82
Max. Negotiated Rate	$24.82
Rate for Payer: Qualcare PPO/HMO/WC	$24.82

DTAP-HIB-IPV INTRAMUSCULAR

Facility

$553.02

Service Code	HCPCS 90698
Hospital Charge Code	83652609
Hospital Revenue Code	636
Min. Negotiated Rate	$82.95
Max. Negotiated Rate	$133.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.83
Rate for Payer: Qualcare PPO/HMO/WC	$82.95

DTAP-HIB-IPV INTRAMUSCULAR

Facility

$553.02

Service Code	HCPCS 90698
Hospital Charge Code	83652609
Hospital Revenue Code	636
Min. Negotiated Rate	$15.71
Max. Negotiated Rate	$276.51
Rate for Payer: Aetna Commercial	$210.15
Rate for Payer: Aetna Medicare Advantage	$165.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.02
Rate for Payer: Cigna Commercial	$276.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.83
Rate for Payer: Qualcare PPO/HMO/WC	$82.95
Rate for Payer: UnitedHealthcare Community & State	$17.48
Rate for Payer: Wellpoint Medicaid Managed Care	$15.71

DTAP-IPV VACCINE (4-6YRS)

Facility

$251.90

Service Code	HCPCS 90696
Hospital Charge Code	412390696
Hospital Revenue Code	636
Min. Negotiated Rate	$7.15
Max. Negotiated Rate	$125.95
Rate for Payer: Aetna Commercial	$95.72
Rate for Payer: Aetna Medicare Advantage	$75.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.23
Rate for Payer: Cigna Commercial	$125.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.96
Rate for Payer: Qualcare PPO/HMO/WC	$37.78
Rate for Payer: UnitedHealthcare Community & State	$7.96
Rate for Payer: Wellpoint Medicaid Managed Care	$7.15

DTAP-IPV VACCINE (4-6YRS)

Facility

$251.90

Service Code	HCPCS 90696
Hospital Charge Code	412390696
Hospital Revenue Code	636
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$60.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.96
Rate for Payer: Qualcare PPO/HMO/WC	$37.78

DTAP VACCINE >7 YRS IM

Facility

$234.27

Service Code	HCPCS 90715
Hospital Charge Code	606380012
Hospital Revenue Code	636
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$117.14
Rate for Payer: Aetna Commercial	$89.02
Rate for Payer: Aetna Medicare Advantage	$70.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.74
Rate for Payer: Cigna Commercial	$117.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14
Rate for Payer: UnitedHealthcare Community & State	$7.40
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

DTAP VACCINE >7 YRS IM

Facility

$234.27

Service Code	HCPCS 90715
Hospital Charge Code	606380012
Hospital Revenue Code	636
Min. Negotiated Rate	$35.14
Max. Negotiated Rate	$56.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.69
Rate for Payer: Qualcare PPO/HMO/WC	$35.14

Know your out-of-pocket cost for care.

All Charges