Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IIV4 VACCINE SPLT 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90688
Hospital Charge Code	412390688
Hospital Revenue Code	636
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$31.79
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

IIV4 VACCINE SPLT 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90688
Hospital Charge Code	412390688
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IIV4 VACC NO PRSV 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90686
Hospital Charge Code	412390686
Hospital Revenue Code	636
Min. Negotiated Rate	$12.55
Max. Negotiated Rate	$20.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55

IIV4 VACC NO PRSV 0.5 ML IM

Facility

$83.65

Service Code	HCPCS 90686
Hospital Charge Code	412390686
Hospital Revenue Code	636
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$41.83
Rate for Payer: Aetna Commercial	$31.79
Rate for Payer: Aetna Medicare Advantage	$25.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.33
Rate for Payer: Cigna Commercial	$41.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.24
Rate for Payer: Qualcare PPO/HMO/WC	$12.55
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

I-KNIFE II 15 DEGREE 5MM

Facility

$35.50

Hospital Charge Code	270655016
Hospital Revenue Code	272
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$5.33
Rate for Payer: Qualcare PPO/HMO/WC	$5.33

I-KNIFE II 15 DEGREE 5MM

Facility

$35.50

Hospital Charge Code	270655016
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$17.75
Rate for Payer: Aetna Commercial	$13.49
Rate for Payer: Aetna Medicare Advantage	$10.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.05
Rate for Payer: Cigna Commercial	$17.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.23
Rate for Payer: Oxford Commercial	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.33
Rate for Payer: UnitedHealthcare Commercial	$7.10
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

IL ABC BLOOD GAS CONTROLS

Facility

$25.00

Hospital Charge Code	270331754
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

IL ABC BLOOD GAS CONTROLS

Facility

$25.00

Hospital Charge Code	270331754
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

ILIAC ART ANGIO W CATH

Facility

$4,553.61

Service Code	HCPCS G0278
Hospital Charge Code	4046G0278
Hospital Revenue Code	323
Min. Negotiated Rate	$683.04
Max. Negotiated Rate	$683.04
Rate for Payer: Qualcare PPO/HMO/WC	$683.04

ILIAC ART ANGIO W CATH

Facility

$4,553.61

Service Code	HCPCS G0278
Hospital Charge Code	4046G0278
Hospital Revenue Code	323
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$2,276.80
Rate for Payer: Aetna Commercial	$1,730.37
Rate for Payer: Aetna Medicare Advantage	$1,366.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,161.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,161.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,161.17
Rate for Payer: Cigna Commercial	$2,276.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,183.94
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$683.04
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$143.89
Rate for Payer: Wellpoint Medicaid Managed Care	$129.32

ILIAC ART ANGIO, W/CATH

Facility

$4,553.61

Service Code	HCPCS G0278
Hospital Charge Code	3210G0278
Hospital Revenue Code	323
Min. Negotiated Rate	$683.04
Max. Negotiated Rate	$683.04
Rate for Payer: Qualcare PPO/HMO/WC	$683.04

ILIAC ART ANGIO, W/CATH

Facility

$4,553.61

Service Code	HCPCS G0278
Hospital Charge Code	3210G0278
Hospital Revenue Code	323
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$2,276.80
Rate for Payer: Aetna Commercial	$1,730.37
Rate for Payer: Aetna Medicare Advantage	$1,366.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,161.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,161.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,161.17
Rate for Payer: Cigna Commercial	$2,276.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,183.94
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$683.04
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$143.89
Rate for Payer: Wellpoint Medicaid Managed Care	$129.32

ILIAC CREST WEDGE 2.5

Facility

$5,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270663599
Hospital Revenue Code	278
Min. Negotiated Rate	$814.50
Max. Negotiated Rate	$1,314.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,314.06
Rate for Payer: Qualcare PPO/HMO/WC	$814.50

ILIAC CREST WEDGE 2.5

Facility

$5,430.00

Service Code	HCPCS C1713
Hospital Charge Code	270663599
Hospital Revenue Code	278
Min. Negotiated Rate	$154.21
Max. Negotiated Rate	$2,715.00
Rate for Payer: Aetna Commercial	$2,063.40
Rate for Payer: Aetna Medicare Advantage	$1,629.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,384.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,384.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,086.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,384.65
Rate for Payer: Cigna Commercial	$2,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,314.06
Rate for Payer: Qualcare PPO/HMO/WC	$814.50
Rate for Payer: UnitedHealthcare Community & State	$171.59
Rate for Payer: Wellpoint Medicaid Managed Care	$154.21

ILIAC EXTENSION 14X18X100mm 14

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270680532
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC EXTENSION 14X18X100mm 14

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270680532
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

ILIAC EXT SYSTEM 12mm-12mm45cm

Facility

$21,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679992
Hospital Revenue Code	278
Min. Negotiated Rate	$3,224.25
Max. Negotiated Rate	$5,201.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,201.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,224.25

ILIAC EXT SYSTEM 12mm-12mm45cm

Facility

$21,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679992
Hospital Revenue Code	278
Min. Negotiated Rate	$610.46
Max. Negotiated Rate	$10,747.50
Rate for Payer: Aetna Commercial	$8,168.10
Rate for Payer: Aetna Medicare Advantage	$6,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,481.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,481.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,481.23
Rate for Payer: Cigna Commercial	$10,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,201.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,224.25
Rate for Payer: UnitedHealthcare Community & State	$679.24
Rate for Payer: Wellpoint Medicaid Managed Care	$610.46

ILIAC LEG GRAFT

Facility

$18,825.00

Service Code	HCPCS C1768
Hospital Charge Code	270686468
Hospital Revenue Code	278
Min. Negotiated Rate	$2,823.75
Max. Negotiated Rate	$4,555.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,555.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,823.75

ILIAC LEG GRAFT

Facility

$18,825.00

Service Code	HCPCS C1768
Hospital Charge Code	270686468
Hospital Revenue Code	278
Min. Negotiated Rate	$534.63
Max. Negotiated Rate	$9,412.50
Rate for Payer: Aetna Commercial	$7,153.50
Rate for Payer: Aetna Medicare Advantage	$5,647.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,800.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,800.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,800.38
Rate for Payer: Cigna Commercial	$9,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,555.65
Rate for Payer: Qualcare PPO/HMO/WC	$2,823.75
Rate for Payer: UnitedHealthcare Community & State	$594.87
Rate for Payer: Wellpoint Medicaid Managed Care	$534.63

ILIAC LIMB

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270683900
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILIAC LIMB

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679762
Hospital Revenue Code	278
Min. Negotiated Rate	$709.86
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$789.84
Rate for Payer: Wellpoint Medicaid Managed Care	$709.86

ILIAC LIMB

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679762
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

ILIAC LIMB

Facility

$225.00

Service Code	HCPCS C1768
Hospital Charge Code	270679253
Hospital Revenue Code	278
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$54.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.45
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

ILIAC LIMB

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270683900
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

Know your out-of-pocket cost for care.

All Charges