Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IMA INJ

Facility

$440.85

Service Code	HCPCS 93564
Hospital Charge Code	5100136
Hospital Revenue Code	481
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$4,213.00
Rate for Payer: Aetna Commercial	$167.52
Rate for Payer: Aetna Medicare Advantage	$132.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.42
Rate for Payer: Cigna Commercial	$220.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.62
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$66.13
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$13.93
Rate for Payer: Wellpoint Medicaid Managed Care	$12.52

IM GUID PAP W AGEBASE SCR CTNG

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175
Hospital Revenue Code	311
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$72.38
Rate for Payer: Aetna Medicare Advantage	$86.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$26.61
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.61
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	$21.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Medicare Advantage	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

IM GUID PAP W AGEBASE SCR CTNG

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IM GUID PAP W AGEBASE SCR TRIC

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175T
Hospital Revenue Code	311
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

IM GUID PAP W AGEBASE SCR TRIC

Facility

$390.00

Service Code	HCPCS 88175
Hospital Charge Code	401188175T
Hospital Revenue Code	311
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$72.38
Rate for Payer: Aetna Medicare Advantage	$86.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$26.61
Rate for Payer: Clover Medicare Advantage	$25.28
Rate for Payer: EmblemHealth Commercial	$79.83
Rate for Payer: Humana Medicare Advantage	$27.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.61
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	$21.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.61
Rate for Payer: Wellcare Medicare Advantage	$26.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

IM INS BREAST PROSTH S/P M

Facility

$42,601.70

Service Code	HCPCS 19340
Hospital Charge Code	16000665
Hospital Revenue Code	360
Min. Negotiated Rate	$1,209.89
Max. Negotiated Rate	$35,223.75
Rate for Payer: Aetna Commercial	$26,411.74
Rate for Payer: Aetna Medicare Advantage	$31,461.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35,223.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35,223.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9,710.20
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	$35,223.75
Rate for Payer: Cigna Commercial	$19,464.07
Rate for Payer: Cigna Medicare Advantage	$9,710.20
Rate for Payer: Clover Medicare Advantage	$9,224.69
Rate for Payer: EmblemHealth Commercial	$29,130.60
Rate for Payer: Humana Medicare Advantage	$10,001.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9,710.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,076.44
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,346.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$9,710.20
Rate for Payer: Wellcare Medicare Advantage	$9,710.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1,209.89

IM INS BREAST PROSTH S/P M

Facility

$42,601.70

Service Code	HCPCS 19340
Hospital Charge Code	16000665
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

IMIPEN4MG/CILAST4MG/RELEBAC2MG

Facility

$1,846.05

Service Code	HCPCS J0742
Hospital Charge Code	606390434
Hospital Revenue Code	636
Min. Negotiated Rate	$52.43
Max. Negotiated Rate	$923.02
Rate for Payer: Aetna Commercial	$701.50
Rate for Payer: Aetna Medicare Advantage	$553.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$470.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$470.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$470.74
Rate for Payer: Cigna Commercial	$923.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$446.74
Rate for Payer: Qualcare PPO/HMO/WC	$276.91
Rate for Payer: UnitedHealthcare Community & State	$58.34
Rate for Payer: Wellpoint Medicaid Managed Care	$52.43

IMIPEN4MG/CILAST4MG/RELEBAC2MG

Facility

$1,846.05

Service Code	HCPCS J0742
Hospital Charge Code	606390434
Hospital Revenue Code	636
Min. Negotiated Rate	$276.91
Max. Negotiated Rate	$446.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$446.74
Rate for Payer: Qualcare PPO/HMO/WC	$276.91

IMIPRAMINE TAB 10MG

Facility

$4.00

Service Code	NDC 49884005401
Hospital Charge Code	60627767
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IMIPRAMINE TAB 10MG

Facility

$4.00

Service Code	NDC 49884005401
Hospital Charge Code	60627767
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

IMIPRAMINE TAB 25MG

Facility

$5.83

Service Code	NDC 781176413
Hospital Charge Code	60627768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.52
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

IMIPRAMINE TAB 25MG

Facility

$5.83

Service Code	NDC 781176413
Hospital Charge Code	60627768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

IMIPRAMINE TAB 50MG

Facility

$9.78

Service Code	NDC 781176613
Hospital Charge Code	60627769
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.89
Rate for Payer: Aetna Commercial	$3.72
Rate for Payer: Aetna Medicare Advantage	$2.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.49
Rate for Payer: Cigna Commercial	$4.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.54
Rate for Payer: Oxford Commercial	$1.96
Rate for Payer: Qualcare PPO/HMO/WC	$1.47
Rate for Payer: UnitedHealthcare Commercial	$1.96
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

IMIPRAMINE TAB 50MG

Facility

$9.78

Service Code	NDC 781176613
Hospital Charge Code	60627769
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.47

IMIPRAMINE (TOFRANIL)

Facility

$193.00

Service Code	HCPCS 80335
Hospital Charge Code	38472485
Hospital Revenue Code	301
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$73.34
Rate for Payer: Aetna Medicare Advantage	$57.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.22
Rate for Payer: Cigna Commercial	$96.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.48

IMIPRAMINE (TOFRANIL)

Facility

$193.00

Service Code	HCPCS 80335
Hospital Charge Code	38472485
Hospital Revenue Code	301
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

IMM.ADM BY NASAL/ORAL @ADDN'L

Facility

$156.00

Service Code	HCPCS 90474
Hospital Charge Code	73050855
Hospital Revenue Code	771
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

IMM.ADM BY NASAL/ORAL @ADDN'L

Facility

$156.00

Service Code	HCPCS 90474
Hospital Charge Code	73050855
Hospital Revenue Code	771
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$59.28
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.56
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$4.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

IMM ADM BY NASL/ORAL @ ADDTL

Facility

$156.00

Service Code	HCPCS 90474
Hospital Charge Code	87502415
Hospital Revenue Code	771
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

IMM ADM BY NASL/ORAL @ ADDTL

Facility

$156.00

Service Code	HCPCS 90474
Hospital Charge Code	87502415
Hospital Revenue Code	771
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$59.28
Rate for Payer: Aetna Medicare Advantage	$46.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.78
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.56
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$4.93
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

IMM ADM INTRANASAL/ORAL VACC

Facility

$156.00

Service Code	HCPCS 90473
Hospital Charge Code	83652299
Hospital Revenue Code	771
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

IMM ADM INTRANASAL/ORAL VACC

Facility

$156.00

Service Code	HCPCS 90473
Hospital Charge Code	87502395
Hospital Revenue Code	771
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

IMM ADM INTRANASAL/ORAL VACC

Facility

$156.00

Service Code	HCPCS 90473
Hospital Charge Code	87502395
Hospital Revenue Code	771
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$310.30
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.56
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$4.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

IMM ADM INTRANASAL/ORAL VACC

Facility

$156.00

Service Code	HCPCS 90473
Hospital Charge Code	83652299
Hospital Revenue Code	771
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$310.30
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.56
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$4.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

Know your out-of-pocket cost for care.

All Charges