Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IMM.ADM THRG 18YRS @ ADDL VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	73050810
Hospital Revenue Code	771
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

IMM.ADM THRG 18YRS @ ADDL VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	83652293
Hospital Revenue Code	771
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.06
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

IMM.ADM THRG 18YRS @ ADDL VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	73050810
Hospital Revenue Code	771
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$11.78
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.06
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

IMM.ADM THRG 18YRS @ ADDL VAC

Facility

$31.00

Service Code	HCPCS 90461
Hospital Charge Code	83652293
Hospital Revenue Code	771
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$4.65
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

IMM.ADM.THROUGH 18YRS.FST VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83652291
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

IMM.ADM.THROUGH 18YRS.FST VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83652291
Hospital Revenue Code	771
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

IMM.ADM.THROUGH 18YRS.FST VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	73050805
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

IMM.ADM.THROUGH 18YRS.FST VACC

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	73050805
Hospital Revenue Code	771
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

IMM GLOB 50MG/ML 10GM/200ML

Facility

$9,460.40

Service Code	HCPCS J1568
Hospital Charge Code	60635794
Hospital Revenue Code	636
Min. Negotiated Rate	$1,419.06
Max. Negotiated Rate	$2,289.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,289.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,419.06

IMM GLOB 50MG/ML 10GM/200ML

Facility

$9,460.40

Service Code	HCPCS J1568
Hospital Charge Code	60635794
Hospital Revenue Code	636
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$2,289.42
Rate for Payer: Aetna Commercial	$127.95
Rate for Payer: Aetna Medicare Advantage	$152.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.64
Rate for Payer: Cigna Medicare Advantage	$47.04
Rate for Payer: Clover Medicare Advantage	$44.69
Rate for Payer: EmblemHealth Commercial	$141.12
Rate for Payer: Humana Medicare Advantage	$48.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,289.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,419.06
Rate for Payer: UnitedHealthcare Community & State	$298.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.04
Rate for Payer: Wellcare Medicare Advantage	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$268.68

IMMOBILIZER KNEE 16 UNIVERSAL

Facility

$51.90

Service Code	HCPCS L1830
Hospital Charge Code	270650067
Hospital Revenue Code	274
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$25.95
Rate for Payer: Aetna Commercial	$19.72
Rate for Payer: Aetna Medicare Advantage	$15.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.23
Rate for Payer: Cigna Commercial	$25.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.79
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.47

IMMOBILIZER KNEE 16 UNIVERSAL

Facility

$51.90

Service Code	HCPCS L1830
Hospital Charge Code	270650067
Hospital Revenue Code	274
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.56
Rate for Payer: Qualcare PPO/HMO/WC	$7.79

IMMOBILIZER KNEE LG

Facility

$92.35

Hospital Charge Code	270302810
Hospital Revenue Code	270
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$13.85
Rate for Payer: Qualcare PPO/HMO/WC	$13.85

IMMOBILIZER KNEE LG

Facility

$92.35

Hospital Charge Code	270302810
Hospital Revenue Code	270
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$46.17
Rate for Payer: Aetna Commercial	$35.09
Rate for Payer: Aetna Medicare Advantage	$27.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.55
Rate for Payer: Cigna Commercial	$46.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.01
Rate for Payer: Oxford Commercial	$18.47
Rate for Payer: Qualcare PPO/HMO/WC	$13.85
Rate for Payer: UnitedHealthcare Commercial	$18.47
Rate for Payer: UnitedHealthcare Community & State	$2.92
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

IMMOBILIZER KNEE MED

Facility

$127.25

Hospital Charge Code	270302820
Hospital Revenue Code	270
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$19.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.09

IMMOBILIZER KNEE MED

Facility

$127.25

Hospital Charge Code	270302820
Hospital Revenue Code	270
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$63.62
Rate for Payer: Aetna Commercial	$48.35
Rate for Payer: Aetna Medicare Advantage	$38.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.45
Rate for Payer: Cigna Commercial	$63.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.09
Rate for Payer: Oxford Commercial	$25.45
Rate for Payer: Qualcare PPO/HMO/WC	$19.09
Rate for Payer: UnitedHealthcare Commercial	$25.45
Rate for Payer: UnitedHealthcare Community & State	$4.02
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

IMMOBILIZER KNEE ONE SIZE 16

Facility

$80.55

Hospital Charge Code	270302805
Hospital Revenue Code	271
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$40.27
Rate for Payer: Aetna Commercial	$30.61
Rate for Payer: Aetna Medicare Advantage	$24.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.54
Rate for Payer: Cigna Commercial	$40.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.94
Rate for Payer: Oxford Commercial	$16.11
Rate for Payer: Qualcare PPO/HMO/WC	$12.08
Rate for Payer: UnitedHealthcare Commercial	$16.11
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

IMMOBILIZER KNEE ONE SIZE 16

Facility

$80.55

Hospital Charge Code	270302805
Hospital Revenue Code	271
Min. Negotiated Rate	$12.08
Max. Negotiated Rate	$12.08
Rate for Payer: Qualcare PPO/HMO/WC	$12.08

IMMOBILIZER KNEE ONE SIZE 20

Facility

$89.75

Hospital Charge Code	270302815
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$44.88
Rate for Payer: Aetna Commercial	$34.10
Rate for Payer: Aetna Medicare Advantage	$26.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.89
Rate for Payer: Cigna Commercial	$44.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.34
Rate for Payer: Oxford Commercial	$17.95
Rate for Payer: Qualcare PPO/HMO/WC	$13.46
Rate for Payer: UnitedHealthcare Commercial	$17.95
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.55

IMMOBILIZER KNEE ONE SIZE 20

Facility

$89.75

Hospital Charge Code	270302815
Hospital Revenue Code	272
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$13.46
Rate for Payer: Qualcare PPO/HMO/WC	$13.46

IMMOBILIZER KNEE XLG 187650324

Facility

$152.55

Hospital Charge Code	270635372
Hospital Revenue Code	270
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$76.28
Rate for Payer: Aetna Commercial	$57.97
Rate for Payer: Aetna Medicare Advantage	$45.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.90
Rate for Payer: Cigna Commercial	$76.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.66
Rate for Payer: Oxford Commercial	$30.51
Rate for Payer: Qualcare PPO/HMO/WC	$22.88
Rate for Payer: UnitedHealthcare Commercial	$30.51
Rate for Payer: UnitedHealthcare Community & State	$4.82
Rate for Payer: Wellpoint Medicaid Managed Care	$4.33

IMMOBILIZER KNEE XLG 187650324

Facility

$152.55

Hospital Charge Code	270635372
Hospital Revenue Code	270
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$22.88
Rate for Payer: Qualcare PPO/HMO/WC	$22.88

IMMOBILIZER KNEE XLG 187650622

Facility

$149.05

Hospital Charge Code	270635371
Hospital Revenue Code	270
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$74.53
Rate for Payer: Aetna Commercial	$56.64
Rate for Payer: Aetna Medicare Advantage	$44.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.01
Rate for Payer: Cigna Commercial	$74.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.75
Rate for Payer: Oxford Commercial	$29.81
Rate for Payer: Qualcare PPO/HMO/WC	$22.36
Rate for Payer: UnitedHealthcare Commercial	$29.81
Rate for Payer: UnitedHealthcare Community & State	$4.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

IMMOBILIZER KNEE XLG 187650622

Facility

$149.05

Hospital Charge Code	270635371
Hospital Revenue Code	270
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$22.36
Rate for Payer: Qualcare PPO/HMO/WC	$22.36

IMMOBILIZER SHOULDER LG

Facility

$30.00

Hospital Charge Code	270677150
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

Know your out-of-pocket cost for care.

All Charges