Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IMP SYSTM MIDSUBSTANCE SPD BRG

Facility

$4,875.00

Hospital Charge Code	270682376
Hospital Revenue Code	272
Min. Negotiated Rate	$138.45
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,267.50
Rate for Payer: Oxford Commercial	$975.00
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Commercial	$975.00
Rate for Payer: UnitedHealthcare Community & State	$154.05
Rate for Payer: Wellpoint Medicaid Managed Care	$138.45

IMP SYSTM MIDSUBSTANCE SPD BRG

Facility

$4,875.00

Hospital Charge Code	270682376
Hospital Revenue Code	272
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$731.25
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

IM ROD COMP.

Facility

$18,080.00

Hospital Charge Code	270335643
Hospital Revenue Code	278
Min. Negotiated Rate	$2,712.00
Max. Negotiated Rate	$4,375.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,616.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,375.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,712.00

IM ROD COMP.

Facility

$18,080.00

Hospital Charge Code	270335643
Hospital Revenue Code	278
Min. Negotiated Rate	$513.47
Max. Negotiated Rate	$9,040.00
Rate for Payer: Aetna Commercial	$6,870.40
Rate for Payer: Aetna Medicare Advantage	$5,424.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,610.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,610.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,616.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,610.40
Rate for Payer: Cigna Commercial	$9,040.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,375.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,712.00
Rate for Payer: UnitedHealthcare Community & State	$571.33
Rate for Payer: Wellpoint Medicaid Managed Care	$513.47

IMRT DEL COMPLEX

Facility

$3,014.20

Service Code	HCPCS 77386
Hospital Charge Code	85000898
Hospital Revenue Code	333
Min. Negotiated Rate	$85.60
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,145.40
Rate for Payer: Aetna Medicare Advantage	$904.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.62
Rate for Payer: Cigna Commercial	$1,507.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.69
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.13
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$95.25
Rate for Payer: Wellpoint Medicaid Managed Care	$85.60

IMRT DEL COMPLEX

Facility

$3,014.20

Service Code	HCPCS 77386
Hospital Charge Code	85000898
Hospital Revenue Code	333
Min. Negotiated Rate	$452.13
Max. Negotiated Rate	$452.13
Rate for Payer: Qualcare PPO/HMO/WC	$452.13

IMRT DEL SIMPLE

Facility

$3,014.20

Service Code	HCPCS 77385
Hospital Charge Code	85000897
Hospital Revenue Code	333
Min. Negotiated Rate	$452.13
Max. Negotiated Rate	$452.13
Rate for Payer: Qualcare PPO/HMO/WC	$452.13

IMRT DEL SIMPLE

Facility

$3,014.20

Service Code	HCPCS 77385
Hospital Charge Code	85000897
Hospital Revenue Code	333
Min. Negotiated Rate	$85.60
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,145.40
Rate for Payer: Aetna Medicare Advantage	$904.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.62
Rate for Payer: Cigna Commercial	$1,507.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$783.69
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$452.13
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$95.25
Rate for Payer: Wellpoint Medicaid Managed Care	$85.60

IMWD 4X5 DOMESTIC

Facility

$12,155.00

Service Code	HCPCS Q4108
Hospital Charge Code	270660226
Hospital Revenue Code	278
Min. Negotiated Rate	$1,823.25
Max. Negotiated Rate	$2,941.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,431.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,941.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,823.25

IMWD 4X5 DOMESTIC

Facility

$12,155.00

Service Code	HCPCS Q4108
Hospital Charge Code	270660226
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,941.51
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,941.51
Rate for Payer: Qualcare PPO/HMO/WC	$1,823.25
Rate for Payer: UnitedHealthcare Community & State	$384.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$345.20

In-111 Chloride

Facility

$2,677.25

Hospital Charge Code	4509078
Hospital Revenue Code	343
Min. Negotiated Rate	$401.59
Max. Negotiated Rate	$401.59
Rate for Payer: Qualcare PPO/HMO/WC	$401.59

In-111 Chloride

Facility

$2,677.25

Hospital Charge Code	4509078
Hospital Revenue Code	343
Min. Negotiated Rate	$76.03
Max. Negotiated Rate	$1,338.62
Rate for Payer: Aetna Commercial	$1,017.36
Rate for Payer: Aetna Medicare Advantage	$803.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$682.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$682.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$682.70
Rate for Payer: Cigna Commercial	$1,338.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$696.09
Rate for Payer: Qualcare PPO/HMO/WC	$401.59
Rate for Payer: UnitedHealthcare Community & State	$84.60
Rate for Payer: Wellpoint Medicaid Managed Care	$76.03

IN 111 LABELED WBC 20.0 MCI

Facility

$258.67

Hospital Charge Code	4509094
Hospital Revenue Code	343
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$129.34
Rate for Payer: Aetna Commercial	$98.29
Rate for Payer: Aetna Medicare Advantage	$77.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.96
Rate for Payer: Cigna Commercial	$129.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.25
Rate for Payer: Qualcare PPO/HMO/WC	$38.80
Rate for Payer: UnitedHealthcare Community & State	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$7.35

IN 111 LABELED WBC 20.0 MCI

Facility

$258.67

Hospital Charge Code	4509094
Hospital Revenue Code	343
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$38.80
Rate for Payer: Qualcare PPO/HMO/WC	$38.80

IN 111 LABELED WBC PER DOSE

Facility

$7,612.71

Service Code	HCPCS A9570
Hospital Charge Code	4509081
Hospital Revenue Code	343
Min. Negotiated Rate	$216.20
Max. Negotiated Rate	$4,001.82
Rate for Payer: Aetna Commercial	$3,000.68
Rate for Payer: Aetna Medicare Advantage	$3,574.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,001.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,001.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,103.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$680.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,001.82
Rate for Payer: Cigna Medicare Advantage	$772.23
Rate for Payer: Clover Medicare Advantage	$1,048.03
Rate for Payer: EmblemHealth Commercial	$3,309.57
Rate for Payer: Humana Medicare Advantage	$1,136.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,103.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.91
Rate for Payer: UnitedHealthcare Community & State	$240.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,103.19
Rate for Payer: Wellcare Medicare Advantage	$1,103.19
Rate for Payer: Wellpoint Medicaid Managed Care	$216.20

IN 111 LABELED WBC PER DOSE

Facility

$7,612.71

Service Code	HCPCS A9570
Hospital Charge Code	4509081
Hospital Revenue Code	343
Min. Negotiated Rate	$1,141.91
Max. Negotiated Rate	$1,141.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.91

IN 111 PENTETATE PER 0.5 MCI

Facility

$6,984.14

Hospital Charge Code	4509079
Hospital Revenue Code	343
Min. Negotiated Rate	$1,047.62
Max. Negotiated Rate	$1,047.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.62

IN 111 PENTETATE PER 0.5 MCI

Facility

$6,984.14

Hospital Charge Code	4509079
Hospital Revenue Code	343
Min. Negotiated Rate	$198.35
Max. Negotiated Rate	$3,492.07
Rate for Payer: Aetna Commercial	$2,653.97
Rate for Payer: Aetna Medicare Advantage	$2,095.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,780.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,780.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,780.96
Rate for Payer: Cigna Commercial	$3,492.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,047.62
Rate for Payer: UnitedHealthcare Community & State	$220.70
Rate for Payer: Wellpoint Medicaid Managed Care	$198.35

IN-111 PENTETREOTIDE PER DOSE

Facility

$12,338.65

Service Code	HCPCS A9572
Hospital Charge Code	4509080
Hospital Revenue Code	343
Min. Negotiated Rate	$1,850.80
Max. Negotiated Rate	$1,850.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,850.80

IN-111 PENTETREOTIDE PER DOSE

Facility

$12,338.65

Service Code	HCPCS A9572
Hospital Charge Code	4509080
Hospital Revenue Code	343
Min. Negotiated Rate	$350.42
Max. Negotiated Rate	$7,258.41
Rate for Payer: Aetna Commercial	$5,442.56
Rate for Payer: Aetna Medicare Advantage	$6,483.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,258.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,258.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,000.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,263.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,258.41
Rate for Payer: Cigna Medicare Advantage	$1,400.66
Rate for Payer: Clover Medicare Advantage	$1,900.89
Rate for Payer: EmblemHealth Commercial	$6,002.82
Rate for Payer: Humana Medicare Advantage	$2,060.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,000.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,208.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,850.80
Rate for Payer: UnitedHealthcare Community & State	$389.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,000.94
Rate for Payer: Wellcare Medicare Advantage	$2,000.94
Rate for Payer: Wellpoint Medicaid Managed Care	$350.42

INBONE SCREW REMOVAL

Facility

$680.00

Hospital Charge Code	270687135
Hospital Revenue Code	272
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$340.00
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare Advantage	$204.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.40
Rate for Payer: Cigna Commercial	$340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.80
Rate for Payer: Oxford Commercial	$136.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00
Rate for Payer: UnitedHealthcare Commercial	$136.00
Rate for Payer: UnitedHealthcare Community & State	$21.49
Rate for Payer: Wellpoint Medicaid Managed Care	$19.31

INBONE SCREW REMOVAL

Facility

$680.00

Hospital Charge Code	270687135
Hospital Revenue Code	272
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$102.00
Rate for Payer: Qualcare PPO/HMO/WC	$102.00

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$64,393.84

Service Code	MSDRG 642
Min. Negotiated Rate	$19,607.10
Max. Negotiated Rate	$64,393.84
Rate for Payer: Aetna Commercial	$47,720.53
Rate for Payer: Aetna Medicare Advantage	$64,393.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,639.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,016.50
Rate for Payer: Cigna Commercial	$31,702.88
Rate for Payer: Cigna Medicare Advantage	$20,639.05
Rate for Payer: Clover Medicare Advantage	$19,607.10
Rate for Payer: EmblemHealth Commercial	$61,917.15
Rate for Payer: Humana Medicare Advantage	$21,258.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,639.05
Rate for Payer: Oxford Commercial	$25,057.40
Rate for Payer: UnitedHealthcare Commercial	$33,540.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,639.05
Rate for Payer: Wellcare Medicare Advantage	$20,639.05

INBORN ERRORS OF METABOLISM

Facility

$34,449.49

Service Code	APR-DRG 4234
Min. Negotiated Rate	$33,774.01
Max. Negotiated Rate	$34,449.49
Rate for Payer: UnitedHealthcare Community & State	$33,774.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$34,449.49
Rate for Payer: Wellpoint Medicaid Managed Care	$33,774.01

INBORN ERRORS OF METABOLISM

Facility

$14,772.72

Service Code	APR-DRG 4233
Min. Negotiated Rate	$14,483.06
Max. Negotiated Rate	$14,772.72
Rate for Payer: UnitedHealthcare Community & State	$14,483.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,772.72
Rate for Payer: Wellpoint Medicaid Managed Care	$14,483.06

Know your out-of-pocket cost for care.

All Charges