Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INSULIN/MED INSTRUCT EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200019
Hospital Revenue Code	942
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

INSULIN/MED INSTRUCT EST PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200019
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN/MED INSTRUCT NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200018
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

INSULIN/MED INSTRUCT NEW PT

Facility

$2,700.00

Service Code	HCPCS 98960
Hospital Charge Code	9200018
Hospital Revenue Code	942
Min. Negotiated Rate	$17.74
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$1,060.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$1,203.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

INSULIN NPH HUM 10ML 100U/ML

Facility

$290.91

Service Code	NDC 2831517
Hospital Charge Code	6003081
Hospital Revenue Code	250
Min. Negotiated Rate	$43.64
Max. Negotiated Rate	$43.64
Rate for Payer: Qualcare PPO/HMO/WC	$43.64

INSULIN NPH HUM 10ML 100U/ML

Facility

$290.91

Service Code	NDC 2831517
Hospital Charge Code	6003081
Hospital Revenue Code	250
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$145.46
Rate for Payer: Aetna Commercial	$110.55
Rate for Payer: Aetna Medicare Advantage	$87.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.18
Rate for Payer: Cigna Commercial	$145.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.64
Rate for Payer: Oxford Commercial	$58.18
Rate for Payer: Qualcare PPO/HMO/WC	$43.64
Rate for Payer: UnitedHealthcare Commercial	$58.18
Rate for Payer: UnitedHealthcare Community & State	$9.19
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

INSULIN REG-HIGH-COVERAGE

Facility

$264.58

Service Code	NDC 2821517
Hospital Charge Code	60629884
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$132.29
Rate for Payer: Aetna Commercial	$100.54
Rate for Payer: Aetna Medicare Advantage	$79.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.47
Rate for Payer: Cigna Commercial	$132.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.79
Rate for Payer: Oxford Commercial	$52.92
Rate for Payer: Qualcare PPO/HMO/WC	$39.69
Rate for Payer: UnitedHealthcare Commercial	$52.92
Rate for Payer: UnitedHealthcare Community & State	$8.36
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

INSULIN REG-HIGH-COVERAGE

Facility

$264.58

Service Code	NDC 2821517
Hospital Charge Code	60629884
Hospital Revenue Code	250
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$39.69

INSULIN,SERUM

Facility

$667.59

Service Code	HCPCS 83525
Hospital Charge Code	39900099
Hospital Revenue Code	301
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$31.09
Rate for Payer: Aetna Medicare Advantage	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.46
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$11.43
Rate for Payer: Clover Medicare Advantage	$10.86
Rate for Payer: EmblemHealth Commercial	$34.29
Rate for Payer: Humana Medicare Advantage	$11.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.43
Rate for Payer: Wellcare Medicare Advantage	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

INSULIN,SERUM

Facility

$667.59

Service Code	HCPCS 83525
Hospital Charge Code	39900099
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

INSULIN,TOTAL

Facility

$360.00

Service Code	HCPCS 83525
Hospital Charge Code	38472422
Hospital Revenue Code	301
Min. Negotiated Rate	$9.14
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$31.09
Rate for Payer: Aetna Medicare Advantage	$37.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.46
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: Cigna Medicare Advantage	$11.43
Rate for Payer: Clover Medicare Advantage	$10.86
Rate for Payer: EmblemHealth Commercial	$34.29
Rate for Payer: Humana Medicare Advantage	$11.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.43
Rate for Payer: Wellcare Medicare Advantage	$11.43
Rate for Payer: Wellpoint Medicaid Managed Care	$10.22

INSULIN,TOTAL

Facility

$360.00

Service Code	HCPCS 83525
Hospital Charge Code	38472422
Hospital Revenue Code	301
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

INS URETERAL STENT-BIL

Facility

$5,100.00

Hospital Charge Code	2690725
Hospital Revenue Code	320
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

INS URETERAL STENT-BIL

Facility

$5,100.00

Hospital Charge Code	2690725
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

INTAKE

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	83235001
Hospital Revenue Code	900
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.96
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$40.95
Rate for Payer: Wellpoint Medicaid Managed Care	$36.81

INTAKE

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	83235001
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INTAKE ASSESSMENT

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	84504015
Hospital Revenue Code	900
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

INTAKE ASSESSMENT

Facility

$1,296.00

Service Code	HCPCS 90801
Hospital Charge Code	84504015
Hospital Revenue Code	900
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.96
Rate for Payer: Oxford Commercial	$2,715.00
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$3,080.00
Rate for Payer: UnitedHealthcare Community & State	$40.95
Rate for Payer: Wellpoint Medicaid Managed Care	$36.81

INTEGRA BILAYER DERMAL MATRIX

Facility

$14,170.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657175
Hospital Revenue Code	636
Min. Negotiated Rate	$2,125.50
Max. Negotiated Rate	$3,429.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,429.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,125.50

INTEGRA BILAYER DERMAL MATRIX

Facility

$14,170.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657175
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,429.14
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	$156.71
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	$3,429.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,125.50
Rate for Payer: UnitedHealthcare Community & State	$447.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$402.43

INTEGRA BIOFIX FLOW PLACT TIS

Facility

$19,375.00

Service Code	HCPCS C9399
Hospital Charge Code	270684215
Hospital Revenue Code	636
Min. Negotiated Rate	$550.25
Max. Negotiated Rate	$9,687.50
Rate for Payer: Aetna Commercial	$7,362.50
Rate for Payer: Aetna Medicare Advantage	$5,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,940.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,940.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,940.62
Rate for Payer: Cigna Commercial	$9,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,688.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,906.25
Rate for Payer: UnitedHealthcare Community & State	$612.25
Rate for Payer: Wellpoint Medicaid Managed Care	$550.25

INTEGRA BIOFIX FLOW PLACT TIS

Facility

$19,375.00

Service Code	HCPCS C9399
Hospital Charge Code	270684215
Hospital Revenue Code	636
Min. Negotiated Rate	$2,906.25
Max. Negotiated Rate	$4,688.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,688.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,906.25

INTEGRA BONE GRAFT 5CC W/ C

Facility

$8,000.00

Hospital Charge Code	270657178
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

INTEGRA BONE GRAFT 5CC W/ C

Facility

$8,000.00

Hospital Charge Code	270657178
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

INTEGRA FLOWABLE WOUND MATRIX

Facility

$14,105.00

Service Code	HCPCS Q4114
Hospital Charge Code	270646968
Hospital Revenue Code	278
Min. Negotiated Rate	$400.58
Max. Negotiated Rate	$7,052.50
Rate for Payer: Aetna Commercial	$5,359.90
Rate for Payer: Aetna Medicare Advantage	$4,231.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,596.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,596.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,821.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,596.78
Rate for Payer: Cigna Commercial	$7,052.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,413.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.75
Rate for Payer: UnitedHealthcare Community & State	$445.72
Rate for Payer: Wellpoint Medicaid Managed Care	$400.58

Know your out-of-pocket cost for care.

All Charges