Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INTERFERON GAMMA (PROFILE)

Facility

$265.00

Service Code	HCPCS 83520
Hospital Charge Code	401383520A
Hospital Revenue Code	306
Min. Negotiated Rate	$39.75
Max. Negotiated Rate	$39.75
Rate for Payer: Qualcare PPO/HMO/WC	$39.75

INTERFERON GAMMA (PROFILE)

Facility

$265.00

Service Code	HCPCS 83520
Hospital Charge Code	401383520A
Hospital Revenue Code	306
Min. Negotiated Rate	$7.53
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$132.50
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.90
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$7.53

INTERGRA WND DRSG 2X2CM

Facility

$4,990.00

Hospital Charge Code	270332621
Hospital Revenue Code	636
Min. Negotiated Rate	$141.72
Max. Negotiated Rate	$2,495.00
Rate for Payer: Aetna Commercial	$1,896.20
Rate for Payer: Aetna Medicare Advantage	$1,497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,272.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,272.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,272.45
Rate for Payer: Cigna Commercial	$2,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.58
Rate for Payer: Qualcare PPO/HMO/WC	$748.50
Rate for Payer: UnitedHealthcare Community & State	$157.68
Rate for Payer: Wellpoint Medicaid Managed Care	$141.72

INTERGRA WND DRSG 2X2CM

Facility

$4,990.00

Hospital Charge Code	270332621
Hospital Revenue Code	636
Min. Negotiated Rate	$748.50
Max. Negotiated Rate	$1,207.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,207.58
Rate for Payer: Qualcare PPO/HMO/WC	$748.50

INTERGRA WND DRSG 2X2CM/SQCMJW

Facility

$1,247.50

Hospital Charge Code	270332621W
Hospital Revenue Code	636
Min. Negotiated Rate	$187.12
Max. Negotiated Rate	$301.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.89
Rate for Payer: Qualcare PPO/HMO/WC	$187.12

INTERGRA WND DRSG 2X2CM/SQCMJW

Facility

$1,247.50

Hospital Charge Code	270332621W
Hospital Revenue Code	636
Min. Negotiated Rate	$35.43
Max. Negotiated Rate	$623.75
Rate for Payer: Aetna Commercial	$474.05
Rate for Payer: Aetna Medicare Advantage	$374.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.11
Rate for Payer: Cigna Commercial	$623.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.89
Rate for Payer: Qualcare PPO/HMO/WC	$187.12
Rate for Payer: UnitedHealthcare Community & State	$39.42
Rate for Payer: Wellpoint Medicaid Managed Care	$35.43

INTERGRA WND DRSG 4X5CM

Facility

$4,332.00

Hospital Charge Code	270332611
Hospital Revenue Code	636
Min. Negotiated Rate	$649.80
Max. Negotiated Rate	$1,048.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,048.34
Rate for Payer: Qualcare PPO/HMO/WC	$649.80

INTERGRA WND DRSG 4X5CM

Facility

$4,332.00

Hospital Charge Code	270332611
Hospital Revenue Code	636
Min. Negotiated Rate	$123.03
Max. Negotiated Rate	$2,166.00
Rate for Payer: Aetna Commercial	$1,646.16
Rate for Payer: Aetna Medicare Advantage	$1,299.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,104.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,104.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,104.66
Rate for Payer: Cigna Commercial	$2,166.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,048.34
Rate for Payer: Qualcare PPO/HMO/WC	$649.80
Rate for Payer: UnitedHealthcare Community & State	$136.89
Rate for Payer: Wellpoint Medicaid Managed Care	$123.03

INTERGRA WND DRSG 4X5CM/SQCMJW

Facility

$216.60

Hospital Charge Code	270332611W
Hospital Revenue Code	636
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$52.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Qualcare PPO/HMO/WC	$32.49

INTERGRA WND DRSG 4X5CM/SQCMJW

Facility

$216.60

Hospital Charge Code	270332611W
Hospital Revenue Code	636
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$108.30
Rate for Payer: Aetna Commercial	$82.31
Rate for Payer: Aetna Medicare Advantage	$64.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.23
Rate for Payer: Cigna Commercial	$108.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.42
Rate for Payer: Qualcare PPO/HMO/WC	$32.49
Rate for Payer: UnitedHealthcare Community & State	$6.84
Rate for Payer: Wellpoint Medicaid Managed Care	$6.15

INTERGRO DBM 5cc DBM005

Facility

$3,125.00

Hospital Charge Code	270636731
Hospital Revenue Code	272
Min. Negotiated Rate	$88.75
Max. Negotiated Rate	$1,562.50
Rate for Payer: Aetna Commercial	$1,187.50
Rate for Payer: Aetna Medicare Advantage	$937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$796.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$796.88
Rate for Payer: Cigna Commercial	$1,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$812.50
Rate for Payer: Oxford Commercial	$625.00
Rate for Payer: Qualcare PPO/HMO/WC	$468.75
Rate for Payer: UnitedHealthcare Commercial	$625.00
Rate for Payer: UnitedHealthcare Community & State	$98.75
Rate for Payer: Wellpoint Medicaid Managed Care	$88.75

INTERGRO DBM 5cc DBM005

Facility

$3,125.00

Hospital Charge Code	270636731
Hospital Revenue Code	272
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Qualcare PPO/HMO/WC	$468.75

INTERGRO DBM PLUS 5cc DBMW005

Facility

$4,092.00

Hospital Charge Code	270636732
Hospital Revenue Code	272
Min. Negotiated Rate	$116.21
Max. Negotiated Rate	$2,046.00
Rate for Payer: Aetna Commercial	$1,554.96
Rate for Payer: Aetna Medicare Advantage	$1,227.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,043.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,043.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,043.46
Rate for Payer: Cigna Commercial	$2,046.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,063.92
Rate for Payer: Oxford Commercial	$818.40
Rate for Payer: Qualcare PPO/HMO/WC	$613.80
Rate for Payer: UnitedHealthcare Commercial	$818.40
Rate for Payer: UnitedHealthcare Community & State	$129.31
Rate for Payer: Wellpoint Medicaid Managed Care	$116.21

INTERGRO DBM PLUS 5cc DBMW005

Facility

$4,092.00

Hospital Charge Code	270636732
Hospital Revenue Code	272
Min. Negotiated Rate	$613.80
Max. Negotiated Rate	$613.80
Rate for Payer: Qualcare PPO/HMO/WC	$613.80

INTERLAMINATE FUSION DEVICE 10

Facility

$35,000.00

Hospital Charge Code	270702354
Hospital Revenue Code	278
Min. Negotiated Rate	$994.00
Max. Negotiated Rate	$17,500.00
Rate for Payer: Aetna Commercial	$13,300.00
Rate for Payer: Aetna Medicare Advantage	$10,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,925.00
Rate for Payer: Cigna Commercial	$17,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00
Rate for Payer: UnitedHealthcare Community & State	$1,106.00
Rate for Payer: Wellpoint Medicaid Managed Care	$994.00

INTERLAMINATE FUSION DEVICE 10

Facility

$35,000.00

Hospital Charge Code	270702354
Hospital Revenue Code	278
Min. Negotiated Rate	$5,250.00
Max. Negotiated Rate	$8,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,470.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,250.00

INTERLEUKIN-10 (IL-10) Serum

Facility

$86.35

Service Code	HCPCS 83520
Hospital Charge Code	401383520
Hospital Revenue Code	306
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$12.95
Rate for Payer: Qualcare PPO/HMO/WC	$12.95

INTERLEUKIN-10 (IL-10) Serum

Facility

$86.35

Service Code	HCPCS 83520
Hospital Charge Code	401383520
Hospital Revenue Code	306
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$43.17
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.45

INTERLEUKIN-1 BETA

Facility

$582.68

Service Code	HCPCS 83520
Hospital Charge Code	401183520H
Hospital Revenue Code	301
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$291.34
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$291.34
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$87.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$16.55

INTERLEUKIN-1 BETA

Facility

$582.68

Service Code	HCPCS 83520
Hospital Charge Code	401183520H
Hospital Revenue Code	301
Min. Negotiated Rate	$87.40
Max. Negotiated Rate	$87.40
Rate for Payer: Qualcare PPO/HMO/WC	$87.40

INTERLEUKIN 6 HIGH SENSITIVEIT

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900440
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
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	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

INTERLEUKIN 6 HIGH SENSITIVEIT

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900440
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

INTERLOCK 10MM X 30CM

Facility

$2,695.00

Hospital Charge Code	270662973
Hospital Revenue Code	278
Min. Negotiated Rate	$404.25
Max. Negotiated Rate	$652.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: Qualcare PPO/HMO/WC	$404.25

INTERLOCK 10MM X 30CM

Facility

$2,695.00

Hospital Charge Code	270662973
Hospital Revenue Code	278
Min. Negotiated Rate	$76.54
Max. Negotiated Rate	$1,347.50
Rate for Payer: Aetna Commercial	$1,024.10
Rate for Payer: Aetna Medicare Advantage	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$687.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$687.23
Rate for Payer: Cigna Commercial	$1,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$652.19
Rate for Payer: Qualcare PPO/HMO/WC	$404.25
Rate for Payer: UnitedHealthcare Community & State	$85.16
Rate for Payer: Wellpoint Medicaid Managed Care	$76.54

INTERLOCK 12MM X 30CM

Facility

$2,499.00

Hospital Charge Code	270662972
Hospital Revenue Code	278
Min. Negotiated Rate	$70.97
Max. Negotiated Rate	$1,249.50
Rate for Payer: Aetna Commercial	$949.62
Rate for Payer: Aetna Medicare Advantage	$749.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$499.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.25
Rate for Payer: Cigna Commercial	$1,249.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$604.76
Rate for Payer: Qualcare PPO/HMO/WC	$374.85
Rate for Payer: UnitedHealthcare Community & State	$78.97
Rate for Payer: Wellpoint Medicaid Managed Care	$70.97

Know your out-of-pocket cost for care.

All Charges