Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4510628
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4824628
Hospital Revenue Code	919
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4509628
Hospital Revenue Code	919
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4510628
Hospital Revenue Code	919
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

MED MNG CHILD/15MIN PH MCAID

Facility

$375.00

Service Code	HCPCS 99211
Hospital Charge Code	4824628
Hospital Revenue Code	919
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

MED ROCKER SHOE

Facility

$6,644.50

Hospital Charge Code	270702659
Hospital Revenue Code	275
Min. Negotiated Rate	$996.67
Max. Negotiated Rate	$1,607.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: Qualcare PPO/HMO/WC	$996.67

MED ROCKER SHOE

Facility

$6,644.50

Hospital Charge Code	270702659
Hospital Revenue Code	275
Min. Negotiated Rate	$188.70
Max. Negotiated Rate	$3,322.25
Rate for Payer: Aetna Commercial	$2,524.91
Rate for Payer: Aetna Medicare Advantage	$1,993.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,694.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,328.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,694.35
Rate for Payer: Cigna Commercial	$3,322.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,607.97
Rate for Payer: Qualcare PPO/HMO/WC	$996.67
Rate for Payer: UnitedHealthcare Community & State	$209.97
Rate for Payer: Wellpoint Medicaid Managed Care	$188.70

MEDROXY ACE 150 MG/ML

Facility

$1,164.19

Service Code	HCPCS J1050
Hospital Charge Code	60630099
Hospital Revenue Code	636
Min. Negotiated Rate	$33.06
Max. Negotiated Rate	$582.10
Rate for Payer: Aetna Commercial	$442.39
Rate for Payer: Aetna Medicare Advantage	$349.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.87
Rate for Payer: Cigna Commercial	$582.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.73
Rate for Payer: Qualcare PPO/HMO/WC	$174.63
Rate for Payer: UnitedHealthcare Community & State	$36.79
Rate for Payer: Wellpoint Medicaid Managed Care	$33.06

MEDROXY ACE 150 MG/ML

Facility

$1,164.19

Service Code	HCPCS J1050
Hospital Charge Code	60630099
Hospital Revenue Code	636
Min. Negotiated Rate	$174.63
Max. Negotiated Rate	$281.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.73
Rate for Payer: Qualcare PPO/HMO/WC	$174.63

MEDROXYPROGESTERN TAB 10MG

Facility

$4.00

Service Code	NDC 555077902
Hospital Charge Code	60628246
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

MEDROXYPROGESTERN TAB 10MG

Facility

$4.00

Service Code	NDC 555077902
Hospital Charge Code	60628246
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MEDROXYPROGESTERN TAB 2.5MG

Facility

$11.86

Service Code	NDC 9006501
Hospital Charge Code	60628247
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$5.93
Rate for Payer: Aetna Commercial	$4.51
Rate for Payer: Aetna Medicare Advantage	$3.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.02
Rate for Payer: Cigna Commercial	$5.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.08
Rate for Payer: Oxford Commercial	$2.37
Rate for Payer: Qualcare PPO/HMO/WC	$1.78
Rate for Payer: UnitedHealthcare Commercial	$2.37
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

MEDROXYPROGESTERN TAB 2.5MG

Facility

$11.86

Service Code	NDC 9006501
Hospital Charge Code	60628247
Hospital Revenue Code	250
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$1.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.78

MEDROXYPROGESTERONE 5MG TAB

Facility

$17.89

Service Code	NDC 9028701
Hospital Charge Code	6063943131
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.65
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$3.58
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

MEDROXYPROGESTERONE 5MG TAB

Facility

$17.89

Service Code	NDC 9028701
Hospital Charge Code	6063943131
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

MEDTRONIC ANTENA-NEUR STMLR

Facility

$160.00

Hospital Charge Code	270339436
Hospital Revenue Code	278
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

MEDTRONIC ANTENA-NEUR STMLR

Facility

$160.00

Hospital Charge Code	270339436
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$38.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.72
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

MEDTRONIC LEAD KIT-STIMULATOR

Facility

$4,600.00

Hospital Charge Code	270339432
Hospital Revenue Code	278
Min. Negotiated Rate	$130.64
Max. Negotiated Rate	$2,300.00
Rate for Payer: Aetna Commercial	$1,748.00
Rate for Payer: Aetna Medicare Advantage	$1,380.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,173.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,173.00
Rate for Payer: Cigna Commercial	$2,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,113.20
Rate for Payer: Qualcare PPO/HMO/WC	$690.00
Rate for Payer: UnitedHealthcare Community & State	$145.36
Rate for Payer: Wellpoint Medicaid Managed Care	$130.64

MEDTRONIC LEAD KIT-STIMULATOR

Facility

$4,600.00

Hospital Charge Code	270339432
Hospital Revenue Code	278
Min. Negotiated Rate	$690.00
Max. Negotiated Rate	$1,113.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$920.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,113.20
Rate for Payer: Qualcare PPO/HMO/WC	$690.00

MEDTRONIC NEUROSTIMULATOR

Facility

$28,150.00

Hospital Charge Code	270339434
Hospital Revenue Code	278
Min. Negotiated Rate	$4,222.50
Max. Negotiated Rate	$6,812.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,812.30
Rate for Payer: Qualcare PPO/HMO/WC	$4,222.50

MEDTRONIC NEUROSTIMULATOR

Facility

$28,150.00

Hospital Charge Code	270339434
Hospital Revenue Code	278
Min. Negotiated Rate	$799.46
Max. Negotiated Rate	$14,075.00
Rate for Payer: Aetna Commercial	$10,697.00
Rate for Payer: Aetna Medicare Advantage	$8,445.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,178.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,178.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,178.25
Rate for Payer: Cigna Commercial	$14,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,812.30
Rate for Payer: Qualcare PPO/HMO/WC	$4,222.50
Rate for Payer: UnitedHealthcare Community & State	$889.54
Rate for Payer: Wellpoint Medicaid Managed Care	$799.46

MEDTRONIC NS CHARGING SYSTEM

Facility

$4,590.00

Hospital Charge Code	270339435
Hospital Revenue Code	278
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$1,110.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$918.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,110.78
Rate for Payer: Qualcare PPO/HMO/WC	$688.50

MEDTRONIC NS CHARGING SYSTEM

Facility

$4,590.00

Hospital Charge Code	270339435
Hospital Revenue Code	278
Min. Negotiated Rate	$130.36
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna Commercial	$1,744.20
Rate for Payer: Aetna Medicare Advantage	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,170.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,170.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,170.45
Rate for Payer: Cigna Commercial	$2,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,110.78
Rate for Payer: Qualcare PPO/HMO/WC	$688.50
Rate for Payer: UnitedHealthcare Community & State	$145.04
Rate for Payer: Wellpoint Medicaid Managed Care	$130.36

MEDTRONIC PT PROGRAMMER-STMLTR

Facility

$1,800.00

Hospital Charge Code	270339433
Hospital Revenue Code	278
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Community & State	$56.88
Rate for Payer: Wellpoint Medicaid Managed Care	$51.12

MEDTRONIC PT PROGRAMMER-STMLTR

Facility

$1,800.00

Hospital Charge Code	270339433
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$435.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$435.60
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

Know your out-of-pocket cost for care.

All Charges