Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

Memory Goal Status CK

Facility

$0.01

Service Code	HCPCS G9169GNCK
Hospital Charge Code	74204079CK
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MEMORY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9169GNCL
Hospital Charge Code	74204079CL
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9169GNCL
Hospital Charge Code	74204079CL
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MEMORY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G9169GNCM
Hospital Charge Code	74204079CM
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY GOAL STATUS CM

Facility

$0.01

Service Code	HCPCS G9169GNCM
Hospital Charge Code	74204079CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MEMORY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9169GNCN
Hospital Charge Code	74204079CN
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

MEMORY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9169GNCN
Hospital Charge Code	74204079CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Memory Goal Status M

Facility

$0.01

Hospital Charge Code	74204079M
Hospital Revenue Code	440
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Memory Goal Status M

Facility

$0.01

Hospital Charge Code	74204079M
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MEMORY SOFT WIRE BASKET

Facility

$191.00

Hospital Charge Code	270325611
Hospital Revenue Code	272
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$95.50
Rate for Payer: Aetna Commercial	$72.58
Rate for Payer: Aetna Medicare Advantage	$57.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.70
Rate for Payer: Cigna Commercial	$95.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.66
Rate for Payer: Oxford Commercial	$38.20
Rate for Payer: Qualcare PPO/HMO/WC	$28.65
Rate for Payer: UnitedHealthcare Commercial	$38.20
Rate for Payer: UnitedHealthcare Community & State	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.42

MEMORY SOFT WIRE BASKET

Facility

$191.00

Hospital Charge Code	270325611
Hospital Revenue Code	272
Min. Negotiated Rate	$28.65
Max. Negotiated Rate	$28.65
Rate for Payer: Qualcare PPO/HMO/WC	$28.65

MEN2/FMTC EXON 10,11,13-16 I

Facility

$2,375.00

Service Code	HCPCS 81404
Hospital Charge Code	39990160A
Hospital Revenue Code	310
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$747.54
Rate for Payer: Aetna Medicare Advantage	$890.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$996.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$996.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$274.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$996.95
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$274.83
Rate for Payer: Clover Medicare Advantage	$261.09
Rate for Payer: EmblemHealth Commercial	$824.49
Rate for Payer: Humana Medicare Advantage	$283.07
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$274.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$219.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$274.83
Rate for Payer: Wellcare Medicare Advantage	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

MEN2/FMTC EXON 10,11,13-16 I

Facility

$2,375.00

Service Code	HCPCS 81404
Hospital Charge Code	39990160A
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

MEN2/FMTC EXON 10,11,13-16 II

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39990160B
Hospital Revenue Code	310
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: Aetna Medicare Advantage	$976.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,093.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$301.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,093.15
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: Cigna Medicare Advantage	$301.35
Rate for Payer: Clover Medicare Advantage	$286.28
Rate for Payer: EmblemHealth Commercial	$904.05
Rate for Payer: Humana Medicare Advantage	$310.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$301.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$241.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.35
Rate for Payer: Wellcare Medicare Advantage	$301.35
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

MEN2/FMTC EXON 10,11,13-16 II

Facility

$2,375.00

Service Code	HCPCS 81405
Hospital Charge Code	39990160B
Hospital Revenue Code	310
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

MENACTRA

Facility

$706.78

Service Code	HCPCS 90734
Hospital Charge Code	83652581
Hospital Revenue Code	636
Min. Negotiated Rate	$106.02
Max. Negotiated Rate	$171.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.04
Rate for Payer: Qualcare PPO/HMO/WC	$106.02

MENACTRA

Facility

$706.78

Service Code	HCPCS 90734
Hospital Charge Code	83652581
Hospital Revenue Code	636
Min. Negotiated Rate	$20.07
Max. Negotiated Rate	$353.39
Rate for Payer: Aetna Commercial	$268.58
Rate for Payer: Aetna Medicare Advantage	$212.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.23
Rate for Payer: Cigna Commercial	$353.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.04
Rate for Payer: Qualcare PPO/HMO/WC	$106.02
Rate for Payer: UnitedHealthcare Community & State	$22.33
Rate for Payer: Wellpoint Medicaid Managed Care	$20.07

MENACTRA(MENINGOCOCCAL) VIAL

Facility

$208.00

Service Code	HCPCS 90734
Hospital Charge Code	83652579
Hospital Revenue Code	636
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$79.04
Rate for Payer: Aetna Medicare Advantage	$62.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.04
Rate for Payer: Cigna Commercial	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.34
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: Wellpoint Medicaid Managed Care	$5.91

MENACTRA(MENINGOCOCCAL) VIAL

Facility

$208.00

Service Code	HCPCS 90734
Hospital Charge Code	83652579
Hospital Revenue Code	636
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$50.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.34
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

MENDER TFCC SUTURE SYSTEM

Facility

$650.00

Hospital Charge Code	270673925
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

MENDER TFCC SUTURE SYSTEM

Facility

$650.00

Hospital Charge Code	270673925
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

MENINGOCOCAL POLY DT VACCINE

Facility

$906.98

Service Code	HCPCS 96373
Hospital Charge Code	606351006
Hospital Revenue Code	636
Min. Negotiated Rate	$136.05
Max. Negotiated Rate	$219.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.49
Rate for Payer: Qualcare PPO/HMO/WC	$136.05

MENINGOCOCAL POLY DT VACCINE

Facility

$906.98

Service Code	HCPCS 96373
Hospital Charge Code	606351006
Hospital Revenue Code	636
Min. Negotiated Rate	$25.76
Max. Negotiated Rate	$916.67
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$267.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.49
Rate for Payer: Qualcare PPO/HMO/WC	$136.05
Rate for Payer: UnitedHealthcare Community & State	$28.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$25.76

MENISCAL CINCH

Facility

$660.00

Hospital Charge Code	270335940
Hospital Revenue Code	272
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

MENISCAL CINCH

Facility

$660.00

Hospital Charge Code	270335940
Hospital Revenue Code	272
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.60
Rate for Payer: Oxford Commercial	$132.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Commercial	$132.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: Wellpoint Medicaid Managed Care	$18.74

Know your out-of-pocket cost for care.

All Charges