Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MIS TICP ROD 40MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705119
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

MIS TICP ROD 40MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270705119
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

MIST THERAPY/DAY

Facility

$117.83

Service Code	HCPCS 97610
Hospital Charge Code	9808216
Hospital Revenue Code	940
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$2,377.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.64
Rate for Payer: Oxford Commercial	$2,054.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.67
Rate for Payer: UnitedHealthcare Commercial	$2,377.00
Rate for Payer: UnitedHealthcare Community & State	$3.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.35

MIST THERAPY/DAY

Facility

$117.83

Service Code	HCPCS 97610
Hospital Charge Code	9808216
Hospital Revenue Code	940
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$17.67
Rate for Payer: Qualcare PPO/HMO/WC	$17.67

MITOCHONDRIAL AB W/RFX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900205
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
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	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

MITOCHONDRIAL AB W/RFX

Facility

$667.59

Service Code	HCPCS 86255
Hospital Charge Code	39900205
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

MITOCHONDRIAL ANTIBODIES

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38476054
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$257.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$257.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.64
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$14.60

MITOCHONDRIAL ANTIBODIES

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38476054
Hospital Revenue Code	302
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

MITOCHONDRIAL ANTIBODY TI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39900207
Hospital Revenue Code	302
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$12.43
Rate for Payer: Qualcare PPO/HMO/WC	$12.43

MITOCHONDRIAL ANTIBODY TI

Facility

$82.85

Service Code	HCPCS 86256
Hospital Charge Code	39900207
Hospital Revenue Code	302
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$41.42
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.43
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.35

MITOCHRONDRIAL

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38479075
Hospital Revenue Code	302
Min. Negotiated Rate	$9.64
Max. Negotiated Rate	$257.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$257.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.64
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$77.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$14.60

MITOCHRONDRIAL

Facility

$514.00

Service Code	HCPCS 86255
Hospital Charge Code	38479075
Hospital Revenue Code	302
Min. Negotiated Rate	$77.10
Max. Negotiated Rate	$77.10
Rate for Payer: Qualcare PPO/HMO/WC	$77.10

MITOMYCIN 20 MG INJ

Facility

$4,742.39

Service Code	HCPCS J9280
Hospital Charge Code	60627402
Hospital Revenue Code	636
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$1,147.66
Rate for Payer: Aetna Commercial	$77.41
Rate for Payer: Aetna Medicare Advantage	$92.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.24
Rate for Payer: Cigna Medicare Advantage	$28.46
Rate for Payer: Clover Medicare Advantage	$27.04
Rate for Payer: EmblemHealth Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$29.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.66
Rate for Payer: Qualcare PPO/HMO/WC	$711.36
Rate for Payer: UnitedHealthcare Community & State	$149.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.46
Rate for Payer: Wellcare Medicare Advantage	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$134.68

MITOMYCIN 20 MG INJ

Facility

$4,742.39

Service Code	HCPCS J9280
Hospital Charge Code	60627402
Hospital Revenue Code	636
Min. Negotiated Rate	$711.36
Max. Negotiated Rate	$1,147.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,147.66
Rate for Payer: Qualcare PPO/HMO/WC	$711.36

MITOMYCIN 40 MG INJ

Facility

$9,484.79

Service Code	HCPCS J9280
Hospital Charge Code	6007686
Hospital Revenue Code	636
Min. Negotiated Rate	$1,422.72
Max. Negotiated Rate	$2,295.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,295.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.72

MITOMYCIN 40 MG INJ

Facility

$9,484.79

Service Code	HCPCS J9280
Hospital Charge Code	6007686
Hospital Revenue Code	636
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$2,295.32
Rate for Payer: Aetna Commercial	$77.41
Rate for Payer: Aetna Medicare Advantage	$92.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.24
Rate for Payer: Cigna Medicare Advantage	$28.46
Rate for Payer: Clover Medicare Advantage	$27.04
Rate for Payer: EmblemHealth Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$29.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,295.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,422.72
Rate for Payer: UnitedHealthcare Community & State	$299.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.46
Rate for Payer: Wellcare Medicare Advantage	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$269.37

MITOMYCIN 5 MG INJ

Facility

$1,825.48

Service Code	HCPCS J9280
Hospital Charge Code	6003792
Hospital Revenue Code	636
Min. Negotiated Rate	$273.82
Max. Negotiated Rate	$441.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.77
Rate for Payer: Qualcare PPO/HMO/WC	$273.82

MITOMYCIN 5 MG INJ

Facility

$1,825.48

Service Code	HCPCS J9280
Hospital Charge Code	6003792
Hospital Revenue Code	636
Min. Negotiated Rate	$27.04
Max. Negotiated Rate	$441.77
Rate for Payer: Aetna Commercial	$77.41
Rate for Payer: Aetna Medicare Advantage	$92.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$28.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.24
Rate for Payer: Cigna Medicare Advantage	$28.46
Rate for Payer: Clover Medicare Advantage	$27.04
Rate for Payer: EmblemHealth Commercial	$85.38
Rate for Payer: Humana Medicare Advantage	$29.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$28.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.77
Rate for Payer: Qualcare PPO/HMO/WC	$273.82
Rate for Payer: UnitedHealthcare Community & State	$57.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.46
Rate for Payer: Wellcare Medicare Advantage	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$51.84

MITOXANTRONE 2 MG/ML INJ

Facility

$1,740.46

Service Code	HCPCS J9293
Hospital Charge Code	60627403
Hospital Revenue Code	636
Min. Negotiated Rate	$261.07
Max. Negotiated Rate	$421.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.19
Rate for Payer: Qualcare PPO/HMO/WC	$261.07

MITOXANTRONE 2 MG/ML INJ

Facility

$1,740.46

Service Code	HCPCS J9293
Hospital Charge Code	60627403
Hospital Revenue Code	636
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$421.19
Rate for Payer: Aetna Commercial	$105.02
Rate for Payer: Aetna Medicare Advantage	$125.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.06
Rate for Payer: Cigna Medicare Advantage	$38.61
Rate for Payer: Clover Medicare Advantage	$36.68
Rate for Payer: EmblemHealth Commercial	$115.83
Rate for Payer: Humana Medicare Advantage	$39.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.19
Rate for Payer: Qualcare PPO/HMO/WC	$261.07
Rate for Payer: UnitedHealthcare Community & State	$55.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.61
Rate for Payer: Wellcare Medicare Advantage	$38.61
Rate for Payer: Wellpoint Medicaid Managed Care	$49.43

MITTEN FINGER & HAND PADDED

Facility

$83.55

Hospital Charge Code	270652202
Hospital Revenue Code	271
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$41.77
Rate for Payer: Aetna Commercial	$31.75
Rate for Payer: Aetna Medicare Advantage	$25.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.31
Rate for Payer: Cigna Commercial	$41.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.72
Rate for Payer: Oxford Commercial	$16.71
Rate for Payer: Qualcare PPO/HMO/WC	$12.53
Rate for Payer: UnitedHealthcare Commercial	$16.71
Rate for Payer: UnitedHealthcare Community & State	$2.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.37

MITTEN FINGER & HAND PADDED

Facility

$83.55

Hospital Charge Code	270652202
Hospital Revenue Code	271
Min. Negotiated Rate	$12.53
Max. Negotiated Rate	$12.53
Rate for Payer: Qualcare PPO/HMO/WC	$12.53

MITTS HAND CONTROL LG

Facility

$72.53

Hospital Charge Code	270301260
Hospital Revenue Code	270
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$36.27
Rate for Payer: Aetna Commercial	$27.56
Rate for Payer: Aetna Medicare Advantage	$21.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.50
Rate for Payer: Cigna Commercial	$36.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.86
Rate for Payer: Oxford Commercial	$14.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.88
Rate for Payer: UnitedHealthcare Commercial	$14.51
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

MITTS HAND CONTROL LG

Facility

$72.53

Hospital Charge Code	270301260
Hospital Revenue Code	270
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$10.88
Rate for Payer: Qualcare PPO/HMO/WC	$10.88

MIXER KYPHON

Facility

$352.00

Hospital Charge Code	270636044N
Hospital Revenue Code	272
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$176.00
Rate for Payer: Aetna Commercial	$133.76
Rate for Payer: Aetna Medicare Advantage	$105.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.76
Rate for Payer: Cigna Commercial	$176.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.52
Rate for Payer: Oxford Commercial	$70.40
Rate for Payer: Qualcare PPO/HMO/WC	$52.80
Rate for Payer: UnitedHealthcare Commercial	$70.40
Rate for Payer: UnitedHealthcare Community & State	$11.12
Rate for Payer: Wellpoint Medicaid Managed Care	$10.00

Know your out-of-pocket cost for care.

All Charges