Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MMR/VZV PROFILE,EIA III

Facility

$390.00

Service Code	HCPCS 86765
Hospital Charge Code	39990121C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
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	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MMR/VZV PROFILE,EIA III

Facility

$390.00

Service Code	HCPCS 86765
Hospital Charge Code	39990121C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MMR/VZV PROFILE,EIA IV

Facility

$390.00

Service Code	HCPCS 86787
Hospital Charge Code	39990121D
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.03
Rate for Payer: Aetna Medicare Advantage	$41.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.72
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.88
Rate for Payer: Clover Medicare Advantage	$12.24
Rate for Payer: EmblemHealth Commercial	$38.64
Rate for Payer: Humana Medicare Advantage	$13.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.88
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	$10.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.88
Rate for Payer: Wellcare Medicare Advantage	$12.88
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MMR/VZV PROFILE,EIA IV

Facility

$390.00

Service Code	HCPCS 86787
Hospital Charge Code	39990121D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MNIPAQUE 240MG 50ML

Facility

$234.75

Service Code	HCPCS Q9966
Hospital Charge Code	64070005
Hospital Revenue Code	636
Min. Negotiated Rate	$35.21
Max. Negotiated Rate	$56.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.21

MNIPAQUE 240MG 50ML

Facility

$234.75

Service Code	HCPCS Q9966
Hospital Charge Code	64070005
Hospital Revenue Code	636
Min. Negotiated Rate	$6.67
Max. Negotiated Rate	$117.38
Rate for Payer: Aetna Commercial	$89.20
Rate for Payer: Aetna Medicare Advantage	$70.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.86
Rate for Payer: Cigna Commercial	$117.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.81
Rate for Payer: Qualcare PPO/HMO/WC	$35.21
Rate for Payer: UnitedHealthcare Community & State	$7.42
Rate for Payer: Wellpoint Medicaid Managed Care	$6.67

MNL PREP&INSJ DP RX DLVR DEV

Facility

$201.37

Service Code	HCPCS 20700
Hospital Charge Code	1600000879
Hospital Revenue Code	360
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$76.52
Rate for Payer: Aetna Medicare Advantage	$60.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.35
Rate for Payer: Cigna Commercial	$100.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.36
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.21
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$6.36
Rate for Payer: Wellpoint Medicaid Managed Care	$5.72

MNL PREP&INSJ DP RX DLVR DEV

Facility

$201.37

Service Code	HCPCS 20700
Hospital Charge Code	1600000879
Hospital Revenue Code	360
Min. Negotiated Rate	$30.21
Max. Negotiated Rate	$30.21
Rate for Payer: Qualcare PPO/HMO/WC	$30.21

MNL PREP&INSJ I-ARTIC RX DEV

Facility

$5,605.99

Service Code	HCPCS 20704
Hospital Charge Code	160000881
Hospital Revenue Code	360
Min. Negotiated Rate	$159.21
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,130.28
Rate for Payer: Aetna Medicare Advantage	$1,681.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,429.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,429.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,429.53
Rate for Payer: Cigna Commercial	$2,802.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,457.56
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$840.90
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$177.15
Rate for Payer: Wellpoint Medicaid Managed Care	$159.21

MNL PREP&INSJ I-ARTIC RX DEV

Facility

$5,605.99

Service Code	HCPCS 20704
Hospital Charge Code	160000881
Hospital Revenue Code	360
Min. Negotiated Rate	$840.90
Max. Negotiated Rate	$840.90
Rate for Payer: Qualcare PPO/HMO/WC	$840.90

MNL PREP&INSJ IMED RX DEV

Facility

$9,686.93

Service Code	HCPCS 20702
Hospital Charge Code	1600000880
Hospital Revenue Code	360
Min. Negotiated Rate	$1,453.04
Max. Negotiated Rate	$1,453.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.04

MNL PREP&INSJ IMED RX DEV

Facility

$9,686.93

Service Code	HCPCS 20702
Hospital Charge Code	1600000880
Hospital Revenue Code	360
Min. Negotiated Rate	$275.11
Max. Negotiated Rate	$4,843.47
Rate for Payer: Aetna Commercial	$3,681.03
Rate for Payer: Aetna Medicare Advantage	$2,906.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,470.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,470.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,470.17
Rate for Payer: Cigna Commercial	$4,843.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,518.60
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,453.04
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$306.11
Rate for Payer: Wellpoint Medicaid Managed Care	$275.11

MNT SUBSEQ EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97803
Hospital Charge Code	395097803
Hospital Revenue Code	942
Min. Negotiated Rate	$19.80
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	$19.80
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

MNT SUBSEQ EA 15 MIN

Facility

$2,700.00

Service Code	HCPCS 97803
Hospital Charge Code	395097803
Hospital Revenue Code	942
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GP
Hospital Charge Code	84202001
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GP
Hospital Charge Code	84201138
Hospital Revenue Code	439
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GP
Hospital Charge Code	84201138
Hospital Revenue Code	439
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) NJ Health	$69.00
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

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GP
Hospital Charge Code	9109130
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GO
Hospital Charge Code	74203087
Hospital Revenue Code	430
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) NJ Health	$69.00
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

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GP
Hospital Charge Code	9109130
Hospital Revenue Code	420
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) NJ Health	$69.00
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

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GO
Hospital Charge Code	74203087
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8978GP
Hospital Charge Code	84202001
Hospital Revenue Code	420
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) NJ Health	$69.00
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

MOBILITY CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8978GOCH
Hospital Charge Code	74203087CH
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOBILITY CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8978GOCH
Hospital Charge Code	74203087CH
Hospital Revenue Code	430
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) NJ Health	$69.00
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

MOBILITY CURRENT STATUS CH

Facility

$0.01

Service Code	HCPCS G8978GPCH
Hospital Charge Code	84202001CH
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Know your out-of-pocket cost for care.

All Charges