Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MOBILITY GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8979GOCN
Hospital Charge Code	74203089CN
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODAFINIL 100 MG TAB

Facility

$147.87

Service Code	NDC 55253080130
Hospital Charge Code	60629289
Hospital Revenue Code	259
Min. Negotiated Rate	$22.18
Max. Negotiated Rate	$22.18
Rate for Payer: Qualcare PPO/HMO/WC	$22.18

MODAFINIL 100 MG TAB

Facility

$147.87

Service Code	NDC 55253080130
Hospital Charge Code	60629289
Hospital Revenue Code	259
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$73.94
Rate for Payer: Aetna Commercial	$56.19
Rate for Payer: Aetna Medicare Advantage	$44.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.71
Rate for Payer: Cigna Commercial	$73.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.45
Rate for Payer: Oxford Commercial	$29.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.18
Rate for Payer: UnitedHealthcare Commercial	$29.57
Rate for Payer: UnitedHealthcare Community & State	$4.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.20

MODEL1090-B SPINAL STIMULATOR

Facility

$108,625.00

Service Code	HCPCS C1778
Hospital Charge Code	270703924
Hospital Revenue Code	278
Min. Negotiated Rate	$3,084.95
Max. Negotiated Rate	$54,312.50
Rate for Payer: Aetna Commercial	$41,277.50
Rate for Payer: Aetna Medicare Advantage	$32,587.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,699.38
Rate for Payer: Cigna Commercial	$54,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,287.25
Rate for Payer: Qualcare PPO/HMO/WC	$16,293.75
Rate for Payer: UnitedHealthcare Community & State	$3,432.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3,084.95

MODEL1090-B SPINAL STIMULATOR

Facility

$108,625.00

Service Code	HCPCS C1778
Hospital Charge Code	270703924
Hospital Revenue Code	278
Min. Negotiated Rate	$16,293.75
Max. Negotiated Rate	$26,287.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26,287.25
Rate for Payer: Qualcare PPO/HMO/WC	$16,293.75

MODEL BONE

Facility

$500.00

Hospital Charge Code	270672088
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

MODEL BONE

Facility

$500.00

Hospital Charge Code	270672088
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	2680380
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	2680380
Hospital Revenue Code	370
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.36
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$20.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.06

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	7411768
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE (CONSCIOUS SEDATION)

Facility

$636.00

Service Code	HCPCS 99149
Hospital Charge Code	7411768
Hospital Revenue Code	370
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.36
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$20.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.06

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$26,672.03

Service Code	APR-DRG 7933
Min. Negotiated Rate	$26,149.05
Max. Negotiated Rate	$26,672.03
Rate for Payer: UnitedHealthcare Community & State	$26,149.05
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,672.03
Rate for Payer: Wellpoint Medicaid Managed Care	$26,149.05

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$51,081.57

Service Code	APR-DRG 7934
Min. Negotiated Rate	$50,079.97
Max. Negotiated Rate	$51,081.57
Rate for Payer: UnitedHealthcare Community & State	$50,079.97
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$51,081.57
Rate for Payer: Wellpoint Medicaid Managed Care	$50,079.97

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$13,834.53

Service Code	APR-DRG 7931
Min. Negotiated Rate	$13,563.26
Max. Negotiated Rate	$13,834.53
Rate for Payer: UnitedHealthcare Community & State	$13,563.26
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$13,834.53
Rate for Payer: Wellpoint Medicaid Managed Care	$13,563.26

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$18,091.27

Service Code	APR-DRG 7932
Min. Negotiated Rate	$17,736.54
Max. Negotiated Rate	$18,091.27
Rate for Payer: UnitedHealthcare Community & State	$17,736.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,091.27
Rate for Payer: Wellpoint Medicaid Managed Care	$17,736.54

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$54,405.72

Service Code	APR-DRG 9514
Min. Negotiated Rate	$53,338.94
Max. Negotiated Rate	$54,405.72
Rate for Payer: UnitedHealthcare Community & State	$53,338.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$54,405.72
Rate for Payer: Wellpoint Medicaid Managed Care	$53,338.94

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$30,323.41

Service Code	APR-DRG 9513
Min. Negotiated Rate	$29,728.83
Max. Negotiated Rate	$30,323.41
Rate for Payer: UnitedHealthcare Community & State	$29,728.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,323.41
Rate for Payer: Wellpoint Medicaid Managed Care	$29,728.83

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$15,338.64

Service Code	APR-DRG 9511
Min. Negotiated Rate	$15,037.88
Max. Negotiated Rate	$15,338.64
Rate for Payer: UnitedHealthcare Community & State	$15,037.88
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,338.64
Rate for Payer: Wellpoint Medicaid Managed Care	$15,037.88

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$20,303.11

Service Code	APR-DRG 9512
Min. Negotiated Rate	$19,905.01
Max. Negotiated Rate	$20,303.11
Rate for Payer: UnitedHealthcare Community & State	$19,905.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$20,303.11
Rate for Payer: Wellpoint Medicaid Managed Care	$19,905.01

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	2680375
Hospital Revenue Code	370
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.36
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$20.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.06

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	2680375
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	7411767
Hospital Revenue Code	370
Min. Negotiated Rate	$95.40
Max. Negotiated Rate	$95.40
Rate for Payer: Qualcare PPO/HMO/WC	$95.40

MODERATE SEDATION <5 YEARS OLD

Facility

$636.00

Service Code	HCPCS 99148
Hospital Charge Code	7411767
Hospital Revenue Code	370
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$241.68
Rate for Payer: Aetna Medicare Advantage	$190.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$162.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$162.18
Rate for Payer: Cigna Commercial	$318.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.36
Rate for Payer: Oxford Commercial	$127.20
Rate for Payer: Qualcare PPO/HMO/WC	$95.40
Rate for Payer: UnitedHealthcare Commercial	$127.20
Rate for Payer: UnitedHealthcare Community & State	$20.10
Rate for Payer: Wellpoint Medicaid Managed Care	$18.06

MODERNABIVAL ADDL 50MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91313
Hospital Charge Code	606390521
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MODERNABIVAL ADDL 50MCG/0.5ML

Facility

$0.01

Service Code	HCPCS 91313
Hospital Charge Code	606390521
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Know your out-of-pocket cost for care.

All Charges