Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MOTOR SPEECH GOAL STATUS

Facility

$0.01

Service Code	HCPCS G9186GN
Hospital Charge Code	84201110
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

Motor Speech Goal Status CH

Facility

$0.01

Service Code	HCPCS G9186GNCH
Hospital Charge Code	74204055CH
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Motor Speech Goal Status CH

Facility

$0.01

Service Code	HCPCS G9186GNCH
Hospital Charge Code	74204055CH
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

Motor Speech Goal Status CI

Facility

$0.01

Service Code	HCPCS G9186GNCI
Hospital Charge Code	74204055CI
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Motor Speech Goal Status CI

Facility

$0.01

Service Code	HCPCS G9186GNCI
Hospital Charge Code	74204055CI
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

Motor Speech Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9186GNCJ
Hospital Charge Code	74204055CJ
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

Motor Speech Goal Status CJ

Facility

$0.01

Service Code	HCPCS G9186GNCJ
Hospital Charge Code	74204055CJ
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Motor Speech Goal Status CK

Facility

$0.01

Service Code	HCPCS G9186GNCK
Hospital Charge Code	74204055CK
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

Motor Speech Goal Status CK

Facility

$0.01

Service Code	HCPCS G9186GNCK
Hospital Charge Code	74204055CK
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOTOR SPEECH GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9186GNCL
Hospital Charge Code	74204055CL
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOTOR SPEECH GOAL STATUS CL

Facility

$0.01

Service Code	HCPCS G9186GNCL
Hospital Charge Code	74204055CL
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

Motor Speech Goal Status CM

Facility

$0.01

Service Code	HCPCS G9186GNCM
Hospital Charge Code	74204055CM
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

Motor Speech Goal Status CM

Facility

$0.01

Service Code	HCPCS G9186GNCM
Hospital Charge Code	74204055CM
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

MOTOR SPEECH GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9186GNCN
Hospital Charge Code	74204055CN
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

MOTOR SPEECH GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G9186GNCN
Hospital Charge Code	74204055CN
Hospital Revenue Code	440
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

MOUNT HIP CHECK AND HIP MOUNT

Facility

$4,625.00

Hospital Charge Code	270691819
Hospital Revenue Code	272
Min. Negotiated Rate	$131.35
Max. Negotiated Rate	$2,312.50
Rate for Payer: Aetna Commercial	$1,757.50
Rate for Payer: Aetna Medicare Advantage	$1,387.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,179.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,179.38
Rate for Payer: Cigna Commercial	$2,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,202.50
Rate for Payer: Oxford Commercial	$925.00
Rate for Payer: Qualcare PPO/HMO/WC	$693.75
Rate for Payer: UnitedHealthcare Commercial	$925.00
Rate for Payer: UnitedHealthcare Community & State	$146.15
Rate for Payer: Wellpoint Medicaid Managed Care	$131.35

MOUNT HIP CHECK AND HIP MOUNT

Facility

$4,625.00

Hospital Charge Code	270691819
Hospital Revenue Code	272
Min. Negotiated Rate	$693.75
Max. Negotiated Rate	$693.75
Rate for Payer: Qualcare PPO/HMO/WC	$693.75

MOUTHGUARD DISP 69100

Facility

$11.72

Hospital Charge Code	270601185
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.86
Rate for Payer: Aetna Commercial	$4.45
Rate for Payer: Aetna Medicare Advantage	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.99
Rate for Payer: Cigna Commercial	$5.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.05
Rate for Payer: Oxford Commercial	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.76
Rate for Payer: UnitedHealthcare Commercial	$2.34
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

MOUTHGUARD DISP 69100

Facility

$11.72

Hospital Charge Code	270601185
Hospital Revenue Code	270
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.76

MOUTH PROCEDURES WITH CC/MCC

Facility

$66,640.17

Service Code	MSDRG 137
Min. Negotiated Rate	$20,291.08
Max. Negotiated Rate	$66,640.17
Rate for Payer: Aetna Commercial	$49,320.41
Rate for Payer: Aetna Medicare Advantage	$66,640.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,359.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,557.50
Rate for Payer: Cigna Commercial	$33,287.91
Rate for Payer: Cigna Medicare Advantage	$21,359.03
Rate for Payer: Clover Medicare Advantage	$20,291.08
Rate for Payer: EmblemHealth Commercial	$64,077.09
Rate for Payer: Humana Medicare Advantage	$21,999.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,359.03
Rate for Payer: Oxford Commercial	$26,310.18
Rate for Payer: UnitedHealthcare Commercial	$35,217.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,359.03
Rate for Payer: Wellcare Medicare Advantage	$21,359.03

MOUTH PROCEDURES WITHOUT CC/MCC

Facility

$47,462.84

Service Code	MSDRG 138
Min. Negotiated Rate	$14,451.83
Max. Negotiated Rate	$47,462.84
Rate for Payer: Aetna Commercial	$35,662.06
Rate for Payer: Aetna Medicare Advantage	$47,462.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24,103.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24,103.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,212.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24,103.35
Rate for Payer: Cigna Commercial	$19,756.06
Rate for Payer: Cigna Medicare Advantage	$15,212.45
Rate for Payer: Clover Medicare Advantage	$14,451.83
Rate for Payer: EmblemHealth Commercial	$45,637.35
Rate for Payer: Humana Medicare Advantage	$15,668.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,212.45
Rate for Payer: Oxford Commercial	$15,614.84
Rate for Payer: UnitedHealthcare Commercial	$20,901.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,212.45
Rate for Payer: Wellcare Medicare Advantage	$15,212.45

MOXIFLOXACIN 400 MG/ 250 ML

Facility

$293.13

Service Code	HCPCS J2280
Hospital Charge Code	60629222
Hospital Revenue Code	636
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$70.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.94
Rate for Payer: Qualcare PPO/HMO/WC	$43.97

MOXIFLOXACIN 400 MG/ 250 ML

Facility

$293.13

Service Code	HCPCS J2280
Hospital Charge Code	60629222
Hospital Revenue Code	636
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$146.56
Rate for Payer: Aetna Commercial	$111.39
Rate for Payer: Aetna Medicare Advantage	$87.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.75
Rate for Payer: Cigna Commercial	$146.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.94
Rate for Payer: Qualcare PPO/HMO/WC	$43.97
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

MOXIFLOXACIN 400 MG TAB

Facility

$222.71

Service Code	NDC 50419053001
Hospital Charge Code	60629231
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$111.36
Rate for Payer: Aetna Commercial	$84.63
Rate for Payer: Aetna Medicare Advantage	$66.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.79
Rate for Payer: Cigna Commercial	$111.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.90
Rate for Payer: Oxford Commercial	$44.54
Rate for Payer: Qualcare PPO/HMO/WC	$33.41
Rate for Payer: UnitedHealthcare Commercial	$44.54
Rate for Payer: UnitedHealthcare Community & State	$7.04
Rate for Payer: Wellpoint Medicaid Managed Care	$6.32

MOXIFLOXACIN 400 MG TAB

Facility

$222.71

Service Code	NDC 50419053001
Hospital Charge Code	60629231
Hospital Revenue Code	250
Min. Negotiated Rate	$33.41
Max. Negotiated Rate	$33.41
Rate for Payer: Qualcare PPO/HMO/WC	$33.41

Know your out-of-pocket cost for care.

All Charges