Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4515519
Hospital Revenue Code	915
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4832519
Hospital Revenue Code	915
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4832519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4510519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4822519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4535519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4535519
Hospital Revenue Code	915
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4527519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4518519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4546519
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

MULTI FAMILY GROUP TX CHILD

Facility

$750.00

Service Code	HCPCS 90849
Hospital Charge Code	4546519
Hospital Revenue Code	915
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

MULTI - FAMILY THERAPY

Facility

$464.00

Service Code	HCPCS 90849
Hospital Charge Code	83246270
Hospital Revenue Code	916
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.64
Rate for Payer: Qualcare PPO/HMO/WC	$69.60
Rate for Payer: UnitedHealthcare Community & State	$14.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellpoint Medicaid Managed Care	$13.18

MULTI - FAMILY THERAPY

Facility

$464.00

Service Code	HCPCS 90849
Hospital Charge Code	83246270
Hospital Revenue Code	916
Min. Negotiated Rate	$69.60
Max. Negotiated Rate	$69.60
Rate for Payer: Qualcare PPO/HMO/WC	$69.60

MULTIFIRE ENDO GIA 30V LOADING

Facility

$619.00

Hospital Charge Code	270334729
Hospital Revenue Code	272
Min. Negotiated Rate	$17.58
Max. Negotiated Rate	$309.50
Rate for Payer: Aetna Commercial	$235.22
Rate for Payer: Aetna Medicare Advantage	$185.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.84
Rate for Payer: Cigna Commercial	$309.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$160.94
Rate for Payer: Oxford Commercial	$123.80
Rate for Payer: Qualcare PPO/HMO/WC	$92.85
Rate for Payer: UnitedHealthcare Commercial	$123.80
Rate for Payer: UnitedHealthcare Community & State	$19.56
Rate for Payer: Wellpoint Medicaid Managed Care	$17.58

MULTIFIRE ENDO GIA 30V LOADING

Facility

$619.00

Hospital Charge Code	270334729
Hospital Revenue Code	272
Min. Negotiated Rate	$92.85
Max. Negotiated Rate	$92.85
Rate for Payer: Qualcare PPO/HMO/WC	$92.85

MULTIFIRE ENDO GIA 30V STAPLER

Facility

$1,296.00

Hospital Charge Code	270334753
Hospital Revenue Code	272
Min. Negotiated Rate	$36.81
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Commercial	$492.48
Rate for Payer: Aetna Medicare Advantage	$388.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$330.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$330.48
Rate for Payer: Cigna Commercial	$648.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.96
Rate for Payer: Oxford Commercial	$259.20
Rate for Payer: Qualcare PPO/HMO/WC	$194.40
Rate for Payer: UnitedHealthcare Commercial	$259.20
Rate for Payer: UnitedHealthcare Community & State	$40.95
Rate for Payer: Wellpoint Medicaid Managed Care	$36.81

MULTIFIRE ENDO GIA 30V STAPLER

Facility

$1,296.00

Hospital Charge Code	270334753
Hospital Revenue Code	272
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$194.40
Rate for Payer: Qualcare PPO/HMO/WC	$194.40

MULTIFIRE TA30-3.5 LOADING

Facility

$261.00

Hospital Charge Code	270334690
Hospital Revenue Code	272
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna Commercial	$99.18
Rate for Payer: Aetna Medicare Advantage	$78.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.56
Rate for Payer: Cigna Commercial	$130.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.86
Rate for Payer: Oxford Commercial	$52.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.15
Rate for Payer: UnitedHealthcare Commercial	$52.20
Rate for Payer: UnitedHealthcare Community & State	$8.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.41

MULTIFIRE TA30-3.5 LOADING

Facility

$261.00

Hospital Charge Code	270334690
Hospital Revenue Code	272
Min. Negotiated Rate	$39.15
Max. Negotiated Rate	$39.15
Rate for Payer: Qualcare PPO/HMO/WC	$39.15

MULTIFIRE TA 30-3.5 RELOADABLE

Facility

$555.00

Hospital Charge Code	270334724
Hospital Revenue Code	272
Min. Negotiated Rate	$83.25
Max. Negotiated Rate	$83.25
Rate for Payer: Qualcare PPO/HMO/WC	$83.25

MULTIFIRE TA 30-3.5 RELOADABLE

Facility

$555.00

Hospital Charge Code	270334724
Hospital Revenue Code	272
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$277.50
Rate for Payer: Aetna Commercial	$210.90
Rate for Payer: Aetna Medicare Advantage	$166.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$141.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$141.53
Rate for Payer: Cigna Commercial	$277.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.30
Rate for Payer: Oxford Commercial	$111.00
Rate for Payer: Qualcare PPO/HMO/WC	$83.25
Rate for Payer: UnitedHealthcare Commercial	$111.00
Rate for Payer: UnitedHealthcare Community & State	$17.54
Rate for Payer: Wellpoint Medicaid Managed Care	$15.76

MULTIFIRE TA30-4.8 LOADING

Facility

$283.00

Hospital Charge Code	270334689
Hospital Revenue Code	278
Min. Negotiated Rate	$42.45
Max. Negotiated Rate	$68.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.49
Rate for Payer: Qualcare PPO/HMO/WC	$42.45

MULTIFIRE TA30-4.8 LOADING

Facility

$283.00

Hospital Charge Code	270334689
Hospital Revenue Code	278
Min. Negotiated Rate	$8.04
Max. Negotiated Rate	$141.50
Rate for Payer: Aetna Commercial	$107.54
Rate for Payer: Aetna Medicare Advantage	$84.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$56.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.17
Rate for Payer: Cigna Commercial	$141.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.49
Rate for Payer: Qualcare PPO/HMO/WC	$42.45
Rate for Payer: UnitedHealthcare Community & State	$8.94
Rate for Payer: Wellpoint Medicaid Managed Care	$8.04

MULTIFIRE TA 55-3.5 DISPOSABLE

Facility

$293.00

Hospital Charge Code	270334693
Hospital Revenue Code	272
Min. Negotiated Rate	$8.32
Max. Negotiated Rate	$146.50
Rate for Payer: Aetna Commercial	$111.34
Rate for Payer: Aetna Medicare Advantage	$87.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.72
Rate for Payer: Cigna Commercial	$146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.18
Rate for Payer: Oxford Commercial	$58.60
Rate for Payer: Qualcare PPO/HMO/WC	$43.95
Rate for Payer: UnitedHealthcare Commercial	$58.60
Rate for Payer: UnitedHealthcare Community & State	$9.26
Rate for Payer: Wellpoint Medicaid Managed Care	$8.32

MULTIFIRE TA 55-3.5 DISPOSABLE

Facility

$293.00

Hospital Charge Code	270334693
Hospital Revenue Code	272
Min. Negotiated Rate	$43.95
Max. Negotiated Rate	$43.95
Rate for Payer: Qualcare PPO/HMO/WC	$43.95

Know your out-of-pocket cost for care.

All Charges