Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ARTRL BLOOD GAS W/ SHOCK PANEL

Facility

$1,255.57

Service Code	HCPCS 82803
Hospital Charge Code	397360011
Hospital Revenue Code	300
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$627.78
Rate for Payer: Aetna Commercial	$70.91
Rate for Payer: Aetna Medicare Advantage	$84.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.57
Rate for Payer: Cigna Commercial	$627.78
Rate for Payer: Cigna Medicare Advantage	$26.07
Rate for Payer: Clover Medicare Advantage	$24.77
Rate for Payer: EmblemHealth Commercial	$78.21
Rate for Payer: Humana Medicare Advantage	$26.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.45
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$188.34
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.07
Rate for Payer: Wellcare Medicare Advantage	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$35.66

ARTS & CRAFTS THERAPY GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246105
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

ARTS & CRAFTS THERAPY GROUP

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246105
Hospital Revenue Code	915
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.21
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$25.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

ARTS & CRAFTS THERAPY INDIVIDU

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246110
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

ARTS & CRAFTS THERAPY INDIVIDU

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	83246110
Hospital Revenue Code	915
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.21
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$25.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

ART SURF LCCK CD 3-4 20MM YELL

Facility

$9,271.00

Hospital Charge Code	270669763
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.65
Max. Negotiated Rate	$2,243.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,243.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,390.65

ART SURF LCCK CD 3-4 20MM YELL

Facility

$9,271.00

Hospital Charge Code	270669763
Hospital Revenue Code	278
Min. Negotiated Rate	$263.30
Max. Negotiated Rate	$4,635.50
Rate for Payer: Aetna Commercial	$3,522.98
Rate for Payer: Aetna Medicare Advantage	$2,781.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,364.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,364.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,364.11
Rate for Payer: Cigna Commercial	$4,635.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,243.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,390.65
Rate for Payer: UnitedHealthcare Community & State	$292.96
Rate for Payer: Wellpoint Medicaid Managed Care	$263.30

ART SURF LCCK EF 3-4 17MM YEL

Facility

$9,271.00

Hospital Charge Code	270660877
Hospital Revenue Code	278
Min. Negotiated Rate	$263.30
Max. Negotiated Rate	$4,635.50
Rate for Payer: Aetna Commercial	$3,522.98
Rate for Payer: Aetna Medicare Advantage	$2,781.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,364.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,364.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,364.11
Rate for Payer: Cigna Commercial	$4,635.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,243.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,390.65
Rate for Payer: UnitedHealthcare Community & State	$292.96
Rate for Payer: Wellpoint Medicaid Managed Care	$263.30

ART SURF LCCK EF 3-4 17MM YEL

Facility

$9,271.00

Hospital Charge Code	270660877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.65
Max. Negotiated Rate	$2,243.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,243.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,390.65

ART SURF LCCK EF 3-4 17MM YEL

Facility

$9,271.00

Hospital Charge Code	270671567
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.65
Max. Negotiated Rate	$2,243.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,243.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,390.65

ART SURF LCCK EF 3-4 17MM YEL

Facility

$9,271.00

Hospital Charge Code	270671567
Hospital Revenue Code	278
Min. Negotiated Rate	$263.30
Max. Negotiated Rate	$4,635.50
Rate for Payer: Aetna Commercial	$3,522.98
Rate for Payer: Aetna Medicare Advantage	$2,781.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,364.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,364.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,364.11
Rate for Payer: Cigna Commercial	$4,635.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,243.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,390.65
Rate for Payer: UnitedHealthcare Community & State	$292.96
Rate for Payer: Wellpoint Medicaid Managed Care	$263.30

ART SURF LPS-FLEX EF 3-4 14MM

Facility

$5,862.10

Hospital Charge Code	270663523
Hospital Revenue Code	278
Min. Negotiated Rate	$166.48
Max. Negotiated Rate	$2,931.05
Rate for Payer: Aetna Commercial	$2,227.60
Rate for Payer: Aetna Medicare Advantage	$1,758.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,494.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,494.84
Rate for Payer: Cigna Commercial	$2,931.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32
Rate for Payer: UnitedHealthcare Community & State	$185.24
Rate for Payer: Wellpoint Medicaid Managed Care	$166.48

ART SURF LPS-FLEX EF 3-4 14MM

Facility

$5,862.10

Hospital Charge Code	270663523
Hospital Revenue Code	278
Min. Negotiated Rate	$879.32
Max. Negotiated Rate	$1,418.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,172.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,418.63
Rate for Payer: Qualcare PPO/HMO/WC	$879.32

ARYLSULFATASE A, ANTIBODY

Facility

$337.00

Service Code	HCPCS 84311
Hospital Charge Code	38472906
Hospital Revenue Code	301
Min. Negotiated Rate	$50.55
Max. Negotiated Rate	$50.55
Rate for Payer: Qualcare PPO/HMO/WC	$50.55

ARYLSULFATASE A, ANTIBODY

Facility

$337.00

Service Code	HCPCS 84311
Hospital Charge Code	38472906
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$168.50
Rate for Payer: Aetna Commercial	$22.03
Rate for Payer: Aetna Medicare Advantage	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.38
Rate for Payer: Cigna Commercial	$168.50
Rate for Payer: Cigna Medicare Advantage	$8.10
Rate for Payer: Clover Medicare Advantage	$7.70
Rate for Payer: EmblemHealth Commercial	$24.30
Rate for Payer: Humana Medicare Advantage	$8.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.10
Rate for Payer: Wellcare Medicare Advantage	$8.10
Rate for Payer: Wellpoint Medicaid Managed Care	$9.57

ASCOPE RHINOLARYNGO INTERVENTI

Facility

$1,365.00

Hospital Charge Code	270688727
Hospital Revenue Code	272
Min. Negotiated Rate	$204.75
Max. Negotiated Rate	$204.75
Rate for Payer: Qualcare PPO/HMO/WC	$204.75

ASCOPE RHINOLARYNGO INTERVENTI

Facility

$1,365.00

Hospital Charge Code	270688727
Hospital Revenue Code	272
Min. Negotiated Rate	$38.77
Max. Negotiated Rate	$682.50
Rate for Payer: Aetna Commercial	$518.70
Rate for Payer: Aetna Medicare Advantage	$409.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.07
Rate for Payer: Cigna Commercial	$682.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.90
Rate for Payer: Oxford Commercial	$273.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.75
Rate for Payer: UnitedHealthcare Commercial	$273.00
Rate for Payer: UnitedHealthcare Community & State	$43.13
Rate for Payer: Wellpoint Medicaid Managed Care	$38.77

ASCORBIC ACID 250 MG TAB

Facility

$4.00

Service Code	NDC 904052260
Hospital Charge Code	60628489
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ASCORBIC ACID 250 MG TAB

Facility

$4.00

Service Code	NDC 904052260
Hospital Charge Code	60628489
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ASCORBIC ACID 500 MG/5ML LIQ

Facility

$4.00

Service Code	NDC 536016097
Hospital Charge Code	6000467
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ASCORBIC ACID 500 MG/5ML LIQ

Facility

$4.00

Service Code	NDC 536016097
Hospital Charge Code	6000467
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ASCORBIC ACID500MG/ML50ML VIAL

Facility

$14.54

Service Code	NDC 67457011850
Hospital Charge Code	606390138
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

ASCORBIC ACID500MG/ML50ML VIAL

Facility

$14.54

Service Code	NDC 67457011850
Hospital Charge Code	606390138
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

ASCORBIC ACID 500 MG TAB

Facility

$4.00

Service Code	NDC 904052360
Hospital Charge Code	60628490
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ASCORBIC ACID 500 MG TAB

Facility

$4.00

Service Code	NDC 904052360
Hospital Charge Code	60628490
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

Know your out-of-pocket cost for care.

All Charges