Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PEANUT (F13) IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900353
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PEDCLE FH/CH/CH/M/N/AX/G/H/F

Facility

$8,435.48

Service Code	HCPCS 15574
Hospital Charge Code	16000785
Hospital Revenue Code	360
Min. Negotiated Rate	$239.57
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,193.22
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.32
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$266.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$239.57

PEDCLE FH/CH/CH/M/N/AX/G/H/F

Facility

$8,435.48

Service Code	HCPCS 15574
Hospital Charge Code	16000785
Hospital Revenue Code	360
Min. Negotiated Rate	$1,265.32
Max. Negotiated Rate	$1,265.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,265.32

PED DIPHTHERIA/TETANUS < 7 YRS

Facility

$87.00

Service Code	HCPCS 90702
Hospital Charge Code	83652321
Hospital Revenue Code	636
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Community & State	$2.75
Rate for Payer: Wellpoint Medicaid Managed Care	$2.47

PED DIPHTHERIA/TETANUS < 7 YRS

Facility

$87.00

Service Code	HCPCS 90702
Hospital Charge Code	83652321
Hospital Revenue Code	636
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$21.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

PEDIAREX-DTAP-HEPB-IPV

Facility

$447.36

Service Code	HCPCS 90723
Hospital Charge Code	83652595
Hospital Revenue Code	636
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$108.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.26
Rate for Payer: Qualcare PPO/HMO/WC	$67.10

PEDIAREX-DTAP-HEPB-IPV

Facility

$447.36

Service Code	HCPCS 90723
Hospital Charge Code	83652595
Hospital Revenue Code	636
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$223.68
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: Aetna Medicare Advantage	$134.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.08
Rate for Payer: Cigna Commercial	$223.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.26
Rate for Payer: Qualcare PPO/HMO/WC	$67.10
Rate for Payer: UnitedHealthcare Community & State	$14.14
Rate for Payer: Wellpoint Medicaid Managed Care	$12.71

PEDIARIX PFS

Facility

$563.60

Service Code	NDC 58160081152
Hospital Charge Code	606350929
Hospital Revenue Code	250
Min. Negotiated Rate	$84.54
Max. Negotiated Rate	$84.54
Rate for Payer: Qualcare PPO/HMO/WC	$84.54

PEDIARIX PFS

Facility

$563.60

Service Code	NDC 58160081152
Hospital Charge Code	606350929
Hospital Revenue Code	250
Min. Negotiated Rate	$16.01
Max. Negotiated Rate	$281.80
Rate for Payer: Aetna Commercial	$214.17
Rate for Payer: Aetna Medicare Advantage	$169.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$143.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$143.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$143.72
Rate for Payer: Cigna Commercial	$281.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$146.54
Rate for Payer: Oxford Commercial	$112.72
Rate for Payer: Qualcare PPO/HMO/WC	$84.54
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Community & State	$17.81
Rate for Payer: Wellpoint Medicaid Managed Care	$16.01

PEDIATRIC NPSG < 6 Y/O

Facility

$5,700.00

Service Code	HCPCS 95782
Hospital Charge Code	90000002
Hospital Revenue Code	922
Min. Negotiated Rate	$161.88
Max. Negotiated Rate	$3,700.81
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$674.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,700.81
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.00
Rate for Payer: Oxford Commercial	$2,277.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$2,585.00
Rate for Payer: UnitedHealthcare Community & State	$180.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$161.88

PEDIATRIC NPSG < 6 Y/O

Facility

$5,700.00

Service Code	HCPCS 95782
Hospital Charge Code	90000002
Hospital Revenue Code	922
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

PEDIATRIC RESUSCITATION MED/IN

Facility

$1,050.00

Hospital Charge Code	270665159
Hospital Revenue Code	270
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.00
Rate for Payer: Oxford Commercial	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$210.00
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

PEDIATRIC RESUSCITATION MED/IN

Facility

$1,050.00

Hospital Charge Code	270665159
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

PEDICLE FLAP,TRUNK

Facility

$16,902.88

Service Code	HCPCS 15570
Hospital Charge Code	16000598
Hospital Revenue Code	360
Min. Negotiated Rate	$2,535.43
Max. Negotiated Rate	$2,535.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.43

PEDICLE FLAP,TRUNK

Facility

$16,902.88

Service Code	HCPCS 15570
Hospital Charge Code	1600059816
Hospital Revenue Code	360
Min. Negotiated Rate	$2,535.43
Max. Negotiated Rate	$2,535.43
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.43

PEDICLE FLAP,TRUNK

Facility

$16,902.88

Service Code	HCPCS 15570
Hospital Charge Code	1600059816
Hospital Revenue Code	360
Min. Negotiated Rate	$480.04
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,394.75
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.43
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$534.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$480.04

PEDICLE FLAP,TRUNK

Facility

$16,902.88

Service Code	HCPCS 15570
Hospital Charge Code	16000598
Hospital Revenue Code	360
Min. Negotiated Rate	$480.04
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,394.75
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,535.43
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$534.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$480.04

PEDICLE SPINAL SCREWS

Facility

$3,465.00

Hospital Charge Code	270335300
Hospital Revenue Code	278
Min. Negotiated Rate	$519.75
Max. Negotiated Rate	$838.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$693.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$838.53
Rate for Payer: Qualcare PPO/HMO/WC	$519.75

PEDICLE SPINAL SCREWS

Facility

$3,465.00

Hospital Charge Code	270335300
Hospital Revenue Code	278
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$1,732.50
Rate for Payer: Aetna Commercial	$1,316.70
Rate for Payer: Aetna Medicare Advantage	$1,039.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$883.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$883.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$693.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$883.58
Rate for Payer: Cigna Commercial	$1,732.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$838.53
Rate for Payer: Qualcare PPO/HMO/WC	$519.75
Rate for Payer: UnitedHealthcare Community & State	$109.49
Rate for Payer: Wellpoint Medicaid Managed Care	$98.41

PED NB CARE

Facility

$150.00

Service Code	HCPCS 99431
Hospital Charge Code	87502375
Hospital Revenue Code	510
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

PED NB CARE

Facility

$150.00

Service Code	HCPCS 99431
Hospital Charge Code	87502375
Hospital Revenue Code	510
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

PED PREV E&M NP 12-17 YRS OLD

Facility

$175.00

Service Code	HCPCS 99384
Hospital Charge Code	87502805
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PED PREV E&M NP 12-17 YRS OLD

Facility

$175.00

Service Code	HCPCS 99384
Hospital Charge Code	87502805
Hospital Revenue Code	515
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

PED PREV E&M NP 12-17 YRS. OLD

Facility

$71.00

Service Code	HCPCS 99384
Hospital Charge Code	83652475
Hospital Revenue Code	515
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$10.65
Rate for Payer: Qualcare PPO/HMO/WC	$10.65

PED PREV E&M NP 12-17 YRS. OLD

Facility

$71.00

Service Code	HCPCS 99384
Hospital Charge Code	83652475
Hospital Revenue Code	515
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$35.50
Rate for Payer: Aetna Commercial	$26.98
Rate for Payer: Aetna Medicare Advantage	$21.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.11
Rate for Payer: Cigna Commercial	$35.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.65
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

Know your out-of-pocket cost for care.

All Charges