Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PEDS PED DTAP < 7 YEARS OLD

Facility

$105.00

Service Code	HCPCS 90700
Hospital Charge Code	73050801
Hospital Revenue Code	636
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Community & State	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

PEDS PREV E&M NP 1-4 YRS OLD

Facility

$59.00

Service Code	HCPCS 99382
Hospital Charge Code	73050820
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV E&M NP 1-4 YRS OLD

Facility

$59.00

Service Code	HCPCS 99382
Hospital Charge Code	73050820
Hospital Revenue Code	515
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

PEDS PREV. E&M NP < 1 YEAR OLD

Facility

$59.00

Service Code	HCPCS 99381
Hospital Charge Code	73050815
Hospital Revenue Code	515
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

PEDS PREV. E&M NP < 1 YEAR OLD

Facility

$59.00

Service Code	HCPCS 99381
Hospital Charge Code	73050815
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV E&M NP 5-11 YRS OLD

Facility

$59.00

Service Code	HCPCS 99383
Hospital Charge Code	73050825
Hospital Revenue Code	515
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

PEDS PREV E&M NP 5-11 YRS OLD

Facility

$59.00

Service Code	HCPCS 99383
Hospital Charge Code	73050825
Hospital Revenue Code	515
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

PEDS PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	73050850
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

PEDS PREV EST PT 12 TO 17 YRS

Facility

$175.00

Service Code	HCPCS 99394
Hospital Charge Code	73050850
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	73050840
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

PEDS PREV EST PT 1 TO 4 YRS

Facility

$175.00

Service Code	HCPCS 99392
Hospital Charge Code	73050840
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	73050835
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS PREV EST PT<1 YEAR OLD

Facility

$175.00

Service Code	HCPCS 99391
Hospital Charge Code	73050835
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

PEDS PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	73050845
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

PEDS PREV EST PT 5 TO 11 YRS

Facility

$175.00

Service Code	HCPCS 99393
Hospital Charge Code	73050845
Hospital Revenue Code	515
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83090005
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83092015
Hospital Revenue Code	771
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83080030
Hospital Revenue Code	771
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83090005
Hospital Revenue Code	771
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$15.58
Rate for Payer: Aetna Medicare Advantage	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.46
Rate for Payer: Cigna Commercial	$20.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.66
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.15
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83080030
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PEDS VACCINE ADMINISTRATION

Facility

$41.00

Service Code	HCPCS 90460
Hospital Charge Code	83092015
Hospital Revenue Code	771
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$6.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.15

PED THREADED LOCKING 2.3x26MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664406
Hospital Revenue Code	278
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$125.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00

PED THREADED LOCKING 2.3x26MM

Facility

$520.00

Service Code	HCPCS C1713
Hospital Charge Code	270664406
Hospital Revenue Code	278
Min. Negotiated Rate	$14.77
Max. Negotiated Rate	$260.00
Rate for Payer: Aetna Commercial	$197.60
Rate for Payer: Aetna Medicare Advantage	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$104.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.60
Rate for Payer: Cigna Commercial	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$78.00
Rate for Payer: UnitedHealthcare Community & State	$16.43
Rate for Payer: Wellpoint Medicaid Managed Care	$14.77

PEDVAXHIB VACCINE

Facility

$705.91

Service Code	NDC 6489700
Hospital Charge Code	606350930
Hospital Revenue Code	250
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$352.95
Rate for Payer: Aetna Commercial	$268.25
Rate for Payer: Aetna Medicare Advantage	$211.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.01
Rate for Payer: Cigna Commercial	$352.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.54
Rate for Payer: Oxford Commercial	$141.18
Rate for Payer: Qualcare PPO/HMO/WC	$105.89
Rate for Payer: UnitedHealthcare Commercial	$141.18
Rate for Payer: UnitedHealthcare Community & State	$22.31
Rate for Payer: Wellpoint Medicaid Managed Care	$20.05

PEDVAXHIB VACCINE

Facility

$705.91

Service Code	NDC 6489700
Hospital Charge Code	606350930
Hospital Revenue Code	250
Min. Negotiated Rate	$105.89
Max. Negotiated Rate	$105.89
Rate for Payer: Qualcare PPO/HMO/WC	$105.89

Know your out-of-pocket cost for care.

All Charges