Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PFIZBIONTCOVID19VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0002A
Hospital Charge Code	39500002A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

PFIZBIONTCOVID19VACC ADM DOSE2

Facility

$50.00

Service Code	HCPCS 0002A
Hospital Charge Code	39500002A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZBIONTCOVID19VAXADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0004A
Hospital Charge Code	39500004A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZBIONTCOVID19VAXADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0004A
Hospital Charge Code	39500004A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

PFIZBIONT PEDI COVID19 10MCG

Facility

$0.01

Service Code	HCPCS 91307
Hospital Charge Code	606390468
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PFIZBIONT PEDI COVID19 10MCG

Facility

$0.01

Service Code	HCPCS 91307
Hospital Charge Code	606390468
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PFIZCOV19BIVALADDLDOSEADM12YO

Facility

$50.00

Service Code	HCPCS 0121A
Hospital Charge Code	39500124A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZCOV19BIVALADDLDOSEADM12YO

Facility

$50.00

Service Code	HCPCS 0121A
Hospital Charge Code	39500124A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

PFIZCOV19BIVALADLDOSEADM5TO11Y

Facility

$50.00

Service Code	HCPCS 0151A
Hospital Charge Code	39500154A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZCOV19BIVALADLDOSEADM5TO11Y

Facility

$50.00

Service Code	HCPCS 0151A
Hospital Charge Code	39500154A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

PFIZER COV19 PEDS ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0074A
Hospital Charge Code	39500074A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZER COV19 PEDS ADM BOOSTER

Facility

$50.00

Service Code	HCPCS 0074A
Hospital Charge Code	39500074A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

PF REMOV SKIN TAG & ADDTN'L 10

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	83652033
Hospital Revenue Code	761
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$141.36
Rate for Payer: Aetna Medicare Advantage	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.86
Rate for Payer: Cigna Commercial	$186.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.72
Rate for Payer: Oxford Commercial	$74.40
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$74.40
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.56

PF REMOV SKIN TAG & ADDTN'L 10

Facility

$372.00

Service Code	HCPCS 11201
Hospital Charge Code	83652033
Hospital Revenue Code	761
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

PGR PARAFFIN BLOCK 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061080
Hospital Revenue Code	310
Min. Negotiated Rate	$30.74
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.34
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$86.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$30.74

PGR PARAFFIN BLOCK 1ST

Facility

$1,082.30

Service Code	HCPCS 88342
Hospital Charge Code	397061080
Hospital Revenue Code	310
Min. Negotiated Rate	$162.34
Max. Negotiated Rate	$162.34
Rate for Payer: Qualcare PPO/HMO/WC	$162.34

PHACO EMULSIFIER PACK

Facility

$1,097.00

Hospital Charge Code	270331500
Hospital Revenue Code	272
Min. Negotiated Rate	$31.15
Max. Negotiated Rate	$548.50
Rate for Payer: Aetna Commercial	$416.86
Rate for Payer: Aetna Medicare Advantage	$329.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.74
Rate for Payer: Cigna Commercial	$548.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.22
Rate for Payer: Oxford Commercial	$219.40
Rate for Payer: Qualcare PPO/HMO/WC	$164.55
Rate for Payer: UnitedHealthcare Commercial	$219.40
Rate for Payer: UnitedHealthcare Community & State	$34.67
Rate for Payer: Wellpoint Medicaid Managed Care	$31.15

PHACO EMULSIFIER PACK

Facility

$1,097.00

Hospital Charge Code	270331500
Hospital Revenue Code	272
Min. Negotiated Rate	$164.55
Max. Negotiated Rate	$164.55
Rate for Payer: Qualcare PPO/HMO/WC	$164.55

PHACO TIP 45 DEG.DISPOS.

Facility

$212.00

Hospital Charge Code	270332539
Hospital Revenue Code	272
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

PHACO TIP 45 DEG.DISPOS.

Facility

$212.00

Hospital Charge Code	270332539
Hospital Revenue Code	272
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$42.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$42.40
Rate for Payer: UnitedHealthcare Community & State	$6.70
Rate for Payer: Wellpoint Medicaid Managed Care	$6.02

PHACO W/ 30 DEGREE TIP

Facility

$2,018.00

Hospital Charge Code	270335278
Hospital Revenue Code	272
Min. Negotiated Rate	$57.31
Max. Negotiated Rate	$1,009.00
Rate for Payer: Aetna Commercial	$766.84
Rate for Payer: Aetna Medicare Advantage	$605.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$514.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$514.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$514.59
Rate for Payer: Cigna Commercial	$1,009.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$524.68
Rate for Payer: Oxford Commercial	$403.60
Rate for Payer: Qualcare PPO/HMO/WC	$302.70
Rate for Payer: UnitedHealthcare Commercial	$403.60
Rate for Payer: UnitedHealthcare Community & State	$63.77
Rate for Payer: Wellpoint Medicaid Managed Care	$57.31

PHACO W/ 30 DEGREE TIP

Facility

$2,018.00

Hospital Charge Code	270335278
Hospital Revenue Code	272
Min. Negotiated Rate	$302.70
Max. Negotiated Rate	$302.70
Rate for Payer: Qualcare PPO/HMO/WC	$302.70

PHACO W/O TIP DELUX

Facility

$1,364.00

Hospital Charge Code	270335272
Hospital Revenue Code	272
Min. Negotiated Rate	$204.60
Max. Negotiated Rate	$204.60
Rate for Payer: Qualcare PPO/HMO/WC	$204.60

PHACO W/O TIP DELUX

Facility

$1,364.00

Hospital Charge Code	270335272
Hospital Revenue Code	272
Min. Negotiated Rate	$38.74
Max. Negotiated Rate	$682.00
Rate for Payer: Aetna Commercial	$518.32
Rate for Payer: Aetna Medicare Advantage	$409.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.82
Rate for Payer: Cigna Commercial	$682.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.64
Rate for Payer: Oxford Commercial	$272.80
Rate for Payer: Qualcare PPO/HMO/WC	$204.60
Rate for Payer: UnitedHealthcare Commercial	$272.80
Rate for Payer: UnitedHealthcare Community & State	$43.10
Rate for Payer: Wellpoint Medicaid Managed Care	$38.74

PHAL REAMER 18MM

Facility

$75.00

Hospital Charge Code	270683489
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

Know your out-of-pocket cost for care.

All Charges