Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PM RPR RUPT ACHLS TNDN W GRFT

Facility

$65,621.54

Service Code	HCPCS 27652
Hospital Charge Code	16000379
Hospital Revenue Code	360
Min. Negotiated Rate	$9,843.23
Max. Negotiated Rate	$9,843.23
Rate for Payer: Qualcare PPO/HMO/WC	$9,843.23

PM RPR RUPT ACHLS TNDN W GRFT

Facility

$65,621.54

Service Code	HCPCS 27652
Hospital Charge Code	16000379
Hospital Revenue Code	360
Min. Negotiated Rate	$1,863.65
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,061.60
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,843.23
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$2,073.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,863.65

PM-UR OV EP EXPANDED PROB FOCU

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	75190220
Hospital Revenue Code	510
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$98.28
Rate for Payer: Qualcare PPO/HMO/WC	$98.28

PM-UR OV EP EXPANDED PROB FOCU

Facility

$655.20

Service Code	HCPCS 99213
Hospital Charge Code	75190220
Hospital Revenue Code	510
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$327.60
Rate for Payer: Aetna Commercial	$248.98
Rate for Payer: Aetna Medicare Advantage	$196.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$167.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$167.08
Rate for Payer: Cigna Commercial	$327.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.35
Rate for Payer: Qualcare PPO/HMO/WC	$98.28
Rate for Payer: UnitedHealthcare Community & State	$20.70
Rate for Payer: Wellpoint Medicaid Managed Care	$18.61

PM-UR OV NP EXPANDED FOCUSED

Facility

$260.00

Service Code	HCPCS 99201
Hospital Charge Code	75190170
Hospital Revenue Code	510
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

PM-UR OV NP EXPANDED FOCUSED

Facility

$260.00

Service Code	HCPCS 99201
Hospital Charge Code	75190170
Hospital Revenue Code	510
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

PNA FISH I

Facility

$234.17

Service Code	HCPCS 87149
Hospital Charge Code	39880001A
Hospital Revenue Code	309
Min. Negotiated Rate	$35.13
Max. Negotiated Rate	$35.13
Rate for Payer: Qualcare PPO/HMO/WC	$35.13

PNA FISH I

Facility

$234.17

Service Code	HCPCS 87149
Hospital Charge Code	39880001A
Hospital Revenue Code	309
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$54.54
Rate for Payer: Aetna Medicare Advantage	$64.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.73
Rate for Payer: Cigna Commercial	$117.08
Rate for Payer: Cigna Medicare Advantage	$20.05
Rate for Payer: Clover Medicare Advantage	$19.05
Rate for Payer: EmblemHealth Commercial	$60.15
Rate for Payer: Humana Medicare Advantage	$20.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.13
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.05
Rate for Payer: Wellcare Medicare Advantage	$20.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

PNA FISH II

Facility

$234.17

Service Code	HCPCS 8714959
Hospital Charge Code	39880001B
Hospital Revenue Code	309
Min. Negotiated Rate	$35.13
Max. Negotiated Rate	$35.13
Rate for Payer: Qualcare PPO/HMO/WC	$35.13

PNA FISH II

Facility

$234.17

Service Code	HCPCS 8714959
Hospital Charge Code	39880001B
Hospital Revenue Code	309
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$88.98
Rate for Payer: Aetna Medicare Advantage	$70.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.71
Rate for Payer: Cigna Commercial	$117.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.13
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.40
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

PNEUMGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83090015
Hospital Revenue Code	460
Min. Negotiated Rate	$184.95
Max. Negotiated Rate	$184.95
Rate for Payer: Qualcare PPO/HMO/WC	$184.95

PNEUMGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83090015
Hospital Revenue Code	460
Min. Negotiated Rate	$35.02
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,608.14
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.58
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$184.95
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$38.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$35.02

PNEUMOCOCCAL VACCINE INJ

Facility

$581.96

Service Code	HCPCS 90732
Hospital Charge Code	6009021P
Hospital Revenue Code	636
Min. Negotiated Rate	$87.29
Max. Negotiated Rate	$140.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.83
Rate for Payer: Qualcare PPO/HMO/WC	$87.29

PNEUMOCOCCAL VACCINE INJ

Facility

$581.96

Service Code	NDC 6494300
Hospital Charge Code	6009021
Hospital Revenue Code	259
Min. Negotiated Rate	$87.29
Max. Negotiated Rate	$87.29
Rate for Payer: Qualcare PPO/HMO/WC	$87.29

PNEUMOCOCCAL VACCINE INJ

Facility

$581.96

Service Code	HCPCS 90732
Hospital Charge Code	6009021P
Hospital Revenue Code	636
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$290.98
Rate for Payer: Aetna Commercial	$221.14
Rate for Payer: Aetna Medicare Advantage	$174.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.40
Rate for Payer: Cigna Commercial	$290.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.83
Rate for Payer: Qualcare PPO/HMO/WC	$87.29
Rate for Payer: UnitedHealthcare Community & State	$18.39
Rate for Payer: Wellpoint Medicaid Managed Care	$16.53

PNEUMOCOCCAL VACCINE INJ

Facility

$581.96

Service Code	NDC 6494300
Hospital Charge Code	6009021
Hospital Revenue Code	259
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$290.98
Rate for Payer: Aetna Commercial	$221.14
Rate for Payer: Aetna Medicare Advantage	$174.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$148.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$148.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$148.40
Rate for Payer: Cigna Commercial	$290.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.31
Rate for Payer: Oxford Commercial	$116.39
Rate for Payer: Qualcare PPO/HMO/WC	$87.29
Rate for Payer: UnitedHealthcare Commercial	$116.39
Rate for Payer: UnitedHealthcare Community & State	$18.39
Rate for Payer: Wellpoint Medicaid Managed Care	$16.53

PNEUMOCYSTIS JROVECII DFA A

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39708006A
Hospital Revenue Code	309
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
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	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PNEUMOCYSTIS JROVECII DFA A

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39708006A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PNEUMOCYSTIS JROVECII DFA B

Facility

$390.00

Service Code	HCPCS 87281
Hospital Charge Code	39708006B
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PNEUMOCYSTIS JROVECII DFA B

Facility

$390.00

Service Code	HCPCS 87281
Hospital Charge Code	39708006B
Hospital Revenue Code	309
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
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	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PNEUMOGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83080040
Hospital Revenue Code	460
Min. Negotiated Rate	$35.02
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,608.14
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.58
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$184.95
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$38.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$35.02

PNEUMOGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83080040
Hospital Revenue Code	460
Min. Negotiated Rate	$184.95
Max. Negotiated Rate	$184.95
Rate for Payer: Qualcare PPO/HMO/WC	$184.95

PNEUMOGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83092025
Hospital Revenue Code	460
Min. Negotiated Rate	$184.95
Max. Negotiated Rate	$184.95
Rate for Payer: Qualcare PPO/HMO/WC	$184.95

PNEUMOGRAM

Facility

$1,233.00

Service Code	HCPCS 94772
Hospital Charge Code	83092025
Hospital Revenue Code	460
Min. Negotiated Rate	$35.02
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,608.14
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.58
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$184.95
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$38.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$35.02

PNEUMONOCCOCAL VAC 0.5 ML VIAL

Facility

$541.90

Service Code	HCPCS 90732
Hospital Charge Code	83652335
Hospital Revenue Code	636
Min. Negotiated Rate	$81.28
Max. Negotiated Rate	$131.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$131.14
Rate for Payer: Qualcare PPO/HMO/WC	$81.28

Know your out-of-pocket cost for care.

All Charges