Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

POLIOVIRUS II

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.00
Rate for Payer: Aetna Medicare Advantage	$54.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.91
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	$61.34
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.91
Rate for Payer: Clover Medicare Advantage	$16.06
Rate for Payer: EmblemHealth Commercial	$50.73
Rate for Payer: Humana Medicare Advantage	$17.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.91
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	$13.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.91
Rate for Payer: Wellcare Medicare Advantage	$16.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

POLIOVIRUS III

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POLIOVIRUS III

Facility

$390.00

Service Code	HCPCS 86382
Hospital Charge Code	39990144C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.00
Rate for Payer: Aetna Medicare Advantage	$54.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.91
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	$61.34
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.91
Rate for Payer: Clover Medicare Advantage	$16.06
Rate for Payer: EmblemHealth Commercial	$50.73
Rate for Payer: Humana Medicare Advantage	$17.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.91
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	$13.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.91
Rate for Payer: Wellcare Medicare Advantage	$16.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

POLIOVIRUS SPV SC/IM

Facility

$169.68

Service Code	HCPCS 90713
Hospital Charge Code	412390713
Hospital Revenue Code	636
Min. Negotiated Rate	$25.45
Max. Negotiated Rate	$41.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.06
Rate for Payer: Qualcare PPO/HMO/WC	$25.45

POLIOVIRUS SPV SC/IM

Facility

$169.68

Service Code	HCPCS 90713
Hospital Charge Code	412390713
Hospital Revenue Code	636
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$84.84
Rate for Payer: Aetna Commercial	$64.48
Rate for Payer: Aetna Medicare Advantage	$50.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.27
Rate for Payer: Cigna Commercial	$84.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.06
Rate for Payer: Qualcare PPO/HMO/WC	$25.45
Rate for Payer: UnitedHealthcare Community & State	$5.36
Rate for Payer: Wellpoint Medicaid Managed Care	$4.82

POLISHER TIP

Facility

$130.25

Hospital Charge Code	270655639
Hospital Revenue Code	271
Min. Negotiated Rate	$3.70
Max. Negotiated Rate	$65.12
Rate for Payer: Aetna Commercial	$49.49
Rate for Payer: Aetna Medicare Advantage	$39.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.21
Rate for Payer: Cigna Commercial	$65.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.87
Rate for Payer: Oxford Commercial	$26.05
Rate for Payer: Qualcare PPO/HMO/WC	$19.54
Rate for Payer: UnitedHealthcare Commercial	$26.05
Rate for Payer: UnitedHealthcare Community & State	$4.12
Rate for Payer: Wellpoint Medicaid Managed Care	$3.70

POLISHER TIP

Facility

$130.25

Hospital Charge Code	270655639
Hospital Revenue Code	271
Min. Negotiated Rate	$19.54
Max. Negotiated Rate	$19.54
Rate for Payer: Qualcare PPO/HMO/WC	$19.54

POLLICIZATION OF A DIGIT

Facility

$12,172.00

Service Code	HCPCS 26550T9
Hospital Charge Code	5780070
Hospital Revenue Code	450
Min. Negotiated Rate	$1,825.80
Max. Negotiated Rate	$1,825.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,825.80

POLLICIZATION OF A DIGIT

Facility

$12,172.00

Service Code	HCPCS 26550T9
Hospital Charge Code	5780070
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$6,086.00
Rate for Payer: Aetna Commercial	$4,625.36
Rate for Payer: Aetna Medicare Advantage	$3,651.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,103.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,103.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,103.86
Rate for Payer: Cigna Commercial	$6,086.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,164.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,825.80
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$345.68

POLOCAINE 1% 30MG 10MG/ML

Facility

$54.67

Service Code	NDC 63323026037
Hospital Charge Code	60635357
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$27.34
Rate for Payer: Aetna Commercial	$20.77
Rate for Payer: Aetna Medicare Advantage	$16.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.94
Rate for Payer: Cigna Commercial	$27.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.21
Rate for Payer: Oxford Commercial	$10.93
Rate for Payer: Qualcare PPO/HMO/WC	$8.20
Rate for Payer: UnitedHealthcare Commercial	$10.93
Rate for Payer: UnitedHealthcare Community & State	$1.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

POLOCAINE 1% 30MG 10MG/ML

Facility

$54.67

Service Code	NDC 63323026037
Hospital Charge Code	60635357
Hospital Revenue Code	250
Min. Negotiated Rate	$8.20
Max. Negotiated Rate	$8.20
Rate for Payer: Qualcare PPO/HMO/WC	$8.20

POLY 12 X 71/75

Facility

$12,565.00

Hospital Charge Code	270662791
Hospital Revenue Code	270
Min. Negotiated Rate	$1,884.75
Max. Negotiated Rate	$1,884.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75

POLY 12 X 71/75

Facility

$12,565.00

Hospital Charge Code	270662791
Hospital Revenue Code	270
Min. Negotiated Rate	$356.85
Max. Negotiated Rate	$6,282.50
Rate for Payer: Aetna Commercial	$4,774.70
Rate for Payer: Aetna Medicare Advantage	$3,769.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,204.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,204.07
Rate for Payer: Cigna Commercial	$6,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,266.90
Rate for Payer: Oxford Commercial	$2,513.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,884.75
Rate for Payer: UnitedHealthcare Commercial	$2,513.00
Rate for Payer: UnitedHealthcare Community & State	$397.05
Rate for Payer: Wellpoint Medicaid Managed Care	$356.85

POLY 14X 71/75 IMPLANT

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270661754
Hospital Revenue Code	278
Min. Negotiated Rate	$145.83
Max. Negotiated Rate	$2,567.50
Rate for Payer: Aetna Commercial	$1,951.30
Rate for Payer: Aetna Medicare Advantage	$1,540.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,309.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,309.42
Rate for Payer: Cigna Commercial	$2,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25
Rate for Payer: UnitedHealthcare Community & State	$162.27
Rate for Payer: Wellpoint Medicaid Managed Care	$145.83

POLY 14X 71/75 IMPLANT

Facility

$5,135.00

Service Code	HCPCS C1776
Hospital Charge Code	270661754
Hospital Revenue Code	278
Min. Negotiated Rate	$770.25
Max. Negotiated Rate	$1,242.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,027.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,242.67
Rate for Payer: Qualcare PPO/HMO/WC	$770.25

POLY ALL VE 38 MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270691071
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

POLY ALL VE 38 MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270691071
Hospital Revenue Code	278
Min. Negotiated Rate	$145.69
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$162.11
Rate for Payer: Wellpoint Medicaid Managed Care	$145.69

POLYAXIAL SCREW 6.5X45MM

Facility

$6,250.00

Hospital Charge Code	270702845
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

POLYAXIAL SCREW 6.5X45MM

Facility

$6,250.00

Hospital Charge Code	270702845
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

POLYAXIAL SCREW 7.5X40MM

Facility

$6,250.00

Hospital Charge Code	270702846
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

POLYAXIAL SCREW 7.5X40MM

Facility

$6,250.00

Hospital Charge Code	270702846
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

POLYAXIAL TULIP

Facility

$2,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270704709
Hospital Revenue Code	278
Min. Negotiated Rate	$321.00
Max. Negotiated Rate	$517.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: Qualcare PPO/HMO/WC	$321.00

POLYAXIAL TULIP

Facility

$2,140.00

Service Code	HCPCS C1713
Hospital Charge Code	270704709
Hospital Revenue Code	278
Min. Negotiated Rate	$60.78
Max. Negotiated Rate	$1,070.00
Rate for Payer: Aetna Commercial	$813.20
Rate for Payer: Aetna Medicare Advantage	$642.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$545.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$428.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$545.70
Rate for Payer: Cigna Commercial	$1,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.88
Rate for Payer: Qualcare PPO/HMO/WC	$321.00
Rate for Payer: UnitedHealthcare Community & State	$67.62
Rate for Payer: Wellpoint Medicaid Managed Care	$60.78

POLYETHYLENE GLYCOL 3350 UD

Facility

$20.17

Service Code	NDC 574041207
Hospital Charge Code	60629844
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$3.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.03

POLYETHYLENE GLYCOL 3350 UD

Facility

$20.17

Service Code	NDC 574041207
Hospital Charge Code	60629844
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$10.09
Rate for Payer: Aetna Commercial	$7.66
Rate for Payer: Aetna Medicare Advantage	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.14
Rate for Payer: Cigna Commercial	$10.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.24
Rate for Payer: Oxford Commercial	$4.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.03
Rate for Payer: UnitedHealthcare Commercial	$4.03
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

Know your out-of-pocket cost for care.

All Charges