Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RW INFLUENZA VIRUS VACCINE IM

Facility

$88.00

Service Code	HCPCS 90656
Hospital Charge Code	84206190
Hospital Revenue Code	636
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$21.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.20

RW INFLUENZA VIRUS VACCINE IM

Facility

$88.00

Service Code	HCPCS 90656
Hospital Charge Code	84206190
Hospital Revenue Code	636
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$44.00
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare Advantage	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.44
Rate for Payer: Cigna Commercial	$44.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.20
Rate for Payer: UnitedHealthcare Community & State	$2.78
Rate for Payer: Wellpoint Medicaid Managed Care	$2.50

RW INJ;SNGL TENDON;LIGMT;APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	84206075
Hospital Revenue Code	761
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$1,322.84
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.42
Rate for Payer: Oxford Commercial	$63.40
Rate for Payer: Qualcare PPO/HMO/WC	$47.55
Rate for Payer: UnitedHealthcare Commercial	$63.40
Rate for Payer: UnitedHealthcare Community & State	$10.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$9.00

RW INJ;SNGL TENDON;LIGMT;APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	84206075
Hospital Revenue Code	761
Min. Negotiated Rate	$47.55
Max. Negotiated Rate	$47.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.55

RW INJ, SNGL TEN/LIG APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	87502160
Hospital Revenue Code	761
Min. Negotiated Rate	$47.55
Max. Negotiated Rate	$47.55
Rate for Payer: Qualcare PPO/HMO/WC	$47.55

RW INJ, SNGL TEN/LIG APONE

Facility

$317.00

Service Code	HCPCS 20550
Hospital Charge Code	87502160
Hospital Revenue Code	761
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$1,322.84
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.42
Rate for Payer: Oxford Commercial	$63.40
Rate for Payer: Qualcare PPO/HMO/WC	$47.55
Rate for Payer: UnitedHealthcare Commercial	$63.40
Rate for Payer: UnitedHealthcare Community & State	$10.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$9.00

RW IPRATROPIUM BROMIDE 0.02%

Facility

$2.00

Hospital Charge Code	83652631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

RW IPRATROPIUM BROMIDE 0.02%

Facility

$2.00

Hospital Charge Code	83652631
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

RW I&REM FB SUBC TISS, COMPLEX

Facility

$773.00

Service Code	HCPCS 10121
Hospital Charge Code	84206010
Hospital Revenue Code	761
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.98
Rate for Payer: Oxford Commercial	$154.60
Rate for Payer: Qualcare PPO/HMO/WC	$115.95
Rate for Payer: UnitedHealthcare Commercial	$154.60
Rate for Payer: UnitedHealthcare Community & State	$24.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$4,474.27
Rate for Payer: Wellpoint Medicaid Managed Care	$21.95

RW I&REM FB SUBC TISS, COMPLEX

Facility

$773.00

Service Code	HCPCS 10121
Hospital Charge Code	84206010
Hospital Revenue Code	761
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$115.95
Rate for Payer: Qualcare PPO/HMO/WC	$115.95

RW I&REM FB SUBC TISS SIMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	83652005
Hospital Revenue Code	761
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$115.95
Rate for Payer: Qualcare PPO/HMO/WC	$115.95

RW I&REM FB SUBC TISS SIMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	83652005
Hospital Revenue Code	761
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.98
Rate for Payer: Oxford Commercial	$154.60
Rate for Payer: Qualcare PPO/HMO/WC	$115.95
Rate for Payer: UnitedHealthcare Commercial	$154.60
Rate for Payer: UnitedHealthcare Community & State	$24.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$21.95

RW I&REM FB SUB SUC TS SMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	87502105
Hospital Revenue Code	761
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$115.95
Rate for Payer: Qualcare PPO/HMO/WC	$115.95

RW I&REM FB SUB SUC TS SMPLE

Facility

$773.00

Service Code	HCPCS 10120
Hospital Charge Code	87502105
Hospital Revenue Code	761
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$200.98
Rate for Payer: Oxford Commercial	$154.60
Rate for Payer: Qualcare PPO/HMO/WC	$115.95
Rate for Payer: UnitedHealthcare Commercial	$154.60
Rate for Payer: UnitedHealthcare Community & State	$24.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$21.95

RW I&REM SUB TS COMPLEX

Facility

$1,490.00

Service Code	HCPCS 10120
Hospital Charge Code	87502110
Hospital Revenue Code	761
Min. Negotiated Rate	$42.32
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.40
Rate for Payer: Oxford Commercial	$298.00
Rate for Payer: Qualcare PPO/HMO/WC	$223.50
Rate for Payer: UnitedHealthcare Commercial	$298.00
Rate for Payer: UnitedHealthcare Community & State	$47.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,058.74
Rate for Payer: Wellpoint Medicaid Managed Care	$42.32

RW I&REM SUB TS COMPLEX

Facility

$1,490.00

Service Code	HCPCS 10120
Hospital Charge Code	87502110
Hospital Revenue Code	761
Min. Negotiated Rate	$223.50
Max. Negotiated Rate	$223.50
Rate for Payer: Qualcare PPO/HMO/WC	$223.50

RW MENACTRA

Facility

$463.50

Service Code	HCPCS 90734
Hospital Charge Code	87502858
Hospital Revenue Code	636
Min. Negotiated Rate	$69.53
Max. Negotiated Rate	$112.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.53

RW MENACTRA

Facility

$463.50

Service Code	HCPCS 90734
Hospital Charge Code	87502858
Hospital Revenue Code	636
Min. Negotiated Rate	$13.16
Max. Negotiated Rate	$231.75
Rate for Payer: Aetna Commercial	$176.13
Rate for Payer: Aetna Medicare Advantage	$139.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.19
Rate for Payer: Cigna Commercial	$231.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.17
Rate for Payer: Qualcare PPO/HMO/WC	$69.53
Rate for Payer: UnitedHealthcare Community & State	$14.65
Rate for Payer: Wellpoint Medicaid Managed Care	$13.16

RW MENACTRA(MENINGOCOCCAL)VIAL

Facility

$5.00

Service Code	HCPCS 90734
Hospital Charge Code	84206370
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

RW MENACTRA(MENINGOCOCCAL)VIAL

Facility

$5.00

Service Code	HCPCS 90734
Hospital Charge Code	84206370
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

RW M-M-R II SDV

Facility

$139.00

Service Code	HCPCS 90710
Hospital Charge Code	84206375
Hospital Revenue Code	636
Min. Negotiated Rate	$20.85
Max. Negotiated Rate	$33.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.64
Rate for Payer: Qualcare PPO/HMO/WC	$20.85

RW M-M-R II SDV

Facility

$139.00

Service Code	HCPCS 90710
Hospital Charge Code	84206375
Hospital Revenue Code	636
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$69.50
Rate for Payer: Aetna Commercial	$52.82
Rate for Payer: Aetna Medicare Advantage	$41.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.45
Rate for Payer: Cigna Commercial	$69.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.64
Rate for Payer: Qualcare PPO/HMO/WC	$20.85
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

RW NAIL AVULSION-PART/COMP SIN

Facility

$535.00

Service Code	HCPCS 11730
Hospital Charge Code	87502130
Hospital Revenue Code	761
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

RW NAIL AVULSION-PART/COMP SIN

Facility

$535.00

Service Code	HCPCS 11730
Hospital Charge Code	87502130
Hospital Revenue Code	761
Min. Negotiated Rate	$15.19
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.10
Rate for Payer: Oxford Commercial	$107.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.25
Rate for Payer: UnitedHealthcare Commercial	$107.00
Rate for Payer: UnitedHealthcare Community & State	$16.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.19

RW NAIL AVULSION,PART/COMP SNG

Facility

$535.00

Service Code	HCPCS 11730
Hospital Charge Code	84206055
Hospital Revenue Code	761
Min. Negotiated Rate	$80.25
Max. Negotiated Rate	$80.25
Rate for Payer: Qualcare PPO/HMO/WC	$80.25

Know your out-of-pocket cost for care.

All Charges