Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SUBC INF/IM THERAPY,INT UP 1HR

Facility

$762.00

Service Code	HCPCS 96369
Hospital Charge Code	3408020
Hospital Revenue Code	260
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.12
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$114.30
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$24.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.64

SUBDUAL EVACUATING PORT SYSTEM

Facility

$9,192.40

Hospital Charge Code	270671362
Hospital Revenue Code	272
Min. Negotiated Rate	$1,378.86
Max. Negotiated Rate	$1,378.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,378.86

SUBDUAL EVACUATING PORT SYSTEM

Facility

$9,192.40

Hospital Charge Code	270671362
Hospital Revenue Code	272
Min. Negotiated Rate	$261.06
Max. Negotiated Rate	$4,596.20
Rate for Payer: Aetna Commercial	$3,493.11
Rate for Payer: Aetna Medicare Advantage	$2,757.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,344.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,344.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,344.06
Rate for Payer: Cigna Commercial	$4,596.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,390.02
Rate for Payer: Oxford Commercial	$1,838.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,378.86
Rate for Payer: UnitedHealthcare Commercial	$1,838.48
Rate for Payer: UnitedHealthcare Community & State	$290.48
Rate for Payer: Wellpoint Medicaid Managed Care	$261.06

SUBFIX IMPLANT 8MM

Facility

$10,381.00

Service Code	HCPCS C1713
Hospital Charge Code	270675857
Hospital Revenue Code	278
Min. Negotiated Rate	$294.82
Max. Negotiated Rate	$5,190.50
Rate for Payer: Aetna Commercial	$3,944.78
Rate for Payer: Aetna Medicare Advantage	$3,114.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.16
Rate for Payer: Cigna Commercial	$5,190.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.15
Rate for Payer: UnitedHealthcare Community & State	$328.04
Rate for Payer: Wellpoint Medicaid Managed Care	$294.82

SUBFIX IMPLANT 8MM

Facility

$10,381.00

Service Code	HCPCS C1713
Hospital Charge Code	270675857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,557.15
Max. Negotiated Rate	$2,512.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.20
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.15

SUB OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	9109155
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	9109155
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB OT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GO
Hospital Charge Code	9109157
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB OT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GO
Hospital Charge Code	9109157
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB OT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GO
Hospital Charge Code	9109156
Hospital Revenue Code	430
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB OT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GO
Hospital Charge Code	9109156
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUBOXONE SL FILM 2/0.5MG

Facility

$38.39

Service Code	NDC 12496120203
Hospital Charge Code	606390280
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna Commercial	$14.59
Rate for Payer: Aetna Medicare Advantage	$11.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.79
Rate for Payer: Cigna Commercial	$19.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.98
Rate for Payer: Oxford Commercial	$7.68
Rate for Payer: Qualcare PPO/HMO/WC	$5.76
Rate for Payer: UnitedHealthcare Commercial	$7.68
Rate for Payer: UnitedHealthcare Community & State	$1.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.09

SUBOXONE SL FILM 2/0.5MG

Facility

$38.39

Service Code	NDC 12496120203
Hospital Charge Code	606390280
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$5.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.76

SUBOXONE SL FILM 4/1.0 5MG

Facility

$56.62

Service Code	NDC 12496120403
Hospital Charge Code	606390283
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$28.31
Rate for Payer: Aetna Commercial	$21.52
Rate for Payer: Aetna Medicare Advantage	$16.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.44
Rate for Payer: Cigna Commercial	$28.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.72
Rate for Payer: Oxford Commercial	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.49
Rate for Payer: UnitedHealthcare Commercial	$11.32
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

SUBOXONE SL FILM 4/1.0 5MG

Facility

$56.62

Service Code	NDC 12496120403
Hospital Charge Code	606390283
Hospital Revenue Code	250
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$8.49

SUB PT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	9109145
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	9109145
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB PT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GP
Hospital Charge Code	9109147
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB PT D/C STATUS

Facility

$0.01

Service Code	HCPCS G8995GP
Hospital Charge Code	9109147
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GP
Hospital Charge Code	9109146
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB PT GOAL STATUS

Facility

$0.01

Service Code	HCPCS G8994GP
Hospital Charge Code	9109146
Hospital Revenue Code	420
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	84201153
Hospital Revenue Code	439
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	84201153
Hospital Revenue Code	439
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GO
Hospital Charge Code	74203117
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUB PT/OT CURRENT STATUS

Facility

$0.01

Service Code	HCPCS G8993GP
Hospital Charge Code	84202075
Hospital Revenue Code	420
Max. Negotiated Rate	$1,060.00
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) NJ Health	$69.00
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: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

Know your out-of-pocket cost for care.

All Charges