Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SUB PT/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8994GPCN
Hospital Charge Code	84202080CN
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/OT GOAL STATUS CN

Facility

$0.01

Service Code	HCPCS G8994GOCN
Hospital Charge Code	74203119CN
Hospital Revenue Code	430
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	87506001
Hospital Revenue Code	915
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.21
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$25.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84504070
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	84504070
Hospital Revenue Code	915
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.21
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$25.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

SUBSTANCE ABUSE TREATMENT

Facility

$800.80

Service Code	HCPCS 90853
Hospital Charge Code	87506001
Hospital Revenue Code	915
Min. Negotiated Rate	$120.12
Max. Negotiated Rate	$120.12
Rate for Payer: Qualcare PPO/HMO/WC	$120.12

SUBTALAR ARTHRODESIS W INPLANT

Facility

$12,986.00

Hospital Charge Code	270338797
Hospital Revenue Code	278
Min. Negotiated Rate	$368.80
Max. Negotiated Rate	$6,493.00
Rate for Payer: Aetna Commercial	$4,934.68
Rate for Payer: Aetna Medicare Advantage	$3,895.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,311.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,311.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,597.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,311.43
Rate for Payer: Cigna Commercial	$6,493.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,142.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,947.90
Rate for Payer: UnitedHealthcare Community & State	$410.36
Rate for Payer: Wellpoint Medicaid Managed Care	$368.80

SUBTALAR ARTHRODESIS W INPLANT

Facility

$12,986.00

Hospital Charge Code	270338797
Hospital Revenue Code	278
Min. Negotiated Rate	$1,947.90
Max. Negotiated Rate	$3,142.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,142.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,947.90

SUBTALAR ARTHRO W/DEB

Facility

$25,603.80

Service Code	HCPCS 29906
Hospital Charge Code	16000922
Hospital Revenue Code	360
Min. Negotiated Rate	$727.15
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
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	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,656.99
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$809.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$727.15

SUBTALAR ARTHRO W/DEB

Facility

$25,603.80

Service Code	HCPCS 29906
Hospital Charge Code	16000922
Hospital Revenue Code	360
Min. Negotiated Rate	$3,840.57
Max. Negotiated Rate	$3,840.57
Rate for Payer: Qualcare PPO/HMO/WC	$3,840.57

SUBTALAR IMPLANT STA-PEG MED

Facility

$7,290.00

Hospital Charge Code	270666785
Hospital Revenue Code	278
Min. Negotiated Rate	$207.04
Max. Negotiated Rate	$3,645.00
Rate for Payer: Aetna Commercial	$2,770.20
Rate for Payer: Aetna Medicare Advantage	$2,187.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,858.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,858.95
Rate for Payer: Cigna Commercial	$3,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50
Rate for Payer: UnitedHealthcare Community & State	$230.36
Rate for Payer: Wellpoint Medicaid Managed Care	$207.04

SUBTALAR IMPLANT STA-PEG MED

Facility

$7,290.00

Hospital Charge Code	270666785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

SUBTALAR MBA 10MM

Facility

$5,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270690965
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

SUBTALAR MBA 10MM

Facility

$5,000.00

Service Code	HCPCS L8699
Hospital Charge Code	270690965
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

SUBTALAR MBA 8MM IMPLANT

Facility

$12,495.00

Hospital Charge Code	270667235
Hospital Revenue Code	278
Min. Negotiated Rate	$1,874.25
Max. Negotiated Rate	$3,023.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,023.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,874.25

SUBTALAR MBA 8MM IMPLANT

Facility

$12,495.00

Hospital Charge Code	270667235
Hospital Revenue Code	278
Min. Negotiated Rate	$354.86
Max. Negotiated Rate	$6,247.50
Rate for Payer: Aetna Commercial	$4,748.10
Rate for Payer: Aetna Medicare Advantage	$3,748.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,186.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,186.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,186.22
Rate for Payer: Cigna Commercial	$6,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,023.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,874.25
Rate for Payer: UnitedHealthcare Community & State	$394.84
Rate for Payer: Wellpoint Medicaid Managed Care	$354.86

SUBTALAR PITSTOP 12.7X10MM

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692058
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

SUBTALAR PITSTOP 12.7X10MM

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270692058
Hospital Revenue Code	278
Min. Negotiated Rate	$496.29
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$6,640.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25
Rate for Payer: UnitedHealthcare Community & State	$552.21
Rate for Payer: Wellpoint Medicaid Managed Care	$496.29

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58150
Hospital Charge Code	1600000313
Hospital Revenue Code	360
Min. Negotiated Rate	$430.13
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,755.28
Rate for Payer: Aetna Medicare Advantage	$4,543.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,862.09
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	$3,862.09
Rate for Payer: Cigna Commercial	$7,572.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,937.82
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$478.60
Rate for Payer: Wellpoint Medicaid Managed Care	$430.13

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58180
Hospital Charge Code	1600000563
Hospital Revenue Code	360
Min. Negotiated Rate	$430.13
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,755.28
Rate for Payer: Aetna Medicare Advantage	$4,543.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,862.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,862.09
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	$3,862.09
Rate for Payer: Cigna Commercial	$7,572.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,937.82
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$478.60
Rate for Payer: Wellpoint Medicaid Managed Care	$430.13

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58180
Hospital Charge Code	1600000563
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.82
Max. Negotiated Rate	$2,271.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82

SUBTOTAL ABD HYSTERECTOMY

Facility

$15,145.47

Service Code	HCPCS 58150
Hospital Charge Code	1600000313
Hospital Revenue Code	360
Min. Negotiated Rate	$2,271.82
Max. Negotiated Rate	$2,271.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,271.82

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$154.23

Service Code	HCPCS J0330
Hospital Charge Code	6007538
Hospital Revenue Code	636
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$77.11
Rate for Payer: Aetna Commercial	$58.61
Rate for Payer: Aetna Medicare Advantage	$46.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.33
Rate for Payer: Cigna Commercial	$77.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.13
Rate for Payer: UnitedHealthcare Community & State	$4.87
Rate for Payer: Wellpoint Medicaid Managed Care	$4.38

SUCCINYLCHOLINE 20 MG/ML INJ

Facility

$154.23

Service Code	HCPCS J0330
Hospital Charge Code	6007538
Hospital Revenue Code	636
Min. Negotiated Rate	$23.13
Max. Negotiated Rate	$37.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.32
Rate for Payer: Qualcare PPO/HMO/WC	$23.13

SUCRALFATE 1 GRAM/10ML

Facility

$67.40

Service Code	NDC 121074710
Hospital Charge Code	60629338
Hospital Revenue Code	250
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$10.11
Rate for Payer: Qualcare PPO/HMO/WC	$10.11

Know your out-of-pocket cost for care.

All Charges