Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TCU TRACTION - MECHANICAL

Facility

$148.00

Service Code	HCPCS 97012GP
Hospital Charge Code	1008130
Hospital Revenue Code	420
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

TCU TRANSFER ACTIVITIES 15 MIN

Facility

$97.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008295
Hospital Revenue Code	430
Min. Negotiated Rate	$14.55
Max. Negotiated Rate	$14.55
Rate for Payer: Qualcare PPO/HMO/WC	$14.55

TCU TRANSFER ACTIVITIES 15 MIN

Facility

$97.00

Service Code	HCPCS 97530GO
Hospital Charge Code	1008295
Hospital Revenue Code	430
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$36.86
Rate for Payer: Aetna Medicare Advantage	$29.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.73
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	$24.73
Rate for Payer: Cigna Commercial	$48.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.22
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.55
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.75

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GP
Hospital Charge Code	1008195
Hospital Revenue Code	420
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	1008190
Hospital Revenue Code	430
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GP
Hospital Charge Code	1008195
Hospital Revenue Code	420
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.64
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.92
Rate for Payer: Wellpoint Medicaid Managed Care	$8.92

TCU ULTRASOUND EA 15 MINUTES

Facility

$314.00

Service Code	HCPCS 97035GO
Hospital Charge Code	1008190
Hospital Revenue Code	430
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.64
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.92
Rate for Payer: Wellpoint Medicaid Managed Care	$8.92

TCU UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	1008080
Hospital Revenue Code	420
Min. Negotiated Rate	$13.52
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$135.13
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.76
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.40
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$15.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.52

TCU UNNA BOOT APPLICATION

Facility

$476.00

Service Code	HCPCS 29580
Hospital Charge Code	1008080
Hospital Revenue Code	420
Min. Negotiated Rate	$71.40
Max. Negotiated Rate	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$71.40

TCU WHIRLPOOL

Facility

$185.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008155
Hospital Revenue Code	420
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

TCU WHIRLPOOL

Facility

$78.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008160
Hospital Revenue Code	420
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Qualcare PPO/HMO/WC	$11.70

TCU WHIRLPOOL

Facility

$78.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008160
Hospital Revenue Code	420
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.64
Rate for Payer: Aetna Medicare Advantage	$23.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.89
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	$19.89
Rate for Payer: Cigna Commercial	$39.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.28
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.70
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.46
Rate for Payer: Wellpoint Medicaid Managed Care	$2.22

TCU WHIRLPOOL

Facility

$185.00

Service Code	HCPCS 97022GP
Hospital Charge Code	1008155
Hospital Revenue Code	420
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
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	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.10
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

TDAP (ADACEL) 0.5 ML VACCINE

Facility

$327.90

Service Code	HCPCS 90715
Hospital Charge Code	606350960
Hospital Revenue Code	636
Min. Negotiated Rate	$49.19
Max. Negotiated Rate	$79.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.19

TDAP (ADACEL) 0.5 ML VACCINE

Facility

$327.90

Service Code	HCPCS 90715
Hospital Charge Code	606350960
Hospital Revenue Code	636
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$163.95
Rate for Payer: Aetna Commercial	$124.60
Rate for Payer: Aetna Medicare Advantage	$98.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.61
Rate for Payer: Cigna Commercial	$163.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.19
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: Wellpoint Medicaid Managed Care	$9.31

TDAP (ADACEL) VACC EX

Facility

$327.09

Service Code	NDC 49281040020
Hospital Charge Code	606350960E
Hospital Revenue Code	259
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$163.54
Rate for Payer: Aetna Commercial	$124.29
Rate for Payer: Aetna Medicare Advantage	$98.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.41
Rate for Payer: Cigna Commercial	$163.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.04
Rate for Payer: Oxford Commercial	$65.42
Rate for Payer: Qualcare PPO/HMO/WC	$49.06
Rate for Payer: UnitedHealthcare Commercial	$65.42
Rate for Payer: UnitedHealthcare Community & State	$10.34
Rate for Payer: Wellpoint Medicaid Managed Care	$9.29

TDAP (ADACEL) VACC EX

Facility

$327.09

Service Code	NDC 49281040020
Hospital Charge Code	606350960E
Hospital Revenue Code	259
Min. Negotiated Rate	$49.06
Max. Negotiated Rate	$49.06
Rate for Payer: Qualcare PPO/HMO/WC	$49.06

TEAR DRO GUIDE WIRE

Facility

$845.00

Service Code	HCPCS C1769
Hospital Charge Code	270657835
Hospital Revenue Code	278
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$321.10
Rate for Payer: Aetna Medicare Advantage	$253.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.47
Rate for Payer: Cigna Commercial	$422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75
Rate for Payer: UnitedHealthcare Community & State	$26.70
Rate for Payer: Wellpoint Medicaid Managed Care	$24.00

TEAR DRO GUIDE WIRE

Facility

$845.00

Service Code	HCPCS C1769
Hospital Charge Code	270657835
Hospital Revenue Code	278
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$204.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.49
Rate for Payer: Qualcare PPO/HMO/WC	$126.75

TEARS NATURAL EYE FORTE

Facility

$62.02

Hospital Charge Code	606380013
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$31.01
Rate for Payer: Aetna Commercial	$23.57
Rate for Payer: Aetna Medicare Advantage	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.82
Rate for Payer: Cigna Commercial	$31.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.13
Rate for Payer: Oxford Commercial	$12.40
Rate for Payer: Qualcare PPO/HMO/WC	$9.30
Rate for Payer: UnitedHealthcare Commercial	$12.40
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

TEARS NATURAL EYE FORTE

Facility

$62.02

Hospital Charge Code	606380013
Hospital Revenue Code	250
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

TEARS NATURAL EYE FORTE

Facility

$57.89

Service Code	NDC 65042623
Hospital Charge Code	606351021
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$22.00
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.05
Rate for Payer: Oxford Commercial	$11.58
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$11.58
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

TEARS NATURAL EYE FORTE

Facility

$57.89

Service Code	NDC 65042623
Hospital Charge Code	606351021
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

TEFLON BLOCK

Facility

$149.00

Hospital Charge Code	270335240
Hospital Revenue Code	272
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$74.50
Rate for Payer: Aetna Commercial	$56.62
Rate for Payer: Aetna Medicare Advantage	$44.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.99
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.74
Rate for Payer: Oxford Commercial	$29.80
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$29.80
Rate for Payer: UnitedHealthcare Community & State	$4.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

TEFLON BLOCK

Facility

$149.00

Hospital Charge Code	270335240
Hospital Revenue Code	272
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

Know your out-of-pocket cost for care.

All Charges