Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BPERTAB III

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084C
Hospital Revenue Code	302
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$34.45
Rate for Payer: Aetna Medicare Advantage	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.12
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

BPERTAB IV

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084D
Hospital Revenue Code	302
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$13.60
Rate for Payer: Qualcare PPO/HMO/WC	$13.60

BPERTAB IV

Facility

$90.65

Service Code	HCPCS 8661591
Hospital Charge Code	39990084D
Hospital Revenue Code	302
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$34.45
Rate for Payer: Aetna Medicare Advantage	$27.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.12
Rate for Payer: Cigna Commercial	$45.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

B.PERTUSSIS AB(IGG,A)MAID I

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

B.PERTUSSIS AB(IGG,A)MAID I

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID II

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

B.PERTUSSIS AB(IGG,A)MAID II

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID III

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B.PERTUSSIS AB(IGG,A)MAID III

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

B.PERTUSSIS AB(IGG,A)MAID IV

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085D
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

B.PERTUSSIS AB(IGG,A)MAID IV

Facility

$390.00

Service Code	HCPCS 8661591
Hospital Charge Code	39990085D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

B PERTUSSIS IGG/M/A AB I

Facility

$390.00

Service Code	HCPCS 86615
Hospital Charge Code	3038075A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

B PERTUSSIS IGG/M/A AB I

Facility

$390.00

Service Code	HCPCS 86615
Hospital Charge Code	3038075A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$7,190.70

Service Code	HCPCS 81211
Hospital Charge Code	39990165A
Hospital Revenue Code	310
Min. Negotiated Rate	$1,078.61
Max. Negotiated Rate	$1,078.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.61

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39990165B
Hospital Revenue Code	310
Min. Negotiated Rate	$437.04
Max. Negotiated Rate	$437.04
Rate for Payer: Qualcare PPO/HMO/WC	$437.04

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$2,913.60

Service Code	HCPCS 81213
Hospital Charge Code	39990165B
Hospital Revenue Code	310
Min. Negotiated Rate	$82.75
Max. Negotiated Rate	$1,456.80
Rate for Payer: Aetna Commercial	$1,107.17
Rate for Payer: Aetna Medicare Advantage	$874.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$742.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$742.97
Rate for Payer: Cigna Commercial	$1,456.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$757.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$437.04
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$92.07
Rate for Payer: Wellpoint Medicaid Managed Care	$82.75

BRAC 1/2 ADVANTAGE COMPREHEN I

Facility

$7,190.70

Service Code	HCPCS 81211
Hospital Charge Code	39990165A
Hospital Revenue Code	310
Min. Negotiated Rate	$156.00
Max. Negotiated Rate	$3,595.35
Rate for Payer: Aetna Commercial	$2,732.47
Rate for Payer: Aetna Medicare Advantage	$2,157.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,833.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,833.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,833.63
Rate for Payer: Cigna Commercial	$3,595.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,869.58
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.61
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$227.23
Rate for Payer: Wellpoint Medicaid Managed Care	$204.22

BRACE ANKLE LEFT PEDIATRIC

Facility

$97.50

Hospital Charge Code	270667755
Hospital Revenue Code	270
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$48.75
Rate for Payer: Aetna Commercial	$37.05
Rate for Payer: Aetna Medicare Advantage	$29.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.86
Rate for Payer: Cigna Commercial	$48.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.35
Rate for Payer: Oxford Commercial	$19.50
Rate for Payer: Qualcare PPO/HMO/WC	$14.62
Rate for Payer: UnitedHealthcare Commercial	$19.50
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

BRACE ANKLE LEFT PEDIATRIC

Facility

$97.50

Hospital Charge Code	270667755
Hospital Revenue Code	270
Min. Negotiated Rate	$14.62
Max. Negotiated Rate	$14.62
Rate for Payer: Qualcare PPO/HMO/WC	$14.62

BRACE ANKLE LEFT SMALL

Facility

$119.50

Hospital Charge Code	270653991
Hospital Revenue Code	272
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$59.75
Rate for Payer: Aetna Commercial	$45.41
Rate for Payer: Aetna Medicare Advantage	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.47
Rate for Payer: Cigna Commercial	$59.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.07
Rate for Payer: Oxford Commercial	$23.90
Rate for Payer: Qualcare PPO/HMO/WC	$17.93
Rate for Payer: UnitedHealthcare Commercial	$23.90
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: Wellpoint Medicaid Managed Care	$3.39

BRACE ANKLE LEFT SMALL

Facility

$119.50

Hospital Charge Code	270653991
Hospital Revenue Code	272
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$17.93

BRACE ANKLE MED LEFT AIR STRIP

Facility

$107.20

Hospital Charge Code	270651661
Hospital Revenue Code	270
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$53.60
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$53.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.87
Rate for Payer: Oxford Commercial	$21.44
Rate for Payer: Qualcare PPO/HMO/WC	$16.08
Rate for Payer: UnitedHealthcare Commercial	$21.44
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

BRACE ANKLE MED LEFT AIR STRIP

Facility

$107.20

Hospital Charge Code	270651661
Hospital Revenue Code	270
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$16.08
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

BRACE ANKLE MED RIGHT AIR

Facility

$107.20

Hospital Charge Code	270653965
Hospital Revenue Code	272
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$16.08
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

BRACE ANKLE MED RIGHT AIR

Facility

$107.20

Hospital Charge Code	270653965
Hospital Revenue Code	272
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$53.60
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$53.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.87
Rate for Payer: Oxford Commercial	$21.44
Rate for Payer: Qualcare PPO/HMO/WC	$16.08
Rate for Payer: UnitedHealthcare Commercial	$21.44
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

Know your out-of-pocket cost for care.

All Charges