Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PENICILLIN G BENZATHINE 1.2MU

Facility

$700.82

Service Code	HCPCS J0561
Hospital Charge Code	6008973
Hospital Revenue Code	636
Min. Negotiated Rate	$19.90
Max. Negotiated Rate	$169.60
Rate for Payer: Aetna Commercial	$85.60
Rate for Payer: Aetna Medicare Advantage	$101.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.16
Rate for Payer: Cigna Medicare Advantage	$31.47
Rate for Payer: Clover Medicare Advantage	$29.90
Rate for Payer: EmblemHealth Commercial	$94.41
Rate for Payer: Humana Medicare Advantage	$32.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.60
Rate for Payer: Qualcare PPO/HMO/WC	$105.12
Rate for Payer: UnitedHealthcare Community & State	$22.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.47
Rate for Payer: Wellcare Medicare Advantage	$31.47
Rate for Payer: Wellpoint Medicaid Managed Care	$19.90

PENICILLIN G BENZATH PRO 2.4MU

Facility

$1,436.01

Service Code	HCPCS J0561
Hospital Charge Code	6006910
Hospital Revenue Code	636
Min. Negotiated Rate	$215.40
Max. Negotiated Rate	$347.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.51
Rate for Payer: Qualcare PPO/HMO/WC	$215.40

PENICILLIN G BENZATH PRO 2.4MU

Facility

$1,436.01

Service Code	HCPCS J0561
Hospital Charge Code	6006910
Hospital Revenue Code	636
Min. Negotiated Rate	$29.90
Max. Negotiated Rate	$347.51
Rate for Payer: Aetna Commercial	$85.60
Rate for Payer: Aetna Medicare Advantage	$101.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$31.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.16
Rate for Payer: Cigna Medicare Advantage	$31.47
Rate for Payer: Clover Medicare Advantage	$29.90
Rate for Payer: EmblemHealth Commercial	$94.41
Rate for Payer: Humana Medicare Advantage	$32.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$31.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$347.51
Rate for Payer: Qualcare PPO/HMO/WC	$215.40
Rate for Payer: UnitedHealthcare Community & State	$45.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.47
Rate for Payer: Wellcare Medicare Advantage	$31.47
Rate for Payer: Wellpoint Medicaid Managed Care	$40.78

PENICILLIN G SODIUM 5 Million

Facility

$23.42

Hospital Charge Code	6063943267
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$11.71
Rate for Payer: Aetna Commercial	$8.90
Rate for Payer: Aetna Medicare Advantage	$7.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.97
Rate for Payer: Cigna Commercial	$11.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.09
Rate for Payer: Oxford Commercial	$4.68
Rate for Payer: Qualcare PPO/HMO/WC	$3.51
Rate for Payer: UnitedHealthcare Commercial	$4.68
Rate for Payer: UnitedHealthcare Community & State	$0.74
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

PENICILLIN G SODIUM 5 Million

Facility

$23.42

Hospital Charge Code	6063943267
Hospital Revenue Code	250
Min. Negotiated Rate	$3.51
Max. Negotiated Rate	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$3.51

PENICILLIN SSP 250MG/5ML 100ML

Facility

$74.77

Service Code	NDC 93412773
Hospital Charge Code	60627311
Hospital Revenue Code	251
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$11.22
Rate for Payer: Qualcare PPO/HMO/WC	$11.22

PENICILLIN SSP 250MG/5ML 100ML

Facility

$74.77

Service Code	NDC 93412773
Hospital Charge Code	60627311
Hospital Revenue Code	251
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$37.38
Rate for Payer: Aetna Commercial	$28.41
Rate for Payer: Aetna Medicare Advantage	$22.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.07
Rate for Payer: Cigna Commercial	$37.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.44
Rate for Payer: Oxford Commercial	$14.95
Rate for Payer: Qualcare PPO/HMO/WC	$11.22
Rate for Payer: UnitedHealthcare Commercial	$14.95
Rate for Payer: UnitedHealthcare Community & State	$2.36
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

PENICILLIN V POTASSIUM 125 MG/

Facility

$29.48

Service Code	NDC 67253020210
Hospital Charge Code	6063943228
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$14.74
Rate for Payer: Aetna Commercial	$11.20
Rate for Payer: Aetna Medicare Advantage	$8.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.52
Rate for Payer: Cigna Commercial	$14.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.66
Rate for Payer: Oxford Commercial	$5.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.42
Rate for Payer: UnitedHealthcare Commercial	$5.90
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$0.84

PENICILLIN V POTASSIUM 125 MG/

Facility

$29.48

Service Code	NDC 67253020210
Hospital Charge Code	6063943228
Hospital Revenue Code	250
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$4.42

PENICILLIN V POTAS TAB 250MG

Facility

$4.62

Service Code	NDC 781120501
Hospital Charge Code	60627312
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.31
Rate for Payer: Aetna Commercial	$1.76
Rate for Payer: Aetna Medicare Advantage	$1.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.18
Rate for Payer: Cigna Commercial	$2.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.69
Rate for Payer: UnitedHealthcare Commercial	$0.92
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

PENICILLIN V POTAS TAB 250MG

Facility

$4.62

Service Code	NDC 781120501
Hospital Charge Code	60627312
Hospital Revenue Code	251
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Qualcare PPO/HMO/WC	$0.69

PENILE AMBIVOR PROSTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687490
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.35
Max. Negotiated Rate	$34,812.50
Rate for Payer: Aetna Commercial	$26,457.50
Rate for Payer: Aetna Medicare Advantage	$20,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,754.38
Rate for Payer: Cigna Commercial	$34,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75
Rate for Payer: UnitedHealthcare Community & State	$2,200.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1,977.35

PENILE AMBIVOR PROSTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687490
Hospital Revenue Code	278
Min. Negotiated Rate	$10,443.75
Max. Negotiated Rate	$16,849.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75

PENILE ERECTION DEVICE KIT

Facility

$4,300.00

Hospital Charge Code	270654484
Hospital Revenue Code	272
Min. Negotiated Rate	$645.00
Max. Negotiated Rate	$645.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00

PENILE ERECTION DEVICE KIT

Facility

$4,300.00

Hospital Charge Code	270654484
Hospital Revenue Code	272
Min. Negotiated Rate	$122.12
Max. Negotiated Rate	$2,150.00
Rate for Payer: Aetna Commercial	$1,634.00
Rate for Payer: Aetna Medicare Advantage	$1,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,096.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,096.50
Rate for Payer: Cigna Commercial	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,118.00
Rate for Payer: Oxford Commercial	$860.00
Rate for Payer: Qualcare PPO/HMO/WC	$645.00
Rate for Payer: UnitedHealthcare Commercial	$860.00
Rate for Payer: UnitedHealthcare Community & State	$135.88
Rate for Payer: Wellpoint Medicaid Managed Care	$122.12

PENILE IMP SPECTRA 12MMX20CM

Facility

$29,101.80

Service Code	HCPCS C2622
Hospital Charge Code	270672119
Hospital Revenue Code	278
Min. Negotiated Rate	$826.49
Max. Negotiated Rate	$14,550.90
Rate for Payer: Aetna Commercial	$11,058.68
Rate for Payer: Aetna Medicare Advantage	$8,730.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,420.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,420.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,820.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,420.96
Rate for Payer: Cigna Commercial	$14,550.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,042.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,365.27
Rate for Payer: UnitedHealthcare Community & State	$919.62
Rate for Payer: Wellpoint Medicaid Managed Care	$826.49

PENILE IMP SPECTRA 12MMX20CM

Facility

$29,101.80

Service Code	HCPCS C2622
Hospital Charge Code	270672119
Hospital Revenue Code	278
Min. Negotiated Rate	$4,365.27
Max. Negotiated Rate	$7,042.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,820.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,042.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,365.27

PENILE PLETHYSMOGRAPHY

Facility

$1,628.45

Service Code	HCPCS 54240
Hospital Charge Code	2692110
Hospital Revenue Code	361
Min. Negotiated Rate	$46.25
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
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	$930.53
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.40
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.27
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$51.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$46.25

PENILE PLETHYSMOGRAPHY

Facility

$1,628.45

Service Code	HCPCS 54240
Hospital Charge Code	2692110
Hospital Revenue Code	361
Min. Negotiated Rate	$244.27
Max. Negotiated Rate	$244.27
Rate for Payer: Qualcare PPO/HMO/WC	$244.27

PENILE PROS.MENT.ALPHA I-INFLA

Facility

$1,269.00

Hospital Charge Code	270325378
Hospital Revenue Code	278
Min. Negotiated Rate	$36.04
Max. Negotiated Rate	$634.50
Rate for Payer: Aetna Commercial	$482.22
Rate for Payer: Aetna Medicare Advantage	$380.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$323.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$323.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$253.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$323.60
Rate for Payer: Cigna Commercial	$634.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.10
Rate for Payer: Qualcare PPO/HMO/WC	$190.35
Rate for Payer: UnitedHealthcare Community & State	$40.10
Rate for Payer: Wellpoint Medicaid Managed Care	$36.04

PENILE PROS.MENT.ALPHA I-INFLA

Facility

$1,269.00

Hospital Charge Code	270325378
Hospital Revenue Code	278
Min. Negotiated Rate	$190.35
Max. Negotiated Rate	$307.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$253.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$307.10
Rate for Payer: Qualcare PPO/HMO/WC	$190.35

PENILE PROSTHESIS 14CMX12.5MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,514.11
Max. Negotiated Rate	$44,262.50
Rate for Payer: Aetna Commercial	$33,639.50
Rate for Payer: Aetna Medicare Advantage	$26,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,573.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,573.88
Rate for Payer: Cigna Commercial	$44,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75
Rate for Payer: UnitedHealthcare Community & State	$2,797.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2,514.11

PENILE PROSTHESIS 14CMX12.5MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694754
Hospital Revenue Code	278
Min. Negotiated Rate	$13,278.75
Max. Negotiated Rate	$21,423.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,423.05
Rate for Payer: Qualcare PPO/HMO/WC	$13,278.75

PENILE PROSTHESIS CX 18CM IP

Facility

$35,440.70

Hospital Charge Code	270673750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,006.52
Max. Negotiated Rate	$17,720.35
Rate for Payer: Aetna Commercial	$13,467.47
Rate for Payer: Aetna Medicare Advantage	$10,632.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,037.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,037.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,088.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,037.38
Rate for Payer: Cigna Commercial	$17,720.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,576.65
Rate for Payer: Qualcare PPO/HMO/WC	$5,316.10
Rate for Payer: UnitedHealthcare Community & State	$1,119.93
Rate for Payer: Wellpoint Medicaid Managed Care	$1,006.52

PENILE PROSTHESIS CX 18CM IP

Facility

$35,440.70

Hospital Charge Code	270673750
Hospital Revenue Code	278
Min. Negotiated Rate	$5,316.10
Max. Negotiated Rate	$8,576.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,088.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,576.65
Rate for Payer: Qualcare PPO/HMO/WC	$5,316.10

Know your out-of-pocket cost for care.

All Charges