Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PENILE PROSTHESIS INFLATABLE

Facility

$19,725.00

Service Code	HCPCS C1813
Hospital Charge Code	270654489
Hospital Revenue Code	278
Min. Negotiated Rate	$2,958.75
Max. Negotiated Rate	$4,773.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,773.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,958.75

PENILE PROSTHESIS INFLATABLE

Facility

$19,725.00

Service Code	HCPCS C1813
Hospital Charge Code	270654489
Hospital Revenue Code	278
Min. Negotiated Rate	$560.19
Max. Negotiated Rate	$9,862.50
Rate for Payer: Aetna Commercial	$7,495.50
Rate for Payer: Aetna Medicare Advantage	$5,917.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,029.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,029.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,029.88
Rate for Payer: Cigna Commercial	$9,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,773.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,958.75
Rate for Payer: UnitedHealthcare Community & State	$623.31
Rate for Payer: Wellpoint Medicaid Managed Care	$560.19

PENILE PROSTHESIS INFLATABLE

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270662523
Hospital Revenue Code	278
Min. Negotiated Rate	$7,728.75
Max. Negotiated Rate	$12,469.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75

PENILE PROSTHESIS INFLATABLE

Facility

$51,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270662523
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.31
Max. Negotiated Rate	$25,762.50
Rate for Payer: Aetna Commercial	$19,579.50
Rate for Payer: Aetna Medicare Advantage	$15,457.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,138.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,138.88
Rate for Payer: Cigna Commercial	$25,762.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,469.05
Rate for Payer: Qualcare PPO/HMO/WC	$7,728.75
Rate for Payer: UnitedHealthcare Community & State	$1,628.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1,463.31

PENILE PROSTHESIS PUMP 12X15C

Facility

$67,702.55

Hospital Charge Code	270702115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,922.75
Max. Negotiated Rate	$33,851.28
Rate for Payer: Aetna Commercial	$25,726.97
Rate for Payer: Aetna Medicare Advantage	$20,310.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,264.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,264.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,540.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,264.15
Rate for Payer: Cigna Commercial	$33,851.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,384.02
Rate for Payer: Qualcare PPO/HMO/WC	$10,155.38
Rate for Payer: UnitedHealthcare Community & State	$2,139.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1,922.75

PENILE PROSTHESIS PUMP 12X15C

Facility

$67,702.55

Hospital Charge Code	270702115
Hospital Revenue Code	278
Min. Negotiated Rate	$10,155.38
Max. Negotiated Rate	$16,384.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,540.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,384.02
Rate for Payer: Qualcare PPO/HMO/WC	$10,155.38

PENILE PROSTHESIS PUMP 12X21

Facility

$65,452.55

Hospital Charge Code	270702099
Hospital Revenue Code	278
Min. Negotiated Rate	$9,817.88
Max. Negotiated Rate	$15,839.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,090.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,839.52
Rate for Payer: Qualcare PPO/HMO/WC	$9,817.88

PENILE PROSTHESIS PUMP 12X21

Facility

$65,452.55

Hospital Charge Code	270702099
Hospital Revenue Code	278
Min. Negotiated Rate	$1,858.85
Max. Negotiated Rate	$32,726.28
Rate for Payer: Aetna Commercial	$24,871.97
Rate for Payer: Aetna Medicare Advantage	$19,635.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,690.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,690.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,090.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,690.40
Rate for Payer: Cigna Commercial	$32,726.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,839.52
Rate for Payer: Qualcare PPO/HMO/WC	$9,817.88
Rate for Payer: UnitedHealthcare Community & State	$2,068.30
Rate for Payer: Wellpoint Medicaid Managed Care	$1,858.85

PENILE PROSTHESIS(TACTRA)11X16

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689451
Hospital Revenue Code	278
Min. Negotiated Rate	$1,730.27
Max. Negotiated Rate	$30,462.50
Rate for Payer: Aetna Commercial	$23,151.50
Rate for Payer: Aetna Medicare Advantage	$18,277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,535.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,535.88
Rate for Payer: Cigna Commercial	$30,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75
Rate for Payer: UnitedHealthcare Community & State	$1,925.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1,730.27

PENILE PROSTHESIS(TACTRA)11X16

Facility

$60,925.00

Service Code	HCPCS C1813
Hospital Charge Code	270689451
Hospital Revenue Code	278
Min. Negotiated Rate	$9,138.75
Max. Negotiated Rate	$14,743.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,743.85
Rate for Payer: Qualcare PPO/HMO/WC	$9,138.75

PENILE PROSTH MALLEABLE 13MM

Facility

$64,050.00

Service Code	HCPCS C2622
Hospital Charge Code	270698712
Hospital Revenue Code	278
Min. Negotiated Rate	$9,607.50
Max. Negotiated Rate	$15,500.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,500.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,607.50

PENILE PROSTH MALLEABLE 13MM

Facility

$64,050.00

Service Code	HCPCS C2622
Hospital Charge Code	270698712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,819.02
Max. Negotiated Rate	$32,025.00
Rate for Payer: Aetna Commercial	$24,339.00
Rate for Payer: Aetna Medicare Advantage	$19,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,332.75
Rate for Payer: Cigna Commercial	$32,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,500.10
Rate for Payer: Qualcare PPO/HMO/WC	$9,607.50
Rate for Payer: UnitedHealthcare Community & State	$2,023.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1,819.02

PENILE PROTHESIS 16CMX14MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694753
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 PROTHESIS 16CMX14MM

Facility

$88,525.00

Service Code	HCPCS C1813
Hospital Charge Code	270694753
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 TIP 18CM CX

Facility

$41,915.00

Hospital Charge Code	270674330
Hospital Revenue Code	278
Min. Negotiated Rate	$1,190.39
Max. Negotiated Rate	$20,957.50
Rate for Payer: Aetna Commercial	$15,927.70
Rate for Payer: Aetna Medicare Advantage	$12,574.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,688.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,688.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,383.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,688.33
Rate for Payer: Cigna Commercial	$20,957.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,143.43
Rate for Payer: Qualcare PPO/HMO/WC	$6,287.25
Rate for Payer: UnitedHealthcare Community & State	$1,324.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1,190.39

PENILE TIP 18CM CX

Facility

$41,915.00

Hospital Charge Code	270674330
Hospital Revenue Code	278
Min. Negotiated Rate	$6,287.25
Max. Negotiated Rate	$10,143.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,383.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,143.43
Rate for Payer: Qualcare PPO/HMO/WC	$6,287.25

PENIS PROCEDURES WITH CC/MCC

Facility

$92,985.98

Service Code	MSDRG 709
Min. Negotiated Rate	$28,313.04
Max. Negotiated Rate	$92,985.98
Rate for Payer: Aetna Commercial	$68,084.20
Rate for Payer: Aetna Medicare Advantage	$92,985.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60,119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60,119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29,803.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60,119.85
Rate for Payer: Cigna Commercial	$51,878.04
Rate for Payer: Cigna Medicare Advantage	$29,803.20
Rate for Payer: Clover Medicare Advantage	$28,313.04
Rate for Payer: EmblemHealth Commercial	$89,409.60
Rate for Payer: Humana Medicare Advantage	$30,697.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29,803.20
Rate for Payer: Oxford Commercial	$41,003.50
Rate for Payer: UnitedHealthcare Commercial	$54,884.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$29,803.20
Rate for Payer: Wellcare Medicare Advantage	$29,803.20

PENIS PROCEDURES WITHOUT CC/MCC

Facility

$63,733.58

Service Code	MSDRG 710
Min. Negotiated Rate	$19,406.06
Max. Negotiated Rate	$63,733.58
Rate for Payer: Aetna Commercial	$47,250.30
Rate for Payer: Aetna Medicare Advantage	$63,733.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,016.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20,427.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,016.50
Rate for Payer: Cigna Commercial	$31,236.95
Rate for Payer: Cigna Medicare Advantage	$20,427.43
Rate for Payer: Clover Medicare Advantage	$19,406.06
Rate for Payer: EmblemHealth Commercial	$61,282.29
Rate for Payer: Humana Medicare Advantage	$21,040.25
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20,427.43
Rate for Payer: Oxford Commercial	$24,689.14
Rate for Payer: UnitedHealthcare Commercial	$33,047.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$20,427.43
Rate for Payer: Wellcare Medicare Advantage	$20,427.43

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$25,521.86

Service Code	APR-DRG 4833
Min. Negotiated Rate	$25,021.43
Max. Negotiated Rate	$25,521.86
Rate for Payer: UnitedHealthcare Community & State	$25,021.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,521.86
Rate for Payer: Wellpoint Medicaid Managed Care	$25,021.43

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$16,846.97

Service Code	APR-DRG 4832
Min. Negotiated Rate	$16,516.64
Max. Negotiated Rate	$16,846.97
Rate for Payer: UnitedHealthcare Community & State	$16,516.64
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,846.97
Rate for Payer: Wellpoint Medicaid Managed Care	$16,516.64

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$12,396.44

Service Code	APR-DRG 4831
Min. Negotiated Rate	$12,153.37
Max. Negotiated Rate	$12,396.44
Rate for Payer: UnitedHealthcare Community & State	$12,153.37
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,396.44
Rate for Payer: Wellpoint Medicaid Managed Care	$12,153.37

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$43,388.33

Service Code	APR-DRG 4834
Min. Negotiated Rate	$42,537.58
Max. Negotiated Rate	$43,388.33
Rate for Payer: UnitedHealthcare Community & State	$42,537.58
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$43,388.33
Rate for Payer: Wellpoint Medicaid Managed Care	$42,537.58

PEN SKIN SCRIBE

Facility

$10.45

Hospital Charge Code	270061160
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.72
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

PEN SKIN SCRIBE

Facility

$10.45

Hospital Charge Code	270061160
Hospital Revenue Code	272
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

PENTAM INJ/300MG/VIAL

Facility

$358.05

Service Code	NDC 63323011310
Hospital Charge Code	60634265
Hospital Revenue Code	250
Min. Negotiated Rate	$53.71
Max. Negotiated Rate	$53.71
Rate for Payer: Qualcare PPO/HMO/WC	$53.71

Know your out-of-pocket cost for care.

All Charges