Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PENTAM INJ/300MG/VIAL

Facility

$358.05

Service Code	NDC 63323011310
Hospital Charge Code	60634265
Hospital Revenue Code	250
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$179.03
Rate for Payer: Aetna Commercial	$136.06
Rate for Payer: Aetna Medicare Advantage	$107.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.30
Rate for Payer: Cigna Commercial	$179.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.09
Rate for Payer: Oxford Commercial	$71.61
Rate for Payer: Qualcare PPO/HMO/WC	$53.71
Rate for Payer: UnitedHealthcare Commercial	$71.61
Rate for Payer: UnitedHealthcare Community & State	$11.31
Rate for Payer: Wellpoint Medicaid Managed Care	$10.17

PENTOXIFYLLINE 400 MG ER TAB

Facility

$10.05

Service Code	NDC 51079088920
Hospital Charge Code	60627537
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.03
Rate for Payer: Aetna Commercial	$3.82
Rate for Payer: Aetna Medicare Advantage	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.56
Rate for Payer: Cigna Commercial	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.61
Rate for Payer: Oxford Commercial	$2.01
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Commercial	$2.01
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

PENTOXIFYLLINE 400 MG ER TAB

Facility

$10.05

Service Code	NDC 51079088920
Hospital Charge Code	60627537
Hospital Revenue Code	250
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$1.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131N
Hospital Revenue Code	272
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$273.75
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131
Hospital Revenue Code	272
Min. Negotiated Rate	$51.83
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$474.50
Rate for Payer: Oxford Commercial	$365.00
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Commercial	$365.00
Rate for Payer: UnitedHealthcare Community & State	$57.67
Rate for Payer: Wellpoint Medicaid Managed Care	$51.83

PENUMBRA ASPIRATION TUBING

Facility

$1,825.00

Hospital Charge Code	270681131N
Hospital Revenue Code	272
Min. Negotiated Rate	$51.83
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$474.50
Rate for Payer: Oxford Commercial	$365.00
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Commercial	$365.00
Rate for Payer: UnitedHealthcare Community & State	$57.67
Rate for Payer: Wellpoint Medicaid Managed Care	$51.83

PEN VEC K/500MG/UD

Facility

$6.97

Service Code	NDC 54868117301
Hospital Charge Code	60634672
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

PEN VEC K/500MG/UD

Facility

$6.97

Service Code	NDC 54868117301
Hospital Charge Code	60634672
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.48
Rate for Payer: Aetna Commercial	$2.65
Rate for Payer: Aetna Medicare Advantage	$2.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.81
Rate for Payer: Oxford Commercial	$1.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.39
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

PEPPERMINT SPIRITS/30ML

Facility

$65.12

Service Code	NDC 395224391
Hospital Charge Code	60634614
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.77

PEPPERMINT SPIRITS/30ML

Facility

$65.12

Service Code	NDC 395224391
Hospital Charge Code	60634614
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$32.56
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.61
Rate for Payer: Cigna Commercial	$32.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.93
Rate for Payer: Oxford Commercial	$13.02
Rate for Payer: Qualcare PPO/HMO/WC	$9.77
Rate for Payer: UnitedHealthcare Commercial	$13.02
Rate for Payer: UnitedHealthcare Community & State	$2.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

PEPTIC ULCER AND GASTRITIS

Facility

$29,243.41

Service Code	APR-DRG 2414
Min. Negotiated Rate	$28,670.01
Max. Negotiated Rate	$29,243.41
Rate for Payer: UnitedHealthcare Community & State	$28,670.01
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$29,243.41
Rate for Payer: Wellpoint Medicaid Managed Care	$28,670.01

PEPTIC ULCER AND GASTRITIS

Facility

$15,174.34

Service Code	APR-DRG 2413
Min. Negotiated Rate	$14,876.80
Max. Negotiated Rate	$15,174.34
Rate for Payer: UnitedHealthcare Community & State	$14,876.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,174.34
Rate for Payer: Wellpoint Medicaid Managed Care	$14,876.80

PEPTIC ULCER AND GASTRITIS

Facility

$10,326.41

Service Code	APR-DRG 2412
Min. Negotiated Rate	$10,123.93
Max. Negotiated Rate	$10,326.41
Rate for Payer: UnitedHealthcare Community & State	$10,123.93
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$10,326.41
Rate for Payer: Wellpoint Medicaid Managed Care	$10,123.93

PEPTIC ULCER AND GASTRITIS

Facility

$8,340.60

Service Code	APR-DRG 2411
Min. Negotiated Rate	$8,177.06
Max. Negotiated Rate	$8,340.60
Rate for Payer: UnitedHealthcare Community & State	$8,177.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,340.60
Rate for Payer: Wellpoint Medicaid Managed Care	$8,177.06

PEPTO-BISMOL TABS

Facility

$4.00

Service Code	NDC 904131546
Hospital Charge Code	60634891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PEPTO-BISMOL TABS

Facility

$4.00

Service Code	NDC 904131546
Hospital Charge Code	60634891
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PERC/AUTO/VAC/ASSIST/BREST BIO

Facility

$6,420.00

Hospital Charge Code	75190110
Hospital Revenue Code	361
Min. Negotiated Rate	$182.33
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,439.60
Rate for Payer: Aetna Medicare Advantage	$1,926.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,637.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,637.10
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	$1,637.10
Rate for Payer: Cigna Commercial	$3,210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,669.20
Rate for Payer: Qualcare PPO/HMO/WC	$963.00
Rate for Payer: UnitedHealthcare Community & State	$202.87
Rate for Payer: Wellpoint Medicaid Managed Care	$182.33

PERC/AUTO/VAC/ASSIST/BREST BIO

Facility

$6,420.00

Hospital Charge Code	75190110
Hospital Revenue Code	361
Min. Negotiated Rate	$963.00
Max. Negotiated Rate	$963.00
Rate for Payer: Qualcare PPO/HMO/WC	$963.00

PERC BX OR EXC LN, SUPERFICIAL

Facility

$7,367.00

Service Code	HCPCS 38505
Hospital Charge Code	1600000279
Hospital Revenue Code	360
Min. Negotiated Rate	$1,105.05
Max. Negotiated Rate	$1,105.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,105.05

PERC BX OR EXC LN, SUPERFICIAL

Facility

$7,367.00

Service Code	HCPCS 38505
Hospital Charge Code	1600000279
Hospital Revenue Code	360
Min. Negotiated Rate	$209.22
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,915.42
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,105.05
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$232.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$209.22

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	366847490
Hospital Revenue Code	361
Min. Negotiated Rate	$2,560.13
Max. Negotiated Rate	$2,560.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	366847490
Hospital Revenue Code	361
Min. Negotiated Rate	$484.72
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,437.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$539.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$484.72

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	411047490
Hospital Revenue Code	361
Min. Negotiated Rate	$484.72
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
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	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,437.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$539.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$484.72

PERC CHOLECYSTECTOMY

Facility

$17,067.55

Service Code	HCPCS 47490
Hospital Charge Code	411047490
Hospital Revenue Code	361
Min. Negotiated Rate	$2,560.13
Max. Negotiated Rate	$2,560.13
Rate for Payer: Qualcare PPO/HMO/WC	$2,560.13

Know your out-of-pocket cost for care.

All Charges