Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PERI OB/US<14 WKS SINGLE FETUS

Facility

$6,700.00

Service Code	HCPCS 76801
Hospital Charge Code	74308095
Hospital Revenue Code	402
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PERI OB/US>/=14 WKS SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	74308105
Hospital Revenue Code	402
Min. Negotiated Rate	$106.59
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PERI OB/US>/=14 WKS SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	74308105
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI OB/US DETAILED ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76812
Hospital Charge Code	74308120
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI OB/US DETAILED ADDL FETUS

Facility

$6,700.00

Service Code	HCPCS 76812
Hospital Charge Code	74308120
Hospital Revenue Code	402
Min. Negotiated Rate	$190.28
Max. Negotiated Rate	$3,350.00
Rate for Payer: Aetna Commercial	$2,546.00
Rate for Payer: Aetna Medicare Advantage	$2,010.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,708.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$201.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,708.50
Rate for Payer: Cigna Commercial	$3,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PERI OB/US DETAILED SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76811
Hospital Charge Code	74308115
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI OB/US DETAILED SNGL FETUS

Facility

$6,700.00

Service Code	HCPCS 76811
Hospital Charge Code	74308115
Hospital Revenue Code	402
Min. Negotiated Rate	$190.28
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$336.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PERI OB/US FOLLOW UP PER FETUS

Facility

$6,700.00

Service Code	HCPCS 76816
Hospital Charge Code	74308140
Hospital Revenue Code	402
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.67
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PERI OB/US FOLLOW UP PER FETUS

Facility

$6,700.00

Service Code	HCPCS 76816
Hospital Charge Code	74308140
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI OB US-LIMITED

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	74308135
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PERI OB US-LIMITED

Facility

$6,700.00

Service Code	HCPCS 76815
Hospital Charge Code	74308135
Hospital Revenue Code	402
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PERI OFFICE CONSULT EXPANDED

Facility

$566.00

Service Code	HCPCS 99242
Hospital Charge Code	74308330
Hospital Revenue Code	514
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

PERI OFFICE CONSULT EXPANDED

Facility

$566.00

Service Code	HCPCS 99242
Hospital Charge Code	74308330
Hospital Revenue Code	514
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$215.08
Rate for Payer: Aetna Medicare Advantage	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.33
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.16
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Community & State	$17.89
Rate for Payer: Wellpoint Medicaid Managed Care	$16.07

PERI OFFICE CONSULT FOCUSED

Facility

$453.00

Service Code	HCPCS 99241
Hospital Charge Code	74308325
Hospital Revenue Code	761
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$67.95
Rate for Payer: Qualcare PPO/HMO/WC	$67.95

PERI OFFICE CONSULT FOCUSED

Facility

$453.00

Service Code	HCPCS 99241
Hospital Charge Code	74308325
Hospital Revenue Code	761
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$226.50
Rate for Payer: Aetna Commercial	$172.14
Rate for Payer: Aetna Medicare Advantage	$135.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.52
Rate for Payer: Cigna Commercial	$226.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.78
Rate for Payer: Oxford Commercial	$90.60
Rate for Payer: Qualcare PPO/HMO/WC	$67.95
Rate for Payer: UnitedHealthcare Commercial	$90.60
Rate for Payer: UnitedHealthcare Community & State	$14.31
Rate for Payer: Wellpoint Medicaid Managed Care	$12.87

PERI OV-NEW-BRIEF

Facility

$318.00

Service Code	HCPCS 99201
Hospital Charge Code	74308270
Hospital Revenue Code	514
Min. Negotiated Rate	$9.03
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$120.84
Rate for Payer: Aetna Medicare Advantage	$95.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.09
Rate for Payer: Cigna Commercial	$159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.68
Rate for Payer: Qualcare PPO/HMO/WC	$47.70
Rate for Payer: UnitedHealthcare Community & State	$10.05
Rate for Payer: Wellpoint Medicaid Managed Care	$9.03

PERI OV-NEW-BRIEF

Facility

$318.00

Service Code	HCPCS 99201
Hospital Charge Code	74308270
Hospital Revenue Code	514
Min. Negotiated Rate	$47.70
Max. Negotiated Rate	$47.70
Rate for Payer: Qualcare PPO/HMO/WC	$47.70

PERI OV-NEW-EXTENDED

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	74308285
Hospital Revenue Code	514
Min. Negotiated Rate	$160.23
Max. Negotiated Rate	$160.23
Rate for Payer: Qualcare PPO/HMO/WC	$160.23

PERI OV-NEW-EXTENDED

Facility

$1,068.20

Service Code	HCPCS 99204
Hospital Charge Code	74308285
Hospital Revenue Code	514
Min. Negotiated Rate	$30.34
Max. Negotiated Rate	$534.10
Rate for Payer: Aetna Commercial	$405.92
Rate for Payer: Aetna Medicare Advantage	$320.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.39
Rate for Payer: Cigna Commercial	$534.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.73
Rate for Payer: Qualcare PPO/HMO/WC	$160.23
Rate for Payer: UnitedHealthcare Community & State	$33.76
Rate for Payer: Wellpoint Medicaid Managed Care	$30.34

PERI OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	74308280
Hospital Revenue Code	514
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

PERI OV-NEW-INTERMEDIATE

Facility

$828.80

Service Code	HCPCS 99203
Hospital Charge Code	74308280
Hospital Revenue Code	514
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

PERI OXYTOXIN TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	74308040
Hospital Revenue Code	514
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$871.25
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.94
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Community & State	$21.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$19.00

PERI OXYTOXIN TEST

Facility

$669.00

Service Code	HCPCS 59020
Hospital Charge Code	74308040
Hospital Revenue Code	514
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$6,495.30

Service Code	APR-DRG 1971
Min. Negotiated Rate	$6,367.94
Max. Negotiated Rate	$6,495.30
Rate for Payer: UnitedHealthcare Community & State	$6,367.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,495.30
Rate for Payer: Wellpoint Medicaid Managed Care	$6,367.94

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$8,625.67

Service Code	APR-DRG 1972
Min. Negotiated Rate	$8,456.54
Max. Negotiated Rate	$8,625.67
Rate for Payer: UnitedHealthcare Community & State	$8,456.54
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,625.67
Rate for Payer: Wellpoint Medicaid Managed Care	$8,456.54

Know your out-of-pocket cost for care.

All Charges