Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PERI-STRIP 45MM

Facility

$1,071.00

Hospital Charge Code	270672596
Hospital Revenue Code	272
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$160.65

PERI-STRIP 60MM

Facility

$1,071.00

Hospital Charge Code	270672597
Hospital Revenue Code	272
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$406.98
Rate for Payer: Aetna Medicare Advantage	$321.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.11
Rate for Payer: Cigna Commercial	$535.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.46
Rate for Payer: Oxford Commercial	$214.20
Rate for Payer: Qualcare PPO/HMO/WC	$160.65
Rate for Payer: UnitedHealthcare Commercial	$214.20
Rate for Payer: UnitedHealthcare Community & State	$33.84
Rate for Payer: Wellpoint Medicaid Managed Care	$30.42

PERI-STRIP 60MM

Facility

$1,071.00

Hospital Charge Code	270672597
Hospital Revenue Code	272
Min. Negotiated Rate	$160.65
Max. Negotiated Rate	$160.65
Rate for Payer: Qualcare PPO/HMO/WC	$160.65

PERI-STRP DRY STAP PSD4506-U-V

Facility

$979.13

Service Code	HCPCS C1762
Hospital Charge Code	270660315
Hospital Revenue Code	278
Min. Negotiated Rate	$27.81
Max. Negotiated Rate	$489.56
Rate for Payer: Aetna Commercial	$372.07
Rate for Payer: Aetna Medicare Advantage	$293.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$249.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$249.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$249.68
Rate for Payer: Cigna Commercial	$489.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.87
Rate for Payer: UnitedHealthcare Community & State	$30.94
Rate for Payer: Wellpoint Medicaid Managed Care	$27.81

PERI-STRP DRY STAP PSD4506-U-V

Facility

$979.13

Service Code	HCPCS C1762
Hospital Charge Code	270660315
Hospital Revenue Code	278
Min. Negotiated Rate	$146.87
Max. Negotiated Rate	$236.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$195.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$236.95
Rate for Payer: Qualcare PPO/HMO/WC	$146.87

PERITONEAL ADHESIOLYSIS

Facility

$53,332.78

Service Code	APR-DRG 2244
Min. Negotiated Rate	$52,287.04
Max. Negotiated Rate	$53,332.78
Rate for Payer: UnitedHealthcare Community & State	$52,287.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$53,332.78
Rate for Payer: Wellpoint Medicaid Managed Care	$52,287.04

PERITONEAL ADHESIOLYSIS

Facility

$18,707.78

Service Code	APR-DRG 2241
Min. Negotiated Rate	$18,340.96
Max. Negotiated Rate	$18,707.78
Rate for Payer: UnitedHealthcare Community & State	$18,340.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$18,707.78
Rate for Payer: Wellpoint Medicaid Managed Care	$18,340.96

PERITONEAL ADHESIOLYSIS

Facility

$30,751.75

Service Code	APR-DRG 2243
Min. Negotiated Rate	$30,148.77
Max. Negotiated Rate	$30,751.75
Rate for Payer: UnitedHealthcare Community & State	$30,148.77
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$30,751.75
Rate for Payer: Wellpoint Medicaid Managed Care	$30,148.77

PERITONEAL ADHESIOLYSIS

Facility

$21,970.14

Service Code	APR-DRG 2242
Min. Negotiated Rate	$21,539.35
Max. Negotiated Rate	$21,970.14
Rate for Payer: UnitedHealthcare Community & State	$21,539.35
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,970.14
Rate for Payer: Wellpoint Medicaid Managed Care	$21,539.35

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$86,086.04

Service Code	MSDRG 336
Min. Negotiated Rate	$26,212.10
Max. Negotiated Rate	$86,086.04
Rate for Payer: Aetna Commercial	$63,169.97
Rate for Payer: Aetna Medicare Advantage	$86,086.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58,457.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58,457.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27,591.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58,457.55
Rate for Payer: Cigna Commercial	$47,009.25
Rate for Payer: Cigna Medicare Advantage	$27,591.68
Rate for Payer: Clover Medicare Advantage	$26,212.10
Rate for Payer: EmblemHealth Commercial	$82,775.04
Rate for Payer: Humana Medicare Advantage	$28,419.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27,591.68
Rate for Payer: Oxford Commercial	$37,155.29
Rate for Payer: UnitedHealthcare Commercial	$49,733.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$27,591.68
Rate for Payer: Wellcare Medicare Advantage	$27,591.68

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$132,282.07

Service Code	MSDRG 335
Min. Negotiated Rate	$40,278.19
Max. Negotiated Rate	$132,282.07
Rate for Payer: Aetna Commercial	$96,071.32
Rate for Payer: Aetna Medicare Advantage	$132,282.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99,183.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99,183.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42,398.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99,183.90
Rate for Payer: Cigna Commercial	$79,606.07
Rate for Payer: Cigna Medicare Advantage	$42,398.10
Rate for Payer: Clover Medicare Advantage	$40,278.19
Rate for Payer: EmblemHealth Commercial	$127,194.30
Rate for Payer: Humana Medicare Advantage	$43,670.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42,398.10
Rate for Payer: Oxford Commercial	$62,919.26
Rate for Payer: UnitedHealthcare Commercial	$84,219.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$42,398.10
Rate for Payer: Wellcare Medicare Advantage	$42,398.10

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$67,960.78

Service Code	MSDRG 337
Min. Negotiated Rate	$20,693.19
Max. Negotiated Rate	$67,960.78
Rate for Payer: Aetna Commercial	$50,260.97
Rate for Payer: Aetna Medicare Advantage	$67,960.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41,557.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,782.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41,557.50
Rate for Payer: Cigna Commercial	$34,219.75
Rate for Payer: Cigna Medicare Advantage	$21,782.30
Rate for Payer: Clover Medicare Advantage	$20,693.19
Rate for Payer: EmblemHealth Commercial	$65,346.90
Rate for Payer: Humana Medicare Advantage	$22,435.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,782.30
Rate for Payer: Oxford Commercial	$27,046.70
Rate for Payer: UnitedHealthcare Commercial	$36,202.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,782.30
Rate for Payer: Wellcare Medicare Advantage	$21,782.30

PERITONEAL LAVAGE W/IMG

Facility

$2,275.00

Service Code	HCPCS 49084
Hospital Charge Code	5780235
Hospital Revenue Code	450
Min. Negotiated Rate	$341.25
Max. Negotiated Rate	$341.25
Rate for Payer: Qualcare PPO/HMO/WC	$341.25

PERITONEAL LAVAGE W/IMG

Facility

$2,275.00

Service Code	HCPCS 49084
Hospital Charge Code	5780235
Hospital Revenue Code	450
Min. Negotiated Rate	$64.61
Max. Negotiated Rate	$3,908.70
Rate for Payer: Aetna Commercial	$2,930.85
Rate for Payer: Aetna Medicare Advantage	$3,491.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,908.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,077.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,908.70
Rate for Payer: Cigna Commercial	$2,159.89
Rate for Payer: Cigna Medicare Advantage	$1,077.52
Rate for Payer: Clover Medicare Advantage	$1,023.64
Rate for Payer: EmblemHealth Commercial	$3,232.56
Rate for Payer: Humana Medicare Advantage	$1,109.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,077.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$591.50
Rate for Payer: Qualcare PPO/HMO/WC	$341.25
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,077.52
Rate for Payer: Wellcare Medicare Advantage	$1,077.52
Rate for Payer: Wellpoint Medicaid Managed Care	$64.61

PERI TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	74308145
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 TRANSVAGINAL US OBSTETRIC

Facility

$6,700.00

Service Code	HCPCS 76817
Hospital Charge Code	74308145
Hospital Revenue Code	402
Min. Negotiated Rate	$117.99
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	$133.65
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 ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	74308190
Hospital Revenue Code	402
Min. Negotiated Rate	$65.29
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	$121.61
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	$597.69
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$344.82
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$72.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$65.29

PERI ULTRASOUND, TRANSVAGINAL

Facility

$2,298.80

Service Code	HCPCS 76830
Hospital Charge Code	74308190
Hospital Revenue Code	402
Min. Negotiated Rate	$344.82
Max. Negotiated Rate	$344.82
Rate for Payer: Qualcare PPO/HMO/WC	$344.82

PERI US-GUIDE-AMNIOCENTESIS

Facility

$6,700.00

Service Code	HCPCS 76946
Hospital Charge Code	74308195
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 US-GUIDE-AMNIOCENTESIS

Facility

$6,700.00

Service Code	HCPCS 76946
Hospital Charge Code	74308195
Hospital Revenue Code	402
Min. Negotiated Rate	$51.15
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	$51.15
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 US-NUCHAL TRANSLUCEN-1ST

Facility

$6,700.00

Service Code	HCPCS 76813
Hospital Charge Code	74308125
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 US-NUCHAL TRANSLUCEN-1ST

Facility

$6,700.00

Service Code	HCPCS 76813
Hospital Charge Code	74308125
Hospital Revenue Code	402
Min. Negotiated Rate	$110.14
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	$110.14
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 US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	74308130
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 US-NUCHAL TRANSLUCEN-ADD

Facility

$6,700.00

Service Code	HCPCS 76814
Hospital Charge Code	74308130
Hospital Revenue Code	402
Min. Negotiated Rate	$32.29
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	$32.29
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 VENIPUNCTURE

Facility

$135.80

Service Code	HCPCS 36415
Hospital Charge Code	74308005
Hospital Revenue Code	300
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$25.40
Rate for Payer: Aetna Medicare Advantage	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.88
Rate for Payer: Cigna Commercial	$67.90
Rate for Payer: Cigna Medicare Advantage	$9.34
Rate for Payer: Clover Medicare Advantage	$8.87
Rate for Payer: EmblemHealth Commercial	$28.02
Rate for Payer: Humana Medicare Advantage	$9.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.31
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$20.37
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.34
Rate for Payer: Wellcare Medicare Advantage	$9.34
Rate for Payer: Wellpoint Medicaid Managed Care	$3.86

Know your out-of-pocket cost for care.

All Charges