Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PET BRAIN IMAG METAB EVAL - PI

Facility

$40,000.00

Service Code	HCPCS 78608PI
Hospital Charge Code	80000050PI
Hospital Revenue Code	404
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,803.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$17,936.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PET BRAIN IMAG METAB EVAL- PS

Facility

$40,000.00

Service Code	HCPCS 78608PS
Hospital Charge Code	80000050PS
Hospital Revenue Code	404
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,803.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$17,936.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PET BRAIN IMAG METAB EVAL- PS

Facility

$40,000.00

Service Code	HCPCS 78608PS
Hospital Charge Code	80000050PS
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMAGE W/CT LTD - PI

Facility

$40,000.00

Service Code	HCPCS 78816PI
Hospital Charge Code	80000030PI
Hospital Revenue Code	404
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,803.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$17,936.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PET IMAGE W/CT LTD - PI

Facility

$40,000.00

Service Code	HCPCS 78816PI
Hospital Charge Code	80000030PI
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMAGE W/CT LTD- PS

Facility

$40,000.00

Service Code	HCPCS 78816PS
Hospital Charge Code	80000030PS
Hospital Revenue Code	404
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,803.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$17,936.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PET IMAGE W/CT LTD- PS

Facility

$40,000.00

Service Code	HCPCS 78816PS
Hospital Charge Code	80000030PS
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMAGE W/CT SKULL-THIGH-PI

Facility

$40,000.00

Service Code	HCPCS 78815PI
Hospital Charge Code	80000015PI
Hospital Revenue Code	404
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,803.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$17,936.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PET IMAGE W/CT SKULL-THIGH-PI

Facility

$40,000.00

Service Code	HCPCS 78815PI
Hospital Charge Code	80000015PI
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMGE W/CT SKULL-THIGH -GL

Facility

$40,000.00

Service Code	HCPCS 78815
Hospital Charge Code	80000015
Hospital Revenue Code	404
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$17,936.00
Rate for Payer: Aetna Commercial	$4,620.79
Rate for Payer: Aetna Medicare Advantage	$5,504.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,162.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,162.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,698.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,782.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,162.47
Rate for Payer: Cigna Commercial	$3,405.27
Rate for Payer: Cigna Medicare Advantage	$1,698.82
Rate for Payer: Clover Medicare Advantage	$1,613.88
Rate for Payer: EmblemHealth Commercial	$5,096.46
Rate for Payer: Humana Medicare Advantage	$1,749.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,698.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,803.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$17,936.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,698.82
Rate for Payer: Wellcare Medicare Advantage	$1,698.82
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PET IMGE W/CT SKULL-THIGH -GL

Facility

$40,000.00

Service Code	HCPCS 78815
Hospital Charge Code	80000015
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMGE W/CT SKULL-THIGH- PS

Facility

$40,000.00

Service Code	HCPCS 78815PS
Hospital Charge Code	80000015PS
Hospital Revenue Code	404
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PET IMGE W/CT SKULL-THIGH- PS

Facility

$40,000.00

Service Code	HCPCS 78815PS
Hospital Charge Code	80000015PS
Hospital Revenue Code	404
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,803.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$17,936.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PETONEAL LAVAGE

Facility

$5,762.80

Service Code	HCPCS 49084
Hospital Charge Code	1600000344
Hospital Revenue Code	360
Min. Negotiated Rate	$163.66
Max. Negotiated Rate	$5,347.00
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) NJ Health	$3,536.00
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	$1,498.33
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$864.42
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$182.10
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	$163.66

PETONEAL LAVAGE

Facility

$5,762.80

Service Code	HCPCS 49084
Hospital Charge Code	1600000344
Hospital Revenue Code	360
Min. Negotiated Rate	$864.42
Max. Negotiated Rate	$864.42
Rate for Payer: Qualcare PPO/HMO/WC	$864.42

PETROLATUM JELLY(368G)

Facility

$6.70

Service Code	NDC 904573182
Hospital Charge Code	6063943229
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PETROLATUM JELLY(368G)

Facility

$6.70

Service Code	NDC 904573182
Hospital Charge Code	6063943229
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

PETROLATUM MINERL OIL OIN100GM

Facility

$36.52

Service Code	NDC 54162050002
Hospital Charge Code	60628315
Hospital Revenue Code	250
Min. Negotiated Rate	$5.48
Max. Negotiated Rate	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.48

PETROLATUM MINERL OIL OIN100GM

Facility

$36.52

Service Code	NDC 54162050002
Hospital Charge Code	60628315
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.26
Rate for Payer: Aetna Commercial	$13.88
Rate for Payer: Aetna Medicare Advantage	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.31
Rate for Payer: Cigna Commercial	$18.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.50
Rate for Payer: Oxford Commercial	$7.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.48
Rate for Payer: UnitedHealthcare Commercial	$7.30
Rate for Payer: UnitedHealthcare Community & State	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

PETROLATUM TOPICAL 100% OINT

Facility

$4.00

Service Code	NDC 168005345
Hospital Charge Code	6004170
Hospital Revenue Code	251
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

PETROLATUM TOPICAL 100% OINT

Facility

$4.00

Service Code	NDC 168005345
Hospital Charge Code	6004170
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PFI BIONTCOVID19VAC30MCG/0.3ML

Facility

$0.01

Service Code	HCPCS 91300
Hospital Charge Code	606390386
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

PFI BIONTCOVID19VAC30MCG/0.3ML

Facility

$0.01

Service Code	HCPCS 91300
Hospital Charge Code	606390386
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

PFIZBIONTCOVID19VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0001A
Hospital Charge Code	39500001A
Hospital Revenue Code	771
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

PFIZBIONTCOVID19VACC ADM DOSE1

Facility

$50.00

Service Code	HCPCS 0001A
Hospital Charge Code	39500001A
Hospital Revenue Code	771
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

Know your out-of-pocket cost for care.

All Charges