Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PHAL REAMER 18MM

Facility

$75.00

Hospital Charge Code	270683489
Hospital Revenue Code	272
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

PHARMACOLOGICAL MANAGEMENT

Facility

$421.00

Service Code	HCPCS 90862
Hospital Charge Code	84504075
Hospital Revenue Code	914
Min. Negotiated Rate	$63.15
Max. Negotiated Rate	$63.15
Rate for Payer: Qualcare PPO/HMO/WC	$63.15

PHARMACOLOGICAL MANAGEMENT

Facility

$421.00

Service Code	HCPCS 90862
Hospital Charge Code	84504075
Hospital Revenue Code	914
Min. Negotiated Rate	$11.96
Max. Negotiated Rate	$210.50
Rate for Payer: Aetna Commercial	$159.98
Rate for Payer: Aetna Medicare Advantage	$126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.36
Rate for Payer: Cigna Commercial	$210.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.46
Rate for Payer: Qualcare PPO/HMO/WC	$63.15
Rate for Payer: UnitedHealthcare Community & State	$13.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.96

PHARMACOLOGIC MANAGEMENT

Facility

$275.00

Service Code	HCPCS 90863
Hospital Charge Code	87504150
Hospital Revenue Code	914
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Community & State	$8.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

PHARMACOLOGIC MANAGEMENT

Facility

$275.00

Service Code	HCPCS 90863
Hospital Charge Code	87504150
Hospital Revenue Code	914
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

PHARMACOLOGIC MGMT

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	83246170
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHARMACOLOGIC MGMT

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	83246170
Hospital Revenue Code	914
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

PHARMACOLOGIC MGT W/PSYTX

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	395090863
Hospital Revenue Code	914
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

PHARMACOLOGIC MGT W/PSYTX

Facility

$550.00

Service Code	HCPCS 90863
Hospital Charge Code	395090863
Hospital Revenue Code	914
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

PHASIX 4X6

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270684889
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$592.50
Rate for Payer: Wellpoint Medicaid Managed Care	$532.50

PHASIX 4X6

Facility

$18,750.00

Service Code	HCPCS C1781
Hospital Charge Code	270684889
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

PHASIX MESH EXTRA LARGE

Facility

$2,950.00

Service Code	HCPCS C1781
Hospital Charge Code	270684395
Hospital Revenue Code	278
Min. Negotiated Rate	$83.78
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$93.22
Rate for Payer: Wellpoint Medicaid Managed Care	$83.78

PHASIX MESH EXTRA LARGE

Facility

$2,950.00

Service Code	HCPCS C1781
Hospital Charge Code	270684395
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

PHASIX MESH MEDIUM

Facility

$2,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270684394
Hospital Revenue Code	278
Min. Negotiated Rate	$81.65
Max. Negotiated Rate	$1,437.50
Rate for Payer: Aetna Commercial	$1,092.50
Rate for Payer: Aetna Medicare Advantage	$862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$733.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$733.12
Rate for Payer: Cigna Commercial	$1,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25
Rate for Payer: UnitedHealthcare Community & State	$90.85
Rate for Payer: Wellpoint Medicaid Managed Care	$81.65

PHASIX MESH MEDIUM

Facility

$2,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270684394
Hospital Revenue Code	278
Min. Negotiated Rate	$431.25
Max. Negotiated Rate	$695.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.75
Rate for Payer: Qualcare PPO/HMO/WC	$431.25

PHASIX MESH SMALL

Facility

$2,825.00

Service Code	HCPCS C1781
Hospital Charge Code	270684393
Hospital Revenue Code	278
Min. Negotiated Rate	$80.23
Max. Negotiated Rate	$1,412.50
Rate for Payer: Aetna Commercial	$1,073.50
Rate for Payer: Aetna Medicare Advantage	$847.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$720.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$720.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$720.38
Rate for Payer: Cigna Commercial	$1,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$683.65
Rate for Payer: Qualcare PPO/HMO/WC	$423.75
Rate for Payer: UnitedHealthcare Community & State	$89.27
Rate for Payer: Wellpoint Medicaid Managed Care	$80.23

PHASIX MESH SMALL

Facility

$2,825.00

Service Code	HCPCS C1781
Hospital Charge Code	270684393
Hospital Revenue Code	278
Min. Negotiated Rate	$423.75
Max. Negotiated Rate	$683.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$683.65
Rate for Payer: Qualcare PPO/HMO/WC	$423.75

PHASIX ST 7X10 MESH

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270685545
Hospital Revenue Code	278
Min. Negotiated Rate	$1,410.00
Max. Negotiated Rate	$2,274.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00

PHASIX ST 7X10 MESH

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270685545
Hospital Revenue Code	278
Min. Negotiated Rate	$266.96
Max. Negotiated Rate	$4,700.00
Rate for Payer: Aetna Commercial	$3,572.00
Rate for Payer: Aetna Medicare Advantage	$2,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,397.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,397.00
Rate for Payer: Cigna Commercial	$4,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,274.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,410.00
Rate for Payer: UnitedHealthcare Community & State	$297.04
Rate for Payer: Wellpoint Medicaid Managed Care	$266.96

PHASIX ST ECHO 15X20CM

Facility

$46,967.80

Hospital Charge Code	270702761
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.89
Max. Negotiated Rate	$23,483.90
Rate for Payer: Aetna Commercial	$17,847.76
Rate for Payer: Aetna Medicare Advantage	$14,090.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,976.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,976.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,393.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,976.79
Rate for Payer: Cigna Commercial	$23,483.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$7,045.17
Rate for Payer: UnitedHealthcare Community & State	$1,484.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1,333.89

PHASIX ST ECHO 15X20CM

Facility

$46,967.80

Hospital Charge Code	270702761
Hospital Revenue Code	278
Min. Negotiated Rate	$7,045.17
Max. Negotiated Rate	$11,366.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,393.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,366.21
Rate for Payer: Qualcare PPO/HMO/WC	$7,045.17

PHASIX ST MESH

Facility

$35,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270686889
Hospital Revenue Code	278
Min. Negotiated Rate	$1,006.78
Max. Negotiated Rate	$17,725.00
Rate for Payer: Aetna Commercial	$13,471.00
Rate for Payer: Aetna Medicare Advantage	$10,635.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,039.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,039.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,039.75
Rate for Payer: Cigna Commercial	$17,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,578.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,317.50
Rate for Payer: UnitedHealthcare Community & State	$1,120.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1,006.78

PHASIX ST MESH

Facility

$35,450.00

Service Code	HCPCS C1781
Hospital Charge Code	270686889
Hospital Revenue Code	278
Min. Negotiated Rate	$5,317.50
Max. Negotiated Rate	$8,578.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,578.90
Rate for Payer: Qualcare PPO/HMO/WC	$5,317.50

PHASIX ST MESH 11CM 4ROUND

Facility

$9,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270682097
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

PHASIX ST MESH 11CM 4ROUND

Facility

$9,000.00

Service Code	HCPCS C1781
Hospital Charge Code	270682097
Hospital Revenue Code	278
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$284.40
Rate for Payer: Wellpoint Medicaid Managed Care	$255.60

Know your out-of-pocket cost for care.

All Charges