Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PHASIX ST MESH 15CM 6 ROUND

Facility

$23,762.50

Service Code	HCPCS C1781
Hospital Charge Code	270686792
Hospital Revenue Code	278
Min. Negotiated Rate	$674.86
Max. Negotiated Rate	$11,881.25
Rate for Payer: Aetna Commercial	$9,029.75
Rate for Payer: Aetna Medicare Advantage	$7,128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,059.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,059.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,059.44
Rate for Payer: Cigna Commercial	$11,881.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,750.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.38
Rate for Payer: UnitedHealthcare Community & State	$750.89
Rate for Payer: Wellpoint Medicaid Managed Care	$674.86

PHASIX ST MESH 15CM 6 ROUND

Facility

$23,762.50

Service Code	HCPCS C1781
Hospital Charge Code	270686792
Hospital Revenue Code	278
Min. Negotiated Rate	$3,564.38
Max. Negotiated Rate	$5,750.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,750.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,564.38

PHASIX ST MESH 7CMX10CM

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270682374
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 MESH 7CMX10CM

Facility

$9,400.00

Service Code	HCPCS C1781
Hospital Charge Code	270682374
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 MESH 8 CM 3 ROUND

Facility

$9,125.00

Service Code	HCPCS C1781
Hospital Charge Code	270686791
Hospital Revenue Code	278
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$2,208.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

PHASIX ST MESH 8 CM 3 ROUND

Facility

$9,125.00

Service Code	HCPCS C1781
Hospital Charge Code	270686791
Hospital Revenue Code	278
Min. Negotiated Rate	$259.15
Max. Negotiated Rate	$4,562.50
Rate for Payer: Aetna Commercial	$3,467.50
Rate for Payer: Aetna Medicare Advantage	$2,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,326.88
Rate for Payer: Cigna Commercial	$4,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,208.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75
Rate for Payer: UnitedHealthcare Community & State	$288.35
Rate for Payer: Wellpoint Medicaid Managed Care	$259.15

PH BODY FLUID

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	397071187
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH BODY FLUID

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	397071187
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.99
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PH BODY FLUID NOS

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39990241G
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH BODY FLUID NOS

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	39990241G
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.99
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PH BODY FLUID - RESP THERAPY

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	3002045
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PH BODY FLUID - RESP THERAPY

Facility

$390.00

Service Code	HCPCS 83986
Hospital Charge Code	3002045
Hospital Revenue Code	301
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.74
Rate for Payer: Aetna Medicare Advantage	$11.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.99
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.58
Rate for Payer: Clover Medicare Advantage	$3.40
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Humana Medicare Advantage	$3.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.58
Rate for Payer: Wellcare Medicare Advantage	$3.58
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PHENAZOPYRIDINE 100 MG TAB

Facility

$18.09

Service Code	NDC 51293061101
Hospital Charge Code	6022727
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$9.04
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare Advantage	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.61
Rate for Payer: Cigna Commercial	$9.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.70
Rate for Payer: Oxford Commercial	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Commercial	$3.62
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

PHENAZOPYRIDINE 100 MG TAB

Facility

$18.09

Service Code	NDC 51293061101
Hospital Charge Code	6022727
Hospital Revenue Code	251
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

PHENAZOPYRIDINE 200 MG TAB

Facility

$26.80

Service Code	NDC 51293080201
Hospital Charge Code	60628420
Hospital Revenue Code	250
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.02

PHENAZOPYRIDINE 200 MG TAB

Facility

$26.80

Service Code	NDC 51293080201
Hospital Charge Code	60628420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.40
Rate for Payer: Aetna Commercial	$10.18
Rate for Payer: Aetna Medicare Advantage	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.83
Rate for Payer: Cigna Commercial	$13.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.97
Rate for Payer: Oxford Commercial	$5.36
Rate for Payer: Qualcare PPO/HMO/WC	$4.02
Rate for Payer: UnitedHealthcare Commercial	$5.36
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

PHENCYCLIDINE, SERUM (PCP)

Facility

$253.00

Service Code	HCPCS 83992
Hospital Charge Code	38472527
Hospital Revenue Code	301
Min. Negotiated Rate	$37.95
Max. Negotiated Rate	$37.95
Rate for Payer: Qualcare PPO/HMO/WC	$37.95

PHENCYCLIDINE, SERUM (PCP)

Facility

$253.00

Service Code	HCPCS 83992
Hospital Charge Code	38472527
Hospital Revenue Code	301
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$96.14
Rate for Payer: Aetna Medicare Advantage	$75.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.52
Rate for Payer: Cigna Commercial	$126.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$18.00
Rate for Payer: Wellpoint Medicaid Managed Care	$7.19

PHENCYCLIDINE, URINE

Facility

$536.00

Service Code	HCPCS 80300
Hospital Charge Code	38472530
Hospital Revenue Code	301
Min. Negotiated Rate	$15.22
Max. Negotiated Rate	$268.00
Rate for Payer: Aetna Commercial	$203.68
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$136.68
Rate for Payer: Cigna Commercial	$268.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$80.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.94
Rate for Payer: Wellpoint Medicaid Managed Care	$15.22

PHENCYCLIDINE, URINE

Facility

$536.00

Service Code	HCPCS 80300
Hospital Charge Code	38472530
Hospital Revenue Code	301
Min. Negotiated Rate	$80.40
Max. Negotiated Rate	$80.40
Rate for Payer: Qualcare PPO/HMO/WC	$80.40

PHENELZINE 15 MG TAB

Facility

$5.63

Service Code	NDC 43386036021
Hospital Charge Code	606390055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

PHENELZINE 15 MG TAB

Facility

$5.63

Service Code	NDC 43386036021
Hospital Charge Code	606390055
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

PHENOBARBITAL

Facility

$297.00

Service Code	HCPCS 80184
Hospital Charge Code	38472533
Hospital Revenue Code	301
Min. Negotiated Rate	$8.43
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.50
Rate for Payer: Cigna Commercial	$148.50
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.22
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$8.43

PHENOBARBITAL

Facility

$297.00

Service Code	HCPCS 80184
Hospital Charge Code	38479456
Hospital Revenue Code	301
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$44.55
Rate for Payer: Qualcare PPO/HMO/WC	$44.55

PHENOBARBITAL

Facility

$297.00

Service Code	HCPCS 80184
Hospital Charge Code	38472533
Hospital Revenue Code	301
Min. Negotiated Rate	$44.55
Max. Negotiated Rate	$44.55
Rate for Payer: Qualcare PPO/HMO/WC	$44.55

Know your out-of-pocket cost for care.

All Charges