Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PH URINE

Facility

$390.00

Service Code	HCPCS 81003
Hospital Charge Code	3003860
Hospital Revenue Code	307
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$6.12
Rate for Payer: Aetna Medicare Advantage	$7.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$2.25
Rate for Payer: Clover Medicare Advantage	$2.14
Rate for Payer: EmblemHealth Commercial	$6.75
Rate for Payer: Humana Medicare Advantage	$2.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.25
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	$1.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.25
Rate for Payer: Wellcare Medicare Advantage	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PH URINE

Facility

$390.00

Service Code	HCPCS 81003
Hospital Charge Code	3003860
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PHYSICAL PERFORMANCE TEST

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	84202090
Hospital Revenue Code	420
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.74
Rate for Payer: Aetna Medicare Advantage	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.47
Rate for Payer: Cigna Commercial	$93.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.92
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

PHYSICAL PERFORMANCE TEST

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	84202090
Hospital Revenue Code	420
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.92

PHYSICAL PERF TEST EA 15MIN CQ

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	409197750Q
Hospital Revenue Code	420
Min. Negotiated Rate	$27.92
Max. Negotiated Rate	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$27.92

PHYSICAL PERF TEST EA 15MIN CQ

Facility

$186.15

Service Code	HCPCS 97750GP
Hospital Charge Code	409197750Q
Hospital Revenue Code	420
Min. Negotiated Rate	$5.29
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$70.74
Rate for Payer: Aetna Medicare Advantage	$55.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.47
Rate for Payer: Cigna Commercial	$93.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.92
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.88
Rate for Payer: Wellpoint Medicaid Managed Care	$5.29

PHYS THER FAMILY ED/TRAINING

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	84202130
Hospital Revenue Code	420
Min. Negotiated Rate	$36.67
Max. Negotiated Rate	$36.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.67

PHYS THER FAMILY ED/TRAINING

Facility

$244.50

Service Code	HCPCS 97530GP
Hospital Charge Code	84202130
Hospital Revenue Code	420
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$92.91
Rate for Payer: Aetna Medicare Advantage	$73.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.35
Rate for Payer: Cigna Commercial	$122.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.57
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.67
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$7.73
Rate for Payer: Wellpoint Medicaid Managed Care	$6.94

PHYTONADIONE/1MG/0.5ML

Facility

$31.02

Service Code	HCPCS J3430
Hospital Charge Code	60633662
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$15.51
Rate for Payer: Aetna Commercial	$11.79
Rate for Payer: Aetna Medicare Advantage	$9.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.91
Rate for Payer: Cigna Commercial	$15.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.65
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

PHYTONADIONE/1MG/0.5ML

Facility

$31.02

Service Code	HCPCS J3430
Hospital Charge Code	60633662
Hospital Revenue Code	636
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$7.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.65

PHYTONADIONE 5 MG TAB

Facility

$106.20

Service Code	NDC 55289079302
Hospital Charge Code	60628495
Hospital Revenue Code	250
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$15.93
Rate for Payer: Qualcare PPO/HMO/WC	$15.93

PHYTONADIONE 5 MG TAB

Facility

$106.20

Service Code	NDC 55289079302
Hospital Charge Code	60628495
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$53.10
Rate for Payer: Aetna Commercial	$40.36
Rate for Payer: Aetna Medicare Advantage	$31.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.08
Rate for Payer: Cigna Commercial	$53.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.61
Rate for Payer: Oxford Commercial	$21.24
Rate for Payer: Qualcare PPO/HMO/WC	$15.93
Rate for Payer: UnitedHealthcare Commercial	$21.24
Rate for Payer: UnitedHealthcare Community & State	$3.36
Rate for Payer: Wellpoint Medicaid Managed Care	$3.02

PHYTONADIONE INJ 10MG/ML

Facility

$92.13

Service Code	HCPCS J3430
Hospital Charge Code	6004337
Hospital Revenue Code	636
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$22.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.82

PHYTONADIONE INJ 10MG/ML

Facility

$92.13

Service Code	HCPCS J3430
Hospital Charge Code	6004337
Hospital Revenue Code	636
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$46.06
Rate for Payer: Aetna Commercial	$35.01
Rate for Payer: Aetna Medicare Advantage	$27.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.49
Rate for Payer: Cigna Commercial	$46.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.30
Rate for Payer: Qualcare PPO/HMO/WC	$13.82
Rate for Payer: UnitedHealthcare Community & State	$2.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.62

PICC DECLOTTING

Facility

$397.30

Service Code	HCPCS 36593
Hospital Charge Code	73662001
Hospital Revenue Code	361
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,067.36
Rate for Payer: Aetna Medicare Advantage	$1,271.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,423.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$392.41
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	$1,423.47
Rate for Payer: Cigna Commercial	$786.58
Rate for Payer: Cigna Medicare Advantage	$392.41
Rate for Payer: Clover Medicare Advantage	$372.79
Rate for Payer: EmblemHealth Commercial	$1,177.23
Rate for Payer: Humana Medicare Advantage	$404.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$392.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.30
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.59
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$12.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.41
Rate for Payer: Wellcare Medicare Advantage	$392.41
Rate for Payer: Wellpoint Medicaid Managed Care	$11.28

PICC DECLOTTING

Facility

$397.30

Service Code	HCPCS 36593
Hospital Charge Code	73662001
Hospital Revenue Code	361
Min. Negotiated Rate	$59.59
Max. Negotiated Rate	$59.59
Rate for Payer: Qualcare PPO/HMO/WC	$59.59

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Service Code	HCPCS C1751
Hospital Charge Code	270664038
Hospital Revenue Code	278
Min. Negotiated Rate	$92.44
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,236.90
Rate for Payer: Aetna Medicare Advantage	$976.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$830.02
Rate for Payer: Cigna Commercial	$1,627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25
Rate for Payer: UnitedHealthcare Community & State	$102.86
Rate for Payer: Wellpoint Medicaid Managed Care	$92.44

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Hospital Charge Code	73662011
Hospital Revenue Code	278
Min. Negotiated Rate	$92.44
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,236.90
Rate for Payer: Aetna Medicare Advantage	$976.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$830.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$830.02
Rate for Payer: Cigna Commercial	$1,627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25
Rate for Payer: UnitedHealthcare Community & State	$102.86
Rate for Payer: Wellpoint Medicaid Managed Care	$92.44

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Hospital Charge Code	73662011
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$787.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC DOUBLE LUMEN 5FR

Facility

$3,255.00

Service Code	HCPCS C1751
Hospital Charge Code	270664038
Hospital Revenue Code	278
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$787.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$651.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$787.71
Rate for Payer: Qualcare PPO/HMO/WC	$488.25

PICC INSERTION

Facility

$7,852.40

Service Code	HCPCS 36569
Hospital Charge Code	73662003
Hospital Revenue Code	361
Min. Negotiated Rate	$223.01
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,041.62
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.86
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$248.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$223.01

PICC INSERTION

Facility

$7,852.40

Service Code	HCPCS 36569
Hospital Charge Code	73662003
Hospital Revenue Code	361
Min. Negotiated Rate	$1,177.86
Max. Negotiated Rate	$1,177.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,177.86

PICC LINE INSERTION <5 YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83080010
Hospital Revenue Code	361
Min. Negotiated Rate	$132.03
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.74
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$146.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$132.03

PICC LINE INSERTION <5 YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83080010
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83092010
Hospital Revenue Code	361
Min. Negotiated Rate	$132.03
Max. Negotiated Rate	$6,783.93
Rate for Payer: Aetna Commercial	$5,086.78
Rate for Payer: Aetna Medicare Advantage	$6,059.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,783.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,870.14
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	$6,783.93
Rate for Payer: Cigna Commercial	$3,748.67
Rate for Payer: Cigna Medicare Advantage	$1,870.14
Rate for Payer: Clover Medicare Advantage	$1,776.63
Rate for Payer: EmblemHealth Commercial	$5,610.42
Rate for Payer: Humana Medicare Advantage	$1,926.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,870.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.74
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$697.35
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$146.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,870.14
Rate for Payer: Wellcare Medicare Advantage	$1,870.14
Rate for Payer: Wellpoint Medicaid Managed Care	$132.03

Know your out-of-pocket cost for care.

All Charges