Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PICC LINE INSERTION < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83092010
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	83090001
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 < 5YRS OLD

Facility

$4,649.00

Service Code	HCPCS 36568
Hospital Charge Code	83090001
Hospital Revenue Code	361
Min. Negotiated Rate	$697.35
Max. Negotiated Rate	$697.35
Rate for Payer: Qualcare PPO/HMO/WC	$697.35

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	270664037
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$1,197.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Community & State	$99.54
Rate for Payer: Wellpoint Medicaid Managed Care	$89.46

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	270664037
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	73662010
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

PICC SINGLE LUMEN 4FR

Facility

$3,150.00

Service Code	HCPCS C1751
Hospital Charge Code	73662010
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$1,197.00
Rate for Payer: Aetna Medicare Advantage	$945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$803.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$803.25
Rate for Payer: Cigna Commercial	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Community & State	$99.54
Rate for Payer: Wellpoint Medicaid Managed Care	$89.46

PICC SINGLE LUMEN 5FR

Facility

$608.50

Hospital Charge Code	270669641
Hospital Revenue Code	278
Min. Negotiated Rate	$91.28
Max. Negotiated Rate	$147.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.26
Rate for Payer: Qualcare PPO/HMO/WC	$91.28

PICC SINGLE LUMEN 5FR

Facility

$608.50

Hospital Charge Code	270669641
Hospital Revenue Code	278
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$304.25
Rate for Payer: Aetna Commercial	$231.23
Rate for Payer: Aetna Medicare Advantage	$182.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$121.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.17
Rate for Payer: Cigna Commercial	$304.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.26
Rate for Payer: Qualcare PPO/HMO/WC	$91.28
Rate for Payer: UnitedHealthcare Community & State	$19.23
Rate for Payer: Wellpoint Medicaid Managed Care	$17.28

PICC TOTAL REPLACEMENT

Facility

$4,221.55

Service Code	HCPCS 36584
Hospital Charge Code	73662005
Hospital Revenue Code	361
Min. Negotiated Rate	$633.23
Max. Negotiated Rate	$633.23
Rate for Payer: Qualcare PPO/HMO/WC	$633.23

PICC TOTAL REPLACEMENT

Facility

$4,221.55

Service Code	HCPCS 36584
Hospital Charge Code	73662005
Hospital Revenue Code	361
Min. Negotiated Rate	$119.89
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	$1,097.60
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$633.23
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$133.40
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	$119.89

PICC TRIPLE LUMEN 5FR

Facility

$3,745.50

Hospital Charge Code	270664039
Hospital Revenue Code	278
Min. Negotiated Rate	$106.37
Max. Negotiated Rate	$1,872.75
Rate for Payer: Aetna Commercial	$1,423.29
Rate for Payer: Aetna Medicare Advantage	$1,123.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$955.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$955.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$749.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$955.10
Rate for Payer: Cigna Commercial	$1,872.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.41
Rate for Payer: Qualcare PPO/HMO/WC	$561.83
Rate for Payer: UnitedHealthcare Community & State	$118.36
Rate for Payer: Wellpoint Medicaid Managed Care	$106.37

PICC TRIPLE LUMEN 5FR

Facility

$3,745.50

Hospital Charge Code	270664039
Hospital Revenue Code	278
Min. Negotiated Rate	$561.83
Max. Negotiated Rate	$906.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$749.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$906.41
Rate for Payer: Qualcare PPO/HMO/WC	$561.83

PICK UP STAT

Facility

$10.00

Service Code	HCPCS 99199
Hospital Charge Code	39999999
Hospital Revenue Code	999
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.50

PICK UP STAT

Facility

$10.00

Service Code	HCPCS 99199
Hospital Charge Code	39999999
Hospital Revenue Code	999
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$5.00
Rate for Payer: Aetna Commercial	$3.80
Rate for Payer: Aetna Medicare Advantage	$3.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.55
Rate for Payer: Cigna Commercial	$5.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

PICO 7 NEG PRESS 2 DRESS 15x30

Facility

$1,160.00

Hospital Charge Code	270697769
Hospital Revenue Code	272
Min. Negotiated Rate	$32.94
Max. Negotiated Rate	$580.00
Rate for Payer: Aetna Commercial	$440.80
Rate for Payer: Aetna Medicare Advantage	$348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.80
Rate for Payer: Cigna Commercial	$580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.60
Rate for Payer: Oxford Commercial	$232.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.00
Rate for Payer: UnitedHealthcare Commercial	$232.00
Rate for Payer: UnitedHealthcare Community & State	$36.66
Rate for Payer: Wellpoint Medicaid Managed Care	$32.94

PICO 7 NEG PRESS 2 DRESS 15x30

Facility

$1,160.00

Hospital Charge Code	270697769
Hospital Revenue Code	272
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$174.00
Rate for Payer: Qualcare PPO/HMO/WC	$174.00

PIERCE SKULL IMPLANT DEVICE

Facility

$13,423.00

Service Code	HCPCS 61210
Hospital Charge Code	1600000593
Hospital Revenue Code	360
Min. Negotiated Rate	$381.21
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,100.74
Rate for Payer: Aetna Medicare Advantage	$4,026.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,422.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,422.86
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	$3,422.86
Rate for Payer: Cigna Commercial	$6,711.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,489.98
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.45
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$424.17
Rate for Payer: Wellpoint Medicaid Managed Care	$381.21

PIERCE SKULL IMPLANT DEVICE

Facility

$13,423.00

Service Code	HCPCS 61210
Hospital Charge Code	1600000593
Hospital Revenue Code	360
Min. Negotiated Rate	$2,013.45
Max. Negotiated Rate	$2,013.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,013.45

PIGGY BACK

Facility

$2,290.00

Hospital Charge Code	270665306
Hospital Revenue Code	270
Min. Negotiated Rate	$65.04
Max. Negotiated Rate	$1,145.00
Rate for Payer: Aetna Commercial	$870.20
Rate for Payer: Aetna Medicare Advantage	$687.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$583.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$583.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$583.95
Rate for Payer: Cigna Commercial	$1,145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$595.40
Rate for Payer: Oxford Commercial	$458.00
Rate for Payer: Qualcare PPO/HMO/WC	$343.50
Rate for Payer: UnitedHealthcare Commercial	$458.00
Rate for Payer: UnitedHealthcare Community & State	$72.36
Rate for Payer: Wellpoint Medicaid Managed Care	$65.04

PIGGY BACK

Facility

$2,290.00

Hospital Charge Code	270665306
Hospital Revenue Code	270
Min. Negotiated Rate	$343.50
Max. Negotiated Rate	$343.50
Rate for Payer: Qualcare PPO/HMO/WC	$343.50

PILLCAM SB 3 CAPSULE

Facility

$2,650.00

Hospital Charge Code	270690170
Hospital Revenue Code	271
Min. Negotiated Rate	$397.50
Max. Negotiated Rate	$397.50
Rate for Payer: Qualcare PPO/HMO/WC	$397.50

PILLCAM SB 3 CAPSULE

Facility

$2,650.00

Hospital Charge Code	270690170
Hospital Revenue Code	271
Min. Negotiated Rate	$75.26
Max. Negotiated Rate	$1,325.00
Rate for Payer: Aetna Commercial	$1,007.00
Rate for Payer: Aetna Medicare Advantage	$795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$675.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$675.75
Rate for Payer: Cigna Commercial	$1,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$689.00
Rate for Payer: Oxford Commercial	$530.00
Rate for Payer: Qualcare PPO/HMO/WC	$397.50
Rate for Payer: UnitedHealthcare Commercial	$530.00
Rate for Payer: UnitedHealthcare Community & State	$83.74
Rate for Payer: Wellpoint Medicaid Managed Care	$75.26

PILLCAM SENSOR BELT 2 DISP

Facility

$30.00

Hospital Charge Code	270690171
Hospital Revenue Code	270
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

PILLCAM SENSOR BELT 2 DISP

Facility

$30.00

Hospital Charge Code	270690171
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

Know your out-of-pocket cost for care.

All Charges