Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PIOGLITAZONE 30 MG TAB

Facility

$127.90

Service Code	NDC 64764030114
Hospital Charge Code	60629055
Hospital Revenue Code	250
Min. Negotiated Rate	$3.63
Max. Negotiated Rate	$63.95
Rate for Payer: Aetna Commercial	$48.60
Rate for Payer: Aetna Medicare Advantage	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.61
Rate for Payer: Cigna Commercial	$63.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.25
Rate for Payer: Oxford Commercial	$25.58
Rate for Payer: Qualcare PPO/HMO/WC	$19.18
Rate for Payer: UnitedHealthcare Commercial	$25.58
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.63

PIOGLITAZONE 30 MG TAB

Facility

$127.90

Service Code	NDC 64764030114
Hospital Charge Code	60629055
Hospital Revenue Code	250
Min. Negotiated Rate	$19.18
Max. Negotiated Rate	$19.18
Rate for Payer: Qualcare PPO/HMO/WC	$19.18

PIOGLITAZONE 45 MG TAB

Facility

$138.76

Service Code	NDC 64764045124
Hospital Charge Code	60629060
Hospital Revenue Code	250
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$20.81
Rate for Payer: Qualcare PPO/HMO/WC	$20.81

PIOGLITAZONE 45 MG TAB

Facility

$138.76

Service Code	NDC 64764045124
Hospital Charge Code	60629060
Hospital Revenue Code	250
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$69.38
Rate for Payer: Aetna Commercial	$52.73
Rate for Payer: Aetna Medicare Advantage	$41.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.38
Rate for Payer: Cigna Commercial	$69.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.08
Rate for Payer: Oxford Commercial	$27.75
Rate for Payer: Qualcare PPO/HMO/WC	$20.81
Rate for Payer: UnitedHealthcare Commercial	$27.75
Rate for Payer: UnitedHealthcare Community & State	$4.38
Rate for Payer: Wellpoint Medicaid Managed Care	$3.94

PIPELINE EMBOLIZATION 4.5X20MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270697151S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,536.12
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,821.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2,536.12

PIPELINE EMBOLIZATION 4.5X20MM

Facility

$89,300.00

Service Code	HCPCS C1889
Hospital Charge Code	270697151S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

PIPERACILLN/TAZOBACT 4.5GM INJ

Facility

$200.87

Service Code	HCPCS J2543
Hospital Charge Code	60632212
Hospital Revenue Code	636
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$100.44
Rate for Payer: Aetna Commercial	$76.33
Rate for Payer: Aetna Medicare Advantage	$60.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.22
Rate for Payer: Cigna Commercial	$100.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.61
Rate for Payer: Qualcare PPO/HMO/WC	$30.13
Rate for Payer: UnitedHealthcare Community & State	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5.70

PIPERACILLN/TAZOBACT 4.5GM INJ

Facility

$200.87

Service Code	HCPCS J2543
Hospital Charge Code	60632212
Hospital Revenue Code	636
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$48.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.61
Rate for Payer: Qualcare PPO/HMO/WC	$30.13

PIPERACLLN/TAZOBACT 2.25GM INJ

Facility

$233.23

Service Code	HCPCS J2543
Hospital Charge Code	60627314
Hospital Revenue Code	636
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$116.61
Rate for Payer: Aetna Commercial	$88.63
Rate for Payer: Aetna Medicare Advantage	$69.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.47
Rate for Payer: Cigna Commercial	$116.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$34.98
Rate for Payer: UnitedHealthcare Community & State	$7.37
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

PIPERACLLN/TAZOBACT 2.25GM INJ

Facility

$233.23

Service Code	HCPCS J2543
Hospital Charge Code	60627314
Hospital Revenue Code	636
Min. Negotiated Rate	$34.98
Max. Negotiated Rate	$56.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.44
Rate for Payer: Qualcare PPO/HMO/WC	$34.98

PIPERCILL/TAZO 3.375GM NS100ML

Facility

$147.07

Service Code	HCPCS J2543
Hospital Charge Code	6010391
Hospital Revenue Code	636
Min. Negotiated Rate	$22.06
Max. Negotiated Rate	$35.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.59
Rate for Payer: Qualcare PPO/HMO/WC	$22.06

PIPERCILL/TAZO 3.375GM NS100ML

Facility

$147.07

Service Code	HCPCS J2543
Hospital Charge Code	6010391
Hospital Revenue Code	636
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$73.53
Rate for Payer: Aetna Commercial	$55.89
Rate for Payer: Aetna Medicare Advantage	$44.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.50
Rate for Payer: Cigna Commercial	$73.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.59
Rate for Payer: Qualcare PPO/HMO/WC	$22.06
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4.18

PITOCIN 10U IN LR 1L

Facility

$9,031.60

Service Code	NDC 61553076904
Hospital Charge Code	60635522
Hospital Revenue Code	250
Min. Negotiated Rate	$1,354.74
Max. Negotiated Rate	$1,354.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,354.74

PITOCIN 10U IN LR 1L

Facility

$9,031.60

Service Code	NDC 61553076904
Hospital Charge Code	60635522
Hospital Revenue Code	250
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$4,515.80
Rate for Payer: Aetna Commercial	$3,432.01
Rate for Payer: Aetna Medicare Advantage	$2,709.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,303.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,303.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,303.06
Rate for Payer: Cigna Commercial	$4,515.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,348.22
Rate for Payer: Oxford Commercial	$1,806.32
Rate for Payer: Qualcare PPO/HMO/WC	$1,354.74
Rate for Payer: UnitedHealthcare Commercial	$1,806.32
Rate for Payer: UnitedHealthcare Community & State	$285.40
Rate for Payer: Wellpoint Medicaid Managed Care	$256.50

PITOCIN 20U IN LR 1L

Facility

$36.85

Service Code	NDC 61553076904
Hospital Charge Code	60635523
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$18.43
Rate for Payer: Aetna Commercial	$14.00
Rate for Payer: Aetna Medicare Advantage	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.40
Rate for Payer: Cigna Commercial	$18.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.58
Rate for Payer: Oxford Commercial	$7.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.53
Rate for Payer: UnitedHealthcare Commercial	$7.37
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

PITOCIN 20U IN LR 1L

Facility

$36.85

Service Code	NDC 61553076904
Hospital Charge Code	60635523
Hospital Revenue Code	250
Min. Negotiated Rate	$5.53
Max. Negotiated Rate	$5.53
Rate for Payer: Qualcare PPO/HMO/WC	$5.53

PIVOT SCHANZ SCREW CLAMP

Facility

$2,005.10

Service Code	HCPCS C1713
Hospital Charge Code	270678084
Hospital Revenue Code	278
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$485.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.23
Rate for Payer: Qualcare PPO/HMO/WC	$300.76

PIVOT SCHANZ SCREW CLAMP

Facility

$2,005.10

Service Code	HCPCS C1713
Hospital Charge Code	270678084
Hospital Revenue Code	278
Min. Negotiated Rate	$56.94
Max. Negotiated Rate	$1,002.55
Rate for Payer: Aetna Commercial	$761.94
Rate for Payer: Aetna Medicare Advantage	$601.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$401.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.30
Rate for Payer: Cigna Commercial	$1,002.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$485.23
Rate for Payer: Qualcare PPO/HMO/WC	$300.76
Rate for Payer: UnitedHealthcare Community & State	$63.36
Rate for Payer: Wellpoint Medicaid Managed Care	$56.94

PK CUST TOT JOINT AVIBMBM01008

Facility

$329.00

Hospital Charge Code	270642269
Hospital Revenue Code	272
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$164.50
Rate for Payer: Aetna Commercial	$125.02
Rate for Payer: Aetna Medicare Advantage	$98.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$83.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$83.89
Rate for Payer: Cigna Commercial	$164.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.54
Rate for Payer: Oxford Commercial	$65.80
Rate for Payer: Qualcare PPO/HMO/WC	$49.35
Rate for Payer: UnitedHealthcare Commercial	$65.80
Rate for Payer: UnitedHealthcare Community & State	$10.40
Rate for Payer: Wellpoint Medicaid Managed Care	$9.34

PK CUST TOT JOINT AVIBMBM01008

Facility

$329.00

Hospital Charge Code	270642269
Hospital Revenue Code	272
Min. Negotiated Rate	$49.35
Max. Negotiated Rate	$49.35
Rate for Payer: Qualcare PPO/HMO/WC	$49.35

PKP FULL THICKNESS

Facility

$21,500.00

Hospital Charge Code	270683331
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

PKP FULL THICKNESS

Facility

$21,500.00

Hospital Charge Code	270683331
Hospital Revenue Code	278
Min. Negotiated Rate	$610.60
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$679.40
Rate for Payer: Wellpoint Medicaid Managed Care	$610.60

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83091020
Hospital Revenue Code	301
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.95
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83080025
Hospital Revenue Code	301
Min. Negotiated Rate	$24.45
Max. Negotiated Rate	$24.45
Rate for Payer: Qualcare PPO/HMO/WC	$24.45

PKU TESTING

Facility

$163.00

Service Code	HCPCS 84030
Hospital Charge Code	83080025
Hospital Revenue Code	301
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.95
Rate for Payer: Cigna Commercial	$81.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.38
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.63

Know your out-of-pocket cost for care.

All Charges