Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLASMINOGEN,FUNCTIONAL

Facility

$48.00

Service Code	HCPCS 85420
Hospital Charge Code	38473151
Hospital Revenue Code	305
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$17.76
Rate for Payer: Aetna Medicare Advantage	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.69
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: Cigna Medicare Advantage	$6.53
Rate for Payer: Clover Medicare Advantage	$6.20
Rate for Payer: EmblemHealth Commercial	$19.59
Rate for Payer: Humana Medicare Advantage	$6.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.53
Rate for Payer: Wellcare Medicare Advantage	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

PLASTER BANDAGE ROLL 4

Facility

$7.50

Hospital Charge Code	270650472
Hospital Revenue Code	272
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.91
Rate for Payer: Cigna Commercial	$3.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Oxford Commercial	$1.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.12
Rate for Payer: UnitedHealthcare Commercial	$1.50
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

PLASTER BANDAGE ROLL 4

Facility

$7.50

Hospital Charge Code	270650472
Hospital Revenue Code	272
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

PLASTIC REP UTERINE CERVIX VAG

Facility

$21,775.20

Service Code	HCPCS 57720
Hospital Charge Code	1600000608
Hospital Revenue Code	360
Min. Negotiated Rate	$618.42
Max. Negotiated Rate	$13,950.60
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
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	$13,950.60
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,661.55
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,266.28
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$688.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$618.42

PLASTIC REP UTERINE CERVIX VAG

Facility

$21,775.20

Service Code	HCPCS 57720
Hospital Charge Code	1600000608
Hospital Revenue Code	360
Min. Negotiated Rate	$3,266.28
Max. Negotiated Rate	$3,266.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,266.28

Plastic Stents

Facility

$355.00

Service Code	HCPCS C2617
Hospital Charge Code	270685515
Hospital Revenue Code	278
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$11.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.08

Plastic Stents

Facility

$355.00

Service Code	HCPCS C2617
Hospital Charge Code	270685516
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

Plastic Stents

Facility

$355.00

Service Code	HCPCS C2617
Hospital Charge Code	270685515
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

Plastic Stents

Facility

$355.00

Service Code	HCPCS C2617
Hospital Charge Code	270685514
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$85.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25

Plastic Stents

Facility

$355.00

Service Code	HCPCS C2617
Hospital Charge Code	270685514
Hospital Revenue Code	278
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$11.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.08

Plastic Stents

Facility

$355.00

Service Code	HCPCS C2617
Hospital Charge Code	270685516
Hospital Revenue Code	278
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$177.50
Rate for Payer: Aetna Commercial	$134.90
Rate for Payer: Aetna Medicare Advantage	$106.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$71.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.53
Rate for Payer: Cigna Commercial	$177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.91
Rate for Payer: Qualcare PPO/HMO/WC	$53.25
Rate for Payer: UnitedHealthcare Community & State	$11.22
Rate for Payer: Wellpoint Medicaid Managed Care	$10.08

PLATE 100DEG TUBULAR 10 HOLE

Facility

$467.50

Service Code	HCPCS C1713
Hospital Charge Code	270688923
Hospital Revenue Code	278
Min. Negotiated Rate	$13.28
Max. Negotiated Rate	$233.75
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare Advantage	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.21
Rate for Payer: Cigna Commercial	$233.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.14
Rate for Payer: Qualcare PPO/HMO/WC	$70.12
Rate for Payer: UnitedHealthcare Community & State	$14.77
Rate for Payer: Wellpoint Medicaid Managed Care	$13.28

PLATE 100DEG TUBULAR 10 HOLE

Facility

$467.50

Service Code	HCPCS C1713
Hospital Charge Code	270688923
Hospital Revenue Code	278
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$113.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.14
Rate for Payer: Qualcare PPO/HMO/WC	$70.12

PLATE 100 DEG TUBULAR 7 HOLE

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	270632799
Hospital Revenue Code	278
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$167.20
Rate for Payer: Aetna Medicare Advantage	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.20
Rate for Payer: Cigna Commercial	$220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: Qualcare PPO/HMO/WC	$66.00
Rate for Payer: UnitedHealthcare Community & State	$13.90
Rate for Payer: Wellpoint Medicaid Managed Care	$12.50

PLATE 100 DEG TUBULAR 7 HOLE

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	270632799
Hospital Revenue Code	278
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$106.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.48
Rate for Payer: Qualcare PPO/HMO/WC	$66.00

PLATE 100 DEG TUBULAR 8 HOLE

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	270682614
Hospital Revenue Code	278
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$145.92
Rate for Payer: Aetna Medicare Advantage	$115.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.92
Rate for Payer: Cigna Commercial	$192.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.93
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
Rate for Payer: UnitedHealthcare Community & State	$12.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.91

PLATE 100 DEG TUBULAR 8 HOLE

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	270682614
Hospital Revenue Code	278
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$92.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.93
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

PLATE 10 HOLE RIGHT DISTAL TIB

Facility

$11,065.00

Hospital Charge Code	270671354
Hospital Revenue Code	278
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$5,532.50
Rate for Payer: Aetna Commercial	$4,204.70
Rate for Payer: Aetna Medicare Advantage	$3,319.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,821.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,821.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,821.57
Rate for Payer: Cigna Commercial	$5,532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,677.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,659.75
Rate for Payer: UnitedHealthcare Community & State	$349.65
Rate for Payer: Wellpoint Medicaid Managed Care	$314.25

PLATE 10 HOLE RIGHT DISTAL TIB

Facility

$11,065.00

Hospital Charge Code	270671354
Hospital Revenue Code	278
Min. Negotiated Rate	$1,659.75
Max. Negotiated Rate	$2,677.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,213.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,677.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,659.75

PLATE 10 HOLE RT CLAV SUP 110M

Facility

$9,801.05

Service Code	HCPCS C1713
Hospital Charge Code	270703717
Hospital Revenue Code	278
Min. Negotiated Rate	$278.35
Max. Negotiated Rate	$4,900.52
Rate for Payer: Aetna Commercial	$3,724.40
Rate for Payer: Aetna Medicare Advantage	$2,940.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,499.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,499.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,960.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,499.27
Rate for Payer: Cigna Commercial	$4,900.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,371.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,470.16
Rate for Payer: UnitedHealthcare Community & State	$309.71
Rate for Payer: Wellpoint Medicaid Managed Care	$278.35

PLATE 10 HOLE RT CLAV SUP 110M

Facility

$9,801.05

Service Code	HCPCS C1713
Hospital Charge Code	270703717
Hospital Revenue Code	278
Min. Negotiated Rate	$1,470.16
Max. Negotiated Rate	$2,371.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,960.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,371.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,470.16

PLATE 10MM

Facility

$12,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270688570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,841.25
Max. Negotiated Rate	$2,970.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,970.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.25

PLATE 10MM

Facility

$12,275.00

Service Code	HCPCS C1713
Hospital Charge Code	270688570
Hospital Revenue Code	278
Min. Negotiated Rate	$348.61
Max. Negotiated Rate	$6,137.50
Rate for Payer: Aetna Commercial	$4,664.50
Rate for Payer: Aetna Medicare Advantage	$3,682.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,130.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,130.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,455.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,130.12
Rate for Payer: Cigna Commercial	$6,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,970.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,841.25
Rate for Payer: UnitedHealthcare Community & State	$387.89
Rate for Payer: Wellpoint Medicaid Managed Care	$348.61

PLATE 10MM DOGBONE

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690341
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

PLATE 10MM DOGBONE

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270690341
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

Know your out-of-pocket cost for care.

All Charges