Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PL CATH ART 2ND A/P-BI

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	7411105
Hospital Revenue Code	361
Min. Negotiated Rate	$1,304.55
Max. Negotiated Rate	$1,304.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55

PL CATH ART 2ND A/P-BI

Facility

$8,697.00

Service Code	HCPCS 3624650
Hospital Charge Code	3668362465
Hospital Revenue Code	361
Min. Negotiated Rate	$246.99
Max. Negotiated Rate	$4,348.50
Rate for Payer: Aetna Commercial	$3,304.86
Rate for Payer: Aetna Medicare Advantage	$2,609.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,217.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,217.74
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	$2,217.74
Rate for Payer: Cigna Commercial	$4,348.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,261.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,304.55
Rate for Payer: UnitedHealthcare Community & State	$274.83
Rate for Payer: Wellpoint Medicaid Managed Care	$246.99

PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	366836216L
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	7411089
Hospital Revenue Code	361
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	366836216L
Hospital Revenue Code	361
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.78
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Community & State	$12.73
Rate for Payer: Wellpoint Medicaid Managed Care	$11.45

PL CATH ART 2ND T/B-LT

Facility

$403.00

Service Code	HCPCS 36216LT
Hospital Charge Code	7411089
Hospital Revenue Code	361
Min. Negotiated Rate	$11.45
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$153.14
Rate for Payer: Aetna Medicare Advantage	$120.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.77
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	$102.77
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.78
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Community & State	$12.73
Rate for Payer: Wellpoint Medicaid Managed Care	$11.45

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	366836247L
Hospital Revenue Code	361
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	366836247L
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	7411113
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-LT

Facility

$484.00

Service Code	HCPCS 36247LT
Hospital Charge Code	7411113
Hospital Revenue Code	361
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	366836247R
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	366836247R
Hospital Revenue Code	361
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	7411115
Hospital Revenue Code	361
Min. Negotiated Rate	$72.60
Max. Negotiated Rate	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$72.60

PL CATH ART 3RD A/P-RT

Facility

$484.00

Service Code	HCPCS 36247RT
Hospital Charge Code	7411115
Hospital Revenue Code	361
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$183.92
Rate for Payer: Aetna Medicare Advantage	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.42
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	$123.42
Rate for Payer: Cigna Commercial	$242.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.84
Rate for Payer: Qualcare PPO/HMO/WC	$72.60
Rate for Payer: UnitedHealthcare Community & State	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

PLEDGET FELT 1 X 1

Facility

$210.53

Hospital Charge Code	270669534
Hospital Revenue Code	272
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$31.58
Rate for Payer: Qualcare PPO/HMO/WC	$31.58

PLEDGET FELT 1 X 1

Facility

$210.53

Hospital Charge Code	270669534
Hospital Revenue Code	272
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$105.27
Rate for Payer: Aetna Commercial	$80.00
Rate for Payer: Aetna Medicare Advantage	$63.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.69
Rate for Payer: Cigna Commercial	$105.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.74
Rate for Payer: Oxford Commercial	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$31.58
Rate for Payer: UnitedHealthcare Commercial	$42.11
Rate for Payer: UnitedHealthcare Community & State	$6.65
Rate for Payer: Wellpoint Medicaid Managed Care	$5.98

PLEDGET FIRM TFE 1/4x1/8

Facility

$14.62

Hospital Charge Code	270671495
Hospital Revenue Code	272
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$2.19

PLEDGET FIRM TFE 1/4x1/8

Facility

$14.62

Hospital Charge Code	270671495
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$7.31
Rate for Payer: Aetna Commercial	$5.56
Rate for Payer: Aetna Medicare Advantage	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.73
Rate for Payer: Cigna Commercial	$7.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.80
Rate for Payer: Oxford Commercial	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$2.19
Rate for Payer: UnitedHealthcare Commercial	$2.92
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

PLEDGET PRE PUNCH MM ST

Facility

$17.43

Hospital Charge Code	270661057
Hospital Revenue Code	272
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.61

PLEDGET PRE PUNCH MM ST

Facility

$17.43

Hospital Charge Code	270661057
Hospital Revenue Code	272
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.71
Rate for Payer: Aetna Commercial	$6.62
Rate for Payer: Aetna Medicare Advantage	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.44
Rate for Payer: Cigna Commercial	$8.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.53
Rate for Payer: Oxford Commercial	$3.49
Rate for Payer: Qualcare PPO/HMO/WC	$2.61
Rate for Payer: UnitedHealthcare Commercial	$3.49
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

PLEDGETS FELT 8MMX8MM 007972

Facility

$5.50

Service Code	HCPCS C1713
Hospital Charge Code	270634715
Hospital Revenue Code	278
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.75
Rate for Payer: Aetna Commercial	$2.09
Rate for Payer: Aetna Medicare Advantage	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.40
Rate for Payer: Cigna Commercial	$2.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

PLEDGETS FELT 8MMX8MM 007972

Facility

$5.50

Service Code	HCPCS C1713
Hospital Charge Code	270634715
Hospital Revenue Code	278
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

PLEDGET TFE SOFT 1/4x1/8

Facility

$13.23

Hospital Charge Code	270671496
Hospital Revenue Code	272
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.62
Rate for Payer: Aetna Commercial	$5.03
Rate for Payer: Aetna Medicare Advantage	$3.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.44
Rate for Payer: Oxford Commercial	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.65
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

PLEDGET TFE SOFT 1/4x1/8

Facility

$13.23

Hospital Charge Code	270671496
Hospital Revenue Code	272
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Qualcare PPO/HMO/WC	$1.98

PLEURAL EFFUSION WITH CC

Facility

$50,713.88

Service Code	MSDRG 187
Min. Negotiated Rate	$15,441.73
Max. Negotiated Rate	$50,713.88
Rate for Payer: Aetna Commercial	$37,977.51
Rate for Payer: Aetna Medicare Advantage	$50,713.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,254.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27,705.00
Rate for Payer: Cigna Commercial	$22,050.01
Rate for Payer: Cigna Medicare Advantage	$16,254.45
Rate for Payer: Clover Medicare Advantage	$15,441.73
Rate for Payer: EmblemHealth Commercial	$48,763.35
Rate for Payer: Humana Medicare Advantage	$16,742.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,254.45
Rate for Payer: Oxford Commercial	$17,427.94
Rate for Payer: UnitedHealthcare Commercial	$23,327.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,254.45
Rate for Payer: Wellcare Medicare Advantage	$16,254.45

Know your out-of-pocket cost for care.

All Charges