Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLMT URETRL STNT NEW WO CTH LT

Facility

$13,218.42

Service Code	HCPCS 50694LT
Hospital Charge Code	2011592
Hospital Revenue Code	361
Min. Negotiated Rate	$375.40
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,436.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$417.70
Rate for Payer: Wellpoint Medicaid Managed Care	$375.40

PLMT URETRL STNT NEW WO CTH RT

Facility

$13,218.42

Service Code	HCPCS 50694RT
Hospital Charge Code	2011585
Hospital Revenue Code	361
Min. Negotiated Rate	$1,982.76
Max. Negotiated Rate	$1,982.76
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76

PLMT URETRL STNT NEW WO CTH RT

Facility

$13,218.42

Service Code	HCPCS 50694RT
Hospital Charge Code	2011585
Hospital Revenue Code	361
Min. Negotiated Rate	$375.40
Max. Negotiated Rate	$6,609.21
Rate for Payer: Aetna Commercial	$5,023.00
Rate for Payer: Aetna Medicare Advantage	$3,965.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,370.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,370.70
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	$3,370.70
Rate for Payer: Cigna Commercial	$6,609.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,436.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,982.76
Rate for Payer: UnitedHealthcare Community & State	$417.70
Rate for Payer: Wellpoint Medicaid Managed Care	$375.40

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	321034709
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	321034709
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	2004959
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

PLMT XTN PROSTH EVASC RPR

Facility

$13,570.00

Service Code	HCPCS 34709
Hospital Charge Code	2004959
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
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	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

PLS AIM GUIDES .9MM X 10 DEG

Facility

$260.00

Hospital Charge Code	270671010
Hospital Revenue Code	272
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

PLS AIM GUIDES .9MM X 10 DEG

Facility

$260.00

Hospital Charge Code	270671010
Hospital Revenue Code	272
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Oxford Commercial	$52.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Commercial	$52.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

PLSTC OP URTHRL SPHINCTER,VAGL

Facility

$42,389.30

Service Code	HCPCS 57220
Hospital Charge Code	1600000862
Hospital Revenue Code	360
Min. Negotiated Rate	$6,358.40
Max. Negotiated Rate	$6,358.40
Rate for Payer: Qualcare PPO/HMO/WC	$6,358.40

PLSTC OP URTHRL SPHINCTER,VAGL

Facility

$42,389.30

Service Code	HCPCS 57220
Hospital Charge Code	1600000862
Hospital Revenue Code	360
Min. Negotiated Rate	$1,203.86
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,021.22
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,358.40
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,339.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,203.86

PLT AB HEPARIN IND

Facility

$309.00

Service Code	HCPCS 86022
Hospital Charge Code	38478102
Hospital Revenue Code	309
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$59.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.64
Rate for Payer: Cigna Commercial	$154.50
Rate for Payer: Cigna Medicare Advantage	$18.37
Rate for Payer: Clover Medicare Advantage	$17.45
Rate for Payer: EmblemHealth Commercial	$55.11
Rate for Payer: Humana Medicare Advantage	$18.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.34
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$46.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.37
Rate for Payer: Wellcare Medicare Advantage	$18.37
Rate for Payer: Wellpoint Medicaid Managed Care	$8.78

PLT AB HEPARIN IND

Facility

$309.00

Service Code	HCPCS 86022
Hospital Charge Code	38478102
Hospital Revenue Code	309
Min. Negotiated Rate	$46.35
Max. Negotiated Rate	$46.35
Rate for Payer: Qualcare PPO/HMO/WC	$46.35

PLT AGGREGATION

Facility

$151.00

Service Code	HCPCS 85576
Hospital Charge Code	38478101
Hospital Revenue Code	305
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$22.65
Rate for Payer: Qualcare PPO/HMO/WC	$22.65

PLT AGGREGATION

Facility

$151.00

Service Code	HCPCS 85576
Hospital Charge Code	38478101
Hospital Revenue Code	305
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.36
Rate for Payer: Cigna Commercial	$75.50
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.26
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

PLT ANT CERV ATLANTIS 27.5 MM

Facility

$10,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270691793
Hospital Revenue Code	278
Min. Negotiated Rate	$1,576.50
Max. Negotiated Rate	$2,543.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,543.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.50

PLT ANT CERV ATLANTIS 27.5 MM

Facility

$10,510.00

Service Code	HCPCS C1713
Hospital Charge Code	270691793
Hospital Revenue Code	278
Min. Negotiated Rate	$298.48
Max. Negotiated Rate	$5,255.00
Rate for Payer: Aetna Commercial	$3,993.80
Rate for Payer: Aetna Medicare Advantage	$3,153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,680.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,680.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,680.05
Rate for Payer: Cigna Commercial	$5,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,543.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,576.50
Rate for Payer: UnitedHealthcare Community & State	$332.12
Rate for Payer: Wellpoint Medicaid Managed Care	$298.48

PLT CLOVER VA-LCP 2.7 MM FUS

Facility

$4,868.60

Service Code	HCPCS C1713
Hospital Charge Code	270691568
Hospital Revenue Code	278
Min. Negotiated Rate	$730.29
Max. Negotiated Rate	$1,178.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.20
Rate for Payer: Qualcare PPO/HMO/WC	$730.29

PLT CLOVER VA-LCP 2.7 MM FUS

Facility

$4,868.60

Service Code	HCPCS C1713
Hospital Charge Code	270691568
Hospital Revenue Code	278
Min. Negotiated Rate	$138.27
Max. Negotiated Rate	$2,434.30
Rate for Payer: Aetna Commercial	$1,850.07
Rate for Payer: Aetna Medicare Advantage	$1,460.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,241.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,241.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$973.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,241.49
Rate for Payer: Cigna Commercial	$2,434.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,178.20
Rate for Payer: Qualcare PPO/HMO/WC	$730.29
Rate for Payer: UnitedHealthcare Community & State	$153.85
Rate for Payer: Wellpoint Medicaid Managed Care	$138.27

PLT PERMTR CALCAN FRAC SM RT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693864
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PLT PERMTR CALCAN FRAC SM RT

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270693864
Hospital Revenue Code	278
Min. Negotiated Rate	$155.49
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$173.01
Rate for Payer: Wellpoint Medicaid Managed Care	$155.49

PLT PRX HUM HI LT 4H 90MM

Facility

$7,095.00

Service Code	HCPCS C1713
Hospital Charge Code	270693599
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.25
Max. Negotiated Rate	$1,716.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25

PLT PRX HUM HI LT 4H 90MM

Facility

$7,095.00

Service Code	HCPCS C1713
Hospital Charge Code	270693599
Hospital Revenue Code	278
Min. Negotiated Rate	$201.50
Max. Negotiated Rate	$3,547.50
Rate for Payer: Aetna Commercial	$2,696.10
Rate for Payer: Aetna Medicare Advantage	$2,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,809.22
Rate for Payer: Cigna Commercial	$3,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25
Rate for Payer: UnitedHealthcare Community & State	$224.20
Rate for Payer: Wellpoint Medicaid Managed Care	$201.50

PLT SPINAL HA MIS FUSION

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693153
Hospital Revenue Code	278
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$9,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PLT SPINAL HA MIS FUSION

Facility

$40,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693153
Hospital Revenue Code	278
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

Know your out-of-pocket cost for care.

All Charges