Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PLUG MESH PROLOOP MEDIUM 13704

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651873
Hospital Revenue Code	278
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$311.15
Rate for Payer: Aetna Commercial	$236.47
Rate for Payer: Aetna Medicare Advantage	$186.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.69
Rate for Payer: Cigna Commercial	$311.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34
Rate for Payer: UnitedHealthcare Community & State	$19.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.67

PLUG MESH PROLOOP SMALL

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651874
Hospital Revenue Code	278
Min. Negotiated Rate	$93.34
Max. Negotiated Rate	$150.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34

PLUG MESH PROLOOP SMALL

Facility

$622.30

Service Code	HCPCS C1781
Hospital Charge Code	270651874
Hospital Revenue Code	278
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$311.15
Rate for Payer: Aetna Commercial	$236.47
Rate for Payer: Aetna Medicare Advantage	$186.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$124.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.69
Rate for Payer: Cigna Commercial	$311.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.60
Rate for Payer: Qualcare PPO/HMO/WC	$93.34
Rate for Payer: UnitedHealthcare Community & State	$19.66
Rate for Payer: Wellpoint Medicaid Managed Care	$17.67

PLUG MESH PROLOOP XL

Facility

$673.75

Service Code	HCPCS C1781
Hospital Charge Code	270651876
Hospital Revenue Code	278
Min. Negotiated Rate	$101.06
Max. Negotiated Rate	$163.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.06

PLUG MESH PROLOOP XL

Facility

$673.75

Service Code	HCPCS C1781
Hospital Charge Code	270651876
Hospital Revenue Code	278
Min. Negotiated Rate	$19.13
Max. Negotiated Rate	$336.88
Rate for Payer: Aetna Commercial	$256.02
Rate for Payer: Aetna Medicare Advantage	$202.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$171.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$171.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$171.81
Rate for Payer: Cigna Commercial	$336.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.05
Rate for Payer: Qualcare PPO/HMO/WC	$101.06
Rate for Payer: UnitedHealthcare Community & State	$21.29
Rate for Payer: Wellpoint Medicaid Managed Care	$19.13

PLUG TRUFILL BCA LIQ 1GM

Facility

$23,754.00

Hospital Charge Code	270696473S
Hospital Revenue Code	278
Min. Negotiated Rate	$3,563.10
Max. Negotiated Rate	$5,748.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,748.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,563.10

PLUG TRUFILL BCA LIQ 1GM

Facility

$23,754.00

Hospital Charge Code	270696473S
Hospital Revenue Code	278
Min. Negotiated Rate	$674.61
Max. Negotiated Rate	$11,877.00
Rate for Payer: Aetna Commercial	$9,026.52
Rate for Payer: Aetna Medicare Advantage	$7,126.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,057.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,057.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,750.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,057.27
Rate for Payer: Cigna Commercial	$11,877.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,748.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,563.10
Rate for Payer: UnitedHealthcare Community & State	$750.63
Rate for Payer: Wellpoint Medicaid Managed Care	$674.61

PLUME AWAY

Facility

$199.84

Hospital Charge Code	270663223
Hospital Revenue Code	270
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$99.92
Rate for Payer: Aetna Commercial	$75.94
Rate for Payer: Aetna Medicare Advantage	$59.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.96
Rate for Payer: Cigna Commercial	$99.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.96
Rate for Payer: Oxford Commercial	$39.97
Rate for Payer: Qualcare PPO/HMO/WC	$29.98
Rate for Payer: UnitedHealthcare Commercial	$39.97
Rate for Payer: UnitedHealthcare Community & State	$6.31
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

PLUME AWAY

Facility

$199.84

Hospital Charge Code	270663223
Hospital Revenue Code	270
Min. Negotiated Rate	$29.98
Max. Negotiated Rate	$29.98
Rate for Payer: Qualcare PPO/HMO/WC	$29.98

PL-VAS OV EP MINIMAL VISIT 5 M

Facility

$260.00

Service Code	HCPCS 99211
Hospital Charge Code	75190205
Hospital Revenue Code	510
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

PL-VAS OV EP MINIMAL VISIT 5 M

Facility

$260.00

Service Code	HCPCS 99211
Hospital Charge Code	75190205
Hospital Revenue Code	510
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: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

PL-VAS OV EP PROBLEM FOCUSED

Facility

$365.00

Service Code	HCPCS 99212
Hospital Charge Code	75190215
Hospital Revenue Code	510
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$54.75
Rate for Payer: Qualcare PPO/HMO/WC	$54.75

PL-VAS OV EP PROBLEM FOCUSED

Facility

$365.00

Service Code	HCPCS 99212
Hospital Charge Code	75190215
Hospital Revenue Code	510
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$182.50
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare Advantage	$109.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.08
Rate for Payer: Cigna Commercial	$182.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.90
Rate for Payer: Qualcare PPO/HMO/WC	$54.75
Rate for Payer: UnitedHealthcare Community & State	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.37

PL-VAS OV NP EXPANDED FOCUSED

Facility

$365.00

Service Code	HCPCS 99202
Hospital Charge Code	75190180
Hospital Revenue Code	510
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$54.75
Rate for Payer: Qualcare PPO/HMO/WC	$54.75

PL-VAS OV NP EXPANDED FOCUSED

Facility

$365.00

Service Code	HCPCS 99202
Hospital Charge Code	75190180
Hospital Revenue Code	510
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$182.50
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare Advantage	$109.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.08
Rate for Payer: Cigna Commercial	$182.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.90
Rate for Payer: Qualcare PPO/HMO/WC	$54.75
Rate for Payer: UnitedHealthcare Community & State	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.37

PL-VAS OV PROBLEM FOCUSED

Facility

$260.00

Service Code	HCPCS 99201
Hospital Charge Code	83033020
Hospital Revenue Code	510
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

PL-VAS OV PROBLEM FOCUSED

Facility

$260.00

Service Code	HCPCS 99201
Hospital Charge Code	83033020
Hospital Revenue Code	510
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: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

P-MASTECTOMY W/LN REMOVAL BL

Facility

$42,601.70

Service Code	HCPCS 19302
Hospital Charge Code	16000439
Hospital Revenue Code	360
Min. Negotiated Rate	$1,209.89
Max. Negotiated Rate	$28,616.22
Rate for Payer: Aetna Commercial	$21,457.24
Rate for Payer: Aetna Medicare Advantage	$25,559.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,616.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,616.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,888.69
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	$28,616.22
Rate for Payer: Cigna Commercial	$15,812.86
Rate for Payer: Cigna Medicare Advantage	$7,888.69
Rate for Payer: Clover Medicare Advantage	$7,494.26
Rate for Payer: EmblemHealth Commercial	$23,666.07
Rate for Payer: Humana Medicare Advantage	$8,125.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,888.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,076.44
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,346.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,888.69
Rate for Payer: Wellcare Medicare Advantage	$7,888.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,209.89

P-MASTECTOMY W/LN REMOVAL BL

Facility

$42,601.70

Service Code	HCPCS 19302
Hospital Charge Code	16000439
Hospital Revenue Code	360
Min. Negotiated Rate	$6,390.26
Max. Negotiated Rate	$6,390.26
Rate for Payer: Qualcare PPO/HMO/WC	$6,390.26

PML RARA T (15:17)) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708015C
Hospital Revenue Code	301
Min. Negotiated Rate	$40.16
Max. Negotiated Rate	$752.02
Rate for Payer: Aetna Commercial	$563.88
Rate for Payer: Aetna Medicare Advantage	$671.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$207.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.02
Rate for Payer: Cigna Commercial	$707.08
Rate for Payer: Cigna Medicare Advantage	$207.31
Rate for Payer: Clover Medicare Advantage	$196.94
Rate for Payer: EmblemHealth Commercial	$621.93
Rate for Payer: Humana Medicare Advantage	$213.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$207.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.12
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$165.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$207.31
Rate for Payer: Wellcare Medicare Advantage	$207.31
Rate for Payer: Wellpoint Medicaid Managed Care	$40.16

PML RARA T (15:17)) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708015C
Hospital Revenue Code	301
Min. Negotiated Rate	$212.12
Max. Negotiated Rate	$212.12
Rate for Payer: Qualcare PPO/HMO/WC	$212.12

PML RARA T (1517) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708019
Hospital Revenue Code	310
Min. Negotiated Rate	$40.16
Max. Negotiated Rate	$752.02
Rate for Payer: Aetna Commercial	$563.88
Rate for Payer: Aetna Medicare Advantage	$671.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$207.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.02
Rate for Payer: Cigna Commercial	$707.08
Rate for Payer: Cigna Medicare Advantage	$207.31
Rate for Payer: Clover Medicare Advantage	$196.94
Rate for Payer: EmblemHealth Commercial	$621.93
Rate for Payer: Humana Medicare Advantage	$213.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$207.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$367.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$212.12
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$165.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$207.31
Rate for Payer: Wellcare Medicare Advantage	$207.31
Rate for Payer: Wellpoint Medicaid Managed Care	$40.16

PML RARA T (1517) QUANT PCR

Facility

$1,414.15

Service Code	HCPCS 81315
Hospital Charge Code	39708019
Hospital Revenue Code	310
Min. Negotiated Rate	$212.12
Max. Negotiated Rate	$212.12
Rate for Payer: Qualcare PPO/HMO/WC	$212.12

PM Oxycodone Quant Urine

Facility

$499.75

Service Code	HCPCS 80365
Hospital Charge Code	39900531
Hospital Revenue Code	301
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$249.88
Rate for Payer: Aetna Commercial	$189.91
Rate for Payer: Aetna Medicare Advantage	$149.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.44
Rate for Payer: Cigna Commercial	$249.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.96
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$22.05
Rate for Payer: Wellpoint Medicaid Managed Care	$14.19

PM Oxycodone Quant Urine

Facility

$499.75

Service Code	HCPCS 80365
Hospital Charge Code	39900531
Hospital Revenue Code	301
Min. Negotiated Rate	$74.96
Max. Negotiated Rate	$74.96
Rate for Payer: Qualcare PPO/HMO/WC	$74.96

Know your out-of-pocket cost for care.

All Charges