Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PORPHYRINS 24 HR URINE A

Facility

$390.00

Service Code	HCPCS 84120
Hospital Charge Code	397080010A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PORPHYRINS 24 HR URINE B

Facility

$390.00

Service Code	HCPCS 84110
Hospital Charge Code	397080010B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PORPHYRINS 24 HR URINE B

Facility

$390.00

Service Code	HCPCS 84110
Hospital Charge Code	397080010B
Hospital Revenue Code	301
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$22.96
Rate for Payer: Aetna Medicare Advantage	$27.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.44
Rate for Payer: Clover Medicare Advantage	$8.02
Rate for Payer: EmblemHealth Commercial	$25.32
Rate for Payer: Humana Medicare Advantage	$8.69
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.44
Rate for Payer: Wellcare Medicare Advantage	$8.44
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PORPHYRINS,FRACT,24HR UR

Facility

$390.00

Service Code	HCPCS 84120
Hospital Charge Code	401084120
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.01
Rate for Payer: Aetna Medicare Advantage	$47.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.71
Rate for Payer: Clover Medicare Advantage	$13.97
Rate for Payer: EmblemHealth Commercial	$44.13
Rate for Payer: Humana Medicare Advantage	$15.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.71
Rate for Payer: Wellcare Medicare Advantage	$14.71
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PORPHYRINS,FRACT,24HR UR

Facility

$390.00

Service Code	HCPCS 84120
Hospital Charge Code	401084120
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PORPHYRINS,URINE,QUANT & FCT

Facility

$148.00

Service Code	HCPCS 84120
Hospital Charge Code	38472548
Hospital Revenue Code	301
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$22.20
Rate for Payer: Qualcare PPO/HMO/WC	$22.20

PORPHYRINS,URINE,QUANT & FCT

Facility

$148.00

Service Code	HCPCS 84120
Hospital Charge Code	38472548
Hospital Revenue Code	301
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$40.01
Rate for Payer: Aetna Medicare Advantage	$47.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.36
Rate for Payer: Cigna Commercial	$74.00
Rate for Payer: Cigna Medicare Advantage	$14.71
Rate for Payer: Clover Medicare Advantage	$13.97
Rate for Payer: EmblemHealth Commercial	$44.13
Rate for Payer: Humana Medicare Advantage	$15.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.71
Rate for Payer: Wellcare Medicare Advantage	$14.71
Rate for Payer: Wellpoint Medicaid Managed Care	$4.20

PORT 8 FR LOW PROFILE

Facility

$3,545.55

Service Code	HCPCS C1713
Hospital Charge Code	270701572
Hospital Revenue Code	278
Min. Negotiated Rate	$531.83
Max. Negotiated Rate	$858.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$709.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.02
Rate for Payer: Qualcare PPO/HMO/WC	$531.83

PORT 8 FR LOW PROFILE

Facility

$3,545.55

Service Code	HCPCS C1713
Hospital Charge Code	270701572
Hospital Revenue Code	278
Min. Negotiated Rate	$100.69
Max. Negotiated Rate	$1,772.78
Rate for Payer: Aetna Commercial	$1,347.31
Rate for Payer: Aetna Medicare Advantage	$1,063.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$904.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$904.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$709.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$904.12
Rate for Payer: Cigna Commercial	$1,772.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.02
Rate for Payer: Qualcare PPO/HMO/WC	$531.83
Rate for Payer: UnitedHealthcare Community & State	$112.04
Rate for Payer: Wellpoint Medicaid Managed Care	$100.69

PORTACATH ATTACH 8FR 0605420

Facility

$2,085.00

Service Code	HCPCS C1751
Hospital Charge Code	270614597
Hospital Revenue Code	278
Min. Negotiated Rate	$59.21
Max. Negotiated Rate	$1,042.50
Rate for Payer: Aetna Commercial	$792.30
Rate for Payer: Aetna Medicare Advantage	$625.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.67
Rate for Payer: Cigna Commercial	$1,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: Qualcare PPO/HMO/WC	$312.75
Rate for Payer: UnitedHealthcare Community & State	$65.89
Rate for Payer: Wellpoint Medicaid Managed Care	$59.21

PORTACATH ATTACH 8FR 0605420

Facility

$2,085.00

Service Code	HCPCS C1751
Hospital Charge Code	270614597
Hospital Revenue Code	278
Min. Negotiated Rate	$312.75
Max. Negotiated Rate	$504.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: Qualcare PPO/HMO/WC	$312.75

PORT A CATH POWER PORT 8F S

Facility

$3,215.00

Service Code	HCPCS C1788
Hospital Charge Code	270688735
Hospital Revenue Code	278
Min. Negotiated Rate	$482.25
Max. Negotiated Rate	$778.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$643.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.03
Rate for Payer: Qualcare PPO/HMO/WC	$482.25

PORT A CATH POWER PORT 8F S

Facility

$3,215.00

Service Code	HCPCS C1788
Hospital Charge Code	270688735
Hospital Revenue Code	278
Min. Negotiated Rate	$91.31
Max. Negotiated Rate	$1,607.50
Rate for Payer: Aetna Commercial	$1,221.70
Rate for Payer: Aetna Medicare Advantage	$964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$819.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$819.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$643.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$819.83
Rate for Payer: Cigna Commercial	$1,607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$778.03
Rate for Payer: Qualcare PPO/HMO/WC	$482.25
Rate for Payer: UnitedHealthcare Community & State	$101.59
Rate for Payer: Wellpoint Medicaid Managed Care	$91.31

PORTACATH PRECON 10FR 0607100

Facility

$1,475.00

Service Code	HCPCS C1751
Hospital Charge Code	270614611
Hospital Revenue Code	278
Min. Negotiated Rate	$41.89
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$46.61
Rate for Payer: Wellpoint Medicaid Managed Care	$41.89

PORTACATH PRECON 10FR 0607100

Facility

$1,475.00

Service Code	HCPCS C1751
Hospital Charge Code	270614611
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

PORT A CATH PRECON9.6F 0602610

Facility

$955.00

Service Code	HCPCS C1788
Hospital Charge Code	270614986
Hospital Revenue Code	278
Min. Negotiated Rate	$27.12
Max. Negotiated Rate	$477.50
Rate for Payer: Aetna Commercial	$362.90
Rate for Payer: Aetna Medicare Advantage	$286.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.53
Rate for Payer: Cigna Commercial	$477.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25
Rate for Payer: UnitedHealthcare Community & State	$30.18
Rate for Payer: Wellpoint Medicaid Managed Care	$27.12

PORT A CATH PRECON9.6F 0602610

Facility

$955.00

Service Code	HCPCS C1788
Hospital Charge Code	270614986
Hospital Revenue Code	278
Min. Negotiated Rate	$143.25
Max. Negotiated Rate	$231.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.11
Rate for Payer: Qualcare PPO/HMO/WC	$143.25

PORT ADAPTER Y FEEDING 20F

Facility

$35.88

Hospital Charge Code	270678363
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$17.94
Rate for Payer: Aetna Commercial	$13.63
Rate for Payer: Aetna Medicare Advantage	$10.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.15
Rate for Payer: Cigna Commercial	$17.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.33
Rate for Payer: Oxford Commercial	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$5.38
Rate for Payer: UnitedHealthcare Commercial	$7.18
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

PORT ADAPTER Y FEEDING 20F

Facility

$35.88

Hospital Charge Code	270678363
Hospital Revenue Code	272
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$5.38
Rate for Payer: Qualcare PPO/HMO/WC	$5.38

PORTAL SKID ENDO DIL

Facility

$225.00

Service Code	HCPCS A4649
Hospital Charge Code	270690982
Hospital Revenue Code	272
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

PORTAL SKID ENDO DIL

Facility

$225.00

Service Code	HCPCS A4649
Hospital Charge Code	270690982
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

PORT BIOFLO 6FR PASV VALVED

Facility

$1,975.00

Service Code	HCPCS C1788
Hospital Charge Code	270673515
Hospital Revenue Code	278
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$477.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

PORT BIOFLO 6FR PASV VALVED

Facility

$1,975.00

Service Code	HCPCS C1788
Hospital Charge Code	270673515
Hospital Revenue Code	278
Min. Negotiated Rate	$56.09
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.95
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Community & State	$62.41
Rate for Payer: Wellpoint Medicaid Managed Care	$56.09

PORT BIOFLO 8FR PASV VALVE

Facility

$1,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270704983
Hospital Revenue Code	278
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$332.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

PORT BIOFLO 8FR PASV VALVE

Facility

$1,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270704983
Hospital Revenue Code	278
Min. Negotiated Rate	$39.05
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.75
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Community & State	$43.45
Rate for Payer: Wellpoint Medicaid Managed Care	$39.05

Know your out-of-pocket cost for care.

All Charges