Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PREGABALIN

Facility

$72.40

Service Code	HCPCS 80299
Hospital Charge Code	39708027
Hospital Revenue Code	301
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$36.20
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.86
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

PREGABALIN 100 MG CAP

Facility

$38.59

Service Code	NDC 71101568
Hospital Charge Code	60629900
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.03
Rate for Payer: Oxford Commercial	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$7.72
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

PREGABALIN 100 MG CAP

Facility

$38.59

Service Code	NDC 71101568
Hospital Charge Code	60629900
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN 25 MG CAP

Facility

$38.59

Service Code	NDC 71101268
Hospital Charge Code	60629877
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN 25 MG CAP

Facility

$38.59

Service Code	NDC 71101268
Hospital Charge Code	60629877
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.03
Rate for Payer: Oxford Commercial	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$7.72
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

PREGABALIN 50 MG CAP

Facility

$38.59

Service Code	NDC 71101368
Hospital Charge Code	60629899
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN 50 MG CAP

Facility

$38.59

Service Code	NDC 71101368
Hospital Charge Code	60629899
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.03
Rate for Payer: Oxford Commercial	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$7.72
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

PREGABALIN 75 MG CAP

Facility

$38.59

Service Code	NDC 71101468
Hospital Charge Code	60629881
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

PREGABALIN 75 MG CAP

Facility

$38.59

Service Code	NDC 71101468
Hospital Charge Code	60629881
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.03
Rate for Payer: Oxford Commercial	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$7.72
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

PREGNANCY>1ST TRIM SGL

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	94061169
Hospital Revenue Code	402
Min. Negotiated Rate	$106.59
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.00
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$211.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$190.28

PREGNANCY>1ST TRIM SGL

Facility

$6,700.00

Service Code	HCPCS 76805
Hospital Charge Code	94061169
Hospital Revenue Code	402
Min. Negotiated Rate	$1,005.00
Max. Negotiated Rate	$1,005.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.00

PREGNANCY,URINE-QUAL/VISUAL

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	38477014
Hospital Revenue Code	307
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$62.16

PREGNANCY,URINE-QUAL/VISUAL

Facility

$414.40

Service Code	HCPCS 81025
Hospital Charge Code	38477014
Hospital Revenue Code	307
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$207.20
Rate for Payer: Aetna Commercial	$23.42
Rate for Payer: Aetna Medicare Advantage	$27.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.23
Rate for Payer: Cigna Commercial	$207.20
Rate for Payer: Cigna Medicare Advantage	$8.61
Rate for Payer: Clover Medicare Advantage	$8.18
Rate for Payer: EmblemHealth Commercial	$25.83
Rate for Payer: Humana Medicare Advantage	$8.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.16
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.61
Rate for Payer: Wellcare Medicare Advantage	$8.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.77

PREGN-ASSC PLASMA PROTEIN-A

Facility

$106.00

Service Code	HCPCS 84163
Hospital Charge Code	38477128
Hospital Revenue Code	301
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

PREGN-ASSC PLASMA PROTEIN-A

Facility

$106.00

Service Code	HCPCS 84163
Hospital Charge Code	38477128
Hospital Revenue Code	301
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

PREGNENOLONE

Facility

$146.00

Service Code	HCPCS 84140
Hospital Charge Code	38477168
Hospital Revenue Code	301
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

PREGNENOLONE

Facility

$142.10

Service Code	HCPCS 84140
Hospital Charge Code	39900121
Hospital Revenue Code	301
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$56.22
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.98
Rate for Payer: Cigna Commercial	$71.05
Rate for Payer: Cigna Medicare Advantage	$20.67
Rate for Payer: Clover Medicare Advantage	$19.64
Rate for Payer: EmblemHealth Commercial	$62.01
Rate for Payer: Humana Medicare Advantage	$21.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.95
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.32
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.67
Rate for Payer: Wellcare Medicare Advantage	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.04

PREGNENOLONE

Facility

$146.00

Service Code	HCPCS 84140
Hospital Charge Code	38477168
Hospital Revenue Code	301
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$56.22
Rate for Payer: Aetna Medicare Advantage	$66.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.98
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: Cigna Medicare Advantage	$20.67
Rate for Payer: Clover Medicare Advantage	$19.64
Rate for Payer: EmblemHealth Commercial	$62.01
Rate for Payer: Humana Medicare Advantage	$21.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.67
Rate for Payer: Wellcare Medicare Advantage	$20.67
Rate for Payer: Wellpoint Medicaid Managed Care	$4.15

PREGNENOLONE

Facility

$142.10

Service Code	HCPCS 84140
Hospital Charge Code	39900121
Hospital Revenue Code	301
Min. Negotiated Rate	$21.32
Max. Negotiated Rate	$21.32
Rate for Payer: Qualcare PPO/HMO/WC	$21.32

PREG TEST (SERUM HCG QUAL)

Facility

$667.59

Service Code	HCPCS 84703
Hospital Charge Code	3006350
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

PREG TEST (SERUM HCG QUAL)

Facility

$667.59

Service Code	HCPCS 84703
Hospital Charge Code	3006350
Hospital Revenue Code	301
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$20.45
Rate for Payer: Aetna Medicare Advantage	$24.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.28
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$7.52
Rate for Payer: Clover Medicare Advantage	$7.14
Rate for Payer: EmblemHealth Commercial	$22.56
Rate for Payer: Humana Medicare Advantage	$7.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.52
Rate for Payer: Wellcare Medicare Advantage	$7.52
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

PREKALLIKREIN(FLETCHER FACTOR)

Facility

$233.00

Service Code	HCPCS 85292
Hospital Charge Code	401385292
Hospital Revenue Code	305
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$34.95
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

PREKALLIKREIN(FLETCHER FACTOR)

Facility

$233.00

Service Code	HCPCS 85292
Hospital Charge Code	401385292
Hospital Revenue Code	305
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$51.49
Rate for Payer: Aetna Medicare Advantage	$61.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.67
Rate for Payer: Cigna Commercial	$116.50
Rate for Payer: Cigna Medicare Advantage	$18.93
Rate for Payer: Clover Medicare Advantage	$17.98
Rate for Payer: EmblemHealth Commercial	$56.79
Rate for Payer: Humana Medicare Advantage	$19.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.58
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.93
Rate for Payer: Wellcare Medicare Advantage	$18.93
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

PRELUDE SYNC EVO DEVICE

Facility

$125.00

Service Code	HCPCS A4649
Hospital Charge Code	270692530S
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

PRELUDE SYNC EVO DEVICE

Facility

$125.00

Service Code	HCPCS A4649
Hospital Charge Code	270692530S
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

Know your out-of-pocket cost for care.

All Charges