Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PRIMADONE I

Facility

$78.70

Hospital Charge Code	39990159A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.80

PRIMADONE I

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39990157A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.62
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.30
Rate for Payer: Clover Medicare Advantage	$14.54
Rate for Payer: EmblemHealth Commercial	$45.90
Rate for Payer: Humana Medicare Advantage	$15.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.30
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	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.30
Rate for Payer: Wellcare Medicare Advantage	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PRIMADONE I

Facility

$390.00

Service Code	HCPCS 80184
Hospital Charge Code	39990157A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PRIMADONE I

Facility

$78.70

Hospital Charge Code	39990159A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$29.91
Rate for Payer: Aetna Medicare Advantage	$23.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.07
Rate for Payer: Cigna Commercial	$39.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.46
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.49
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

PRIMADONE II

Facility

$390.00

Service Code	HCPCS 80188
Hospital Charge Code	39990157B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$45.12
Rate for Payer: Aetna Medicare Advantage	$53.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.59
Rate for Payer: Clover Medicare Advantage	$15.76
Rate for Payer: EmblemHealth Commercial	$49.77
Rate for Payer: Humana Medicare Advantage	$17.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.59
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	$13.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.59
Rate for Payer: Wellcare Medicare Advantage	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PRIMADONE II

Facility

$113.20

Service Code	HCPCS 80188
Hospital Charge Code	39990159B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$45.12
Rate for Payer: Aetna Medicare Advantage	$53.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$56.60
Rate for Payer: Cigna Medicare Advantage	$16.59
Rate for Payer: Clover Medicare Advantage	$15.76
Rate for Payer: EmblemHealth Commercial	$49.77
Rate for Payer: Humana Medicare Advantage	$17.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.43
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.98
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.59
Rate for Payer: Wellcare Medicare Advantage	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

PRIMADONE II

Facility

$113.20

Service Code	HCPCS 80188
Hospital Charge Code	39990159B
Hospital Revenue Code	301
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$16.98
Rate for Payer: Qualcare PPO/HMO/WC	$16.98

PRIMADONE II

Facility

$390.00

Service Code	HCPCS 80188
Hospital Charge Code	39990157B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PRIMADONE III

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39990157C
Hospital Revenue Code	301
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$11.08

PRIMADONE III

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39990157C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PRIMADONE III

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990159C
Hospital Revenue Code	301
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$10.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.94

PRIMADONE III

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990159C
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
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	$36.48
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	$18.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.94
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	$2.07

PRIMAQUINE 26.3 MG TAB

Facility

$13.53

Service Code	NDC 24159601
Hospital Charge Code	60627341
Hospital Revenue Code	251
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.03
Rate for Payer: Qualcare PPO/HMO/WC	$2.03

PRIMAQUINE 26.3 MG TAB

Facility

$13.53

Service Code	NDC 24159601
Hospital Charge Code	60627341
Hospital Revenue Code	251
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.76
Rate for Payer: Aetna Commercial	$5.14
Rate for Payer: Aetna Medicare Advantage	$4.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.45
Rate for Payer: Cigna Commercial	$6.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.52
Rate for Payer: Oxford Commercial	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.03
Rate for Payer: UnitedHealthcare Commercial	$2.71
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

PRIM ART M-THRMBC 1ST VSL

Facility

$20,340.00

Service Code	HCPCS 37184
Hospital Charge Code	1600000735
Hospital Revenue Code	360
Min. Negotiated Rate	$577.66
Max. Negotiated Rate	$79,001.40
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$79,001.40
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,288.40
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$642.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$577.66

PRIM ART M-THRMBC 1ST VSL

Facility

$20,340.00

Service Code	HCPCS 37184
Hospital Charge Code	1600000735
Hospital Revenue Code	360
Min. Negotiated Rate	$3,051.00
Max. Negotiated Rate	$3,051.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,051.00

PRIMARY FEMORAL PC STEM 16X152

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704518
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

PRIMARY FEMORAL PC STEM 16X152

Facility

$10,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704518
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

PRIMARY IMPLANT(HIPS) ZIMMER

Facility

$7,925.00

Hospital Charge Code	270335429
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.75
Max. Negotiated Rate	$1,917.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,917.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.75

PRIMARY IMPLANT(HIPS) ZIMMER

Facility

$7,925.00

Hospital Charge Code	270335429
Hospital Revenue Code	278
Min. Negotiated Rate	$225.07
Max. Negotiated Rate	$3,962.50
Rate for Payer: Aetna Commercial	$3,011.50
Rate for Payer: Aetna Medicare Advantage	$2,377.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,020.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,020.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,020.88
Rate for Payer: Cigna Commercial	$3,962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,917.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,188.75
Rate for Payer: UnitedHealthcare Community & State	$250.43
Rate for Payer: Wellpoint Medicaid Managed Care	$225.07

PRIMARY STEM TM 12MM STANDA

Facility

$21,430.00

Hospital Charge Code	270667177
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.50
Max. Negotiated Rate	$5,186.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50

PRIMARY STEM TM 12MM STANDA

Facility

$21,430.00

Hospital Charge Code	270667177
Hospital Revenue Code	278
Min. Negotiated Rate	$608.61
Max. Negotiated Rate	$10,715.00
Rate for Payer: Aetna Commercial	$8,143.40
Rate for Payer: Aetna Medicare Advantage	$6,429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.65
Rate for Payer: Cigna Commercial	$10,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,186.06
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.50
Rate for Payer: UnitedHealthcare Community & State	$677.19
Rate for Payer: Wellpoint Medicaid Managed Care	$608.61

PRIMARY STEM TM 14MM STANDARD

Facility

$21,427.75

Hospital Charge Code	270667174
Hospital Revenue Code	278
Min. Negotiated Rate	$3,214.16
Max. Negotiated Rate	$5,185.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,285.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.16

PRIMARY STEM TM 14MM STANDARD

Facility

$21,427.75

Hospital Charge Code	270667174
Hospital Revenue Code	278
Min. Negotiated Rate	$608.55
Max. Negotiated Rate	$10,713.88
Rate for Payer: Aetna Commercial	$8,142.55
Rate for Payer: Aetna Medicare Advantage	$6,428.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,464.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,464.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,285.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,464.08
Rate for Payer: Cigna Commercial	$10,713.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,185.52
Rate for Payer: Qualcare PPO/HMO/WC	$3,214.16
Rate for Payer: UnitedHealthcare Community & State	$677.12
Rate for Payer: Wellpoint Medicaid Managed Care	$608.55

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	366837184
Hospital Revenue Code	361
Min. Negotiated Rate	$333.53
Max. Negotiated Rate	$79,001.40
Rate for Payer: Aetna Commercial	$59,237.44
Rate for Payer: Aetna Medicare Advantage	$70,562.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79,001.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,778.47
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	$79,001.40
Rate for Payer: Cigna Commercial	$43,654.87
Rate for Payer: Cigna Medicare Advantage	$21,778.47
Rate for Payer: Clover Medicare Advantage	$20,689.55
Rate for Payer: EmblemHealth Commercial	$65,335.41
Rate for Payer: Humana Medicare Advantage	$22,431.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,778.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,053.44
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$371.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,778.47
Rate for Payer: Wellcare Medicare Advantage	$21,778.47
Rate for Payer: Wellpoint Medicaid Managed Care	$333.53

Know your out-of-pocket cost for care.

All Charges