Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	366837184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	411037184
Hospital Revenue Code	361
Min. Negotiated Rate	$1,761.60
Max. Negotiated Rate	$1,761.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,761.60

PRIMARY THROMB ANY VESSEL

Facility

$11,744.00

Service Code	HCPCS 37184
Hospital Charge Code	411037184
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

PRIMATRIX AG 8X8CM

Facility

$12,412.55

Service Code	HCPCS Q4110
Hospital Charge Code	270689627
Hospital Revenue Code	636
Min. Negotiated Rate	$1,861.88
Max. Negotiated Rate	$3,003.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,003.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.88

PRIMATRIX AG 8X8CM

Facility

$12,412.55

Service Code	HCPCS Q4110
Hospital Charge Code	270689627
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,003.84
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,003.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,861.88
Rate for Payer: UnitedHealthcare Community & State	$392.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$352.52

PRIMATRIX MESHED 10 X 25CM

Facility

$22,370.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684234
Hospital Revenue Code	278
Min. Negotiated Rate	$3,355.50
Max. Negotiated Rate	$5,413.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,474.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,413.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50

PRIMATRIX MESHED 10 X 25CM

Facility

$22,370.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684234
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$5,413.54
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,474.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,413.54
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50
Rate for Payer: UnitedHealthcare Community & State	$706.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$635.31

PRIMATRIX PERF 4x4CM

Facility

$3,423.00

Service Code	HCPCS Q4110
Hospital Charge Code	270674002
Hospital Revenue Code	278
Min. Negotiated Rate	$513.45
Max. Negotiated Rate	$828.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.37
Rate for Payer: Qualcare PPO/HMO/WC	$513.45

PRIMATRIX PERF 4x4CM

Facility

$3,423.00

Service Code	HCPCS Q4110
Hospital Charge Code	270674002
Hospital Revenue Code	278
Min. Negotiated Rate	$97.21
Max. Negotiated Rate	$828.37
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$684.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$828.37
Rate for Payer: Qualcare PPO/HMO/WC	$513.45
Rate for Payer: UnitedHealthcare Community & State	$108.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$97.21

PRIMATRIX PERF 4x4CM/SQ CM JW

Facility

$855.75

Hospital Charge Code	270674002W
Hospital Revenue Code	636
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$427.88
Rate for Payer: Aetna Commercial	$325.19
Rate for Payer: Aetna Medicare Advantage	$256.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.22
Rate for Payer: Cigna Commercial	$427.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.09
Rate for Payer: Qualcare PPO/HMO/WC	$128.36
Rate for Payer: UnitedHealthcare Community & State	$27.04
Rate for Payer: Wellpoint Medicaid Managed Care	$24.30

PRIMATRIX PERF 4x4CM/SQ CM JW

Facility

$855.75

Hospital Charge Code	270674002W
Hospital Revenue Code	636
Min. Negotiated Rate	$128.36
Max. Negotiated Rate	$207.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.09
Rate for Payer: Qualcare PPO/HMO/WC	$128.36

PRIME ADVANCED 37702

Facility

$76,200.00

Service Code	HCPCS C1767
Hospital Charge Code	270640283
Hospital Revenue Code	278
Min. Negotiated Rate	$11,430.00
Max. Negotiated Rate	$18,440.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,440.40
Rate for Payer: Qualcare PPO/HMO/WC	$11,430.00

PRIME ADVANCED 37702

Facility

$76,200.00

Service Code	HCPCS C1767
Hospital Charge Code	270640283
Hospital Revenue Code	278
Min. Negotiated Rate	$2,164.08
Max. Negotiated Rate	$38,100.00
Rate for Payer: Aetna Commercial	$28,956.00
Rate for Payer: Aetna Medicare Advantage	$22,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,431.00
Rate for Payer: Cigna Commercial	$38,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,440.40
Rate for Payer: Qualcare PPO/HMO/WC	$11,430.00
Rate for Payer: UnitedHealthcare Community & State	$2,407.92
Rate for Payer: Wellpoint Medicaid Managed Care	$2,164.08

PRIMIDONE 250 MG TAB

Facility

$6.70

Service Code	NDC 527123101
Hospital Charge Code	60627738
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.00
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

PRIMIDONE 250 MG TAB

Facility

$6.70

Service Code	NDC 527123101
Hospital Charge Code	60627738
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$1.00

PRIMIDONE 50 MG TAB

Facility

$4.00

Service Code	NDC 527130101
Hospital Charge Code	60627739
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

PRIMIDONE 50 MG TAB

Facility

$4.00

Service Code	NDC 527130101
Hospital Charge Code	60627739
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PRIMIDONE (MYSOLINE)

Facility

$384.00

Service Code	HCPCS 80188
Hospital Charge Code	38472557
Hospital Revenue Code	301
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$192.00
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	$192.00
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	$99.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
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	$10.91

PRIMIDONE (MYSOLINE)

Facility

$384.00

Service Code	HCPCS 80188
Hospital Charge Code	38472557
Hospital Revenue Code	301
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

PRIMIDONE (MYSOLINE)

Facility

$384.00

Service Code	HCPCS 80188
Hospital Charge Code	38479457
Hospital Revenue Code	301
Min. Negotiated Rate	$57.60
Max. Negotiated Rate	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$57.60

PRIMIDONE (MYSOLINE)

Facility

$384.00

Service Code	HCPCS 80188
Hospital Charge Code	38479457
Hospital Revenue Code	301
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$192.00
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	$192.00
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	$99.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.60
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	$10.91

PRNLG SRV IP ADDTL 30 MINS

Facility

$289.00

Service Code	HCPCS 99357
Hospital Charge Code	87502365
Hospital Revenue Code	510
Min. Negotiated Rate	$43.35
Max. Negotiated Rate	$43.35
Rate for Payer: Qualcare PPO/HMO/WC	$43.35

PRNLG SRV IP ADDTL 30 MINS

Facility

$289.00

Service Code	HCPCS 99357
Hospital Charge Code	87502365
Hospital Revenue Code	510
Min. Negotiated Rate	$8.21
Max. Negotiated Rate	$144.50
Rate for Payer: Aetna Commercial	$109.82
Rate for Payer: Aetna Medicare Advantage	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.69
Rate for Payer: Cigna Commercial	$144.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.14
Rate for Payer: Qualcare PPO/HMO/WC	$43.35
Rate for Payer: UnitedHealthcare Community & State	$9.13
Rate for Payer: Wellpoint Medicaid Managed Care	$8.21

PRO AIR HFA

Facility

$589.33

Service Code	NDC 59310057922
Hospital Charge Code	6063943276
Hospital Revenue Code	250
Min. Negotiated Rate	$16.74
Max. Negotiated Rate	$294.67
Rate for Payer: Aetna Commercial	$223.95
Rate for Payer: Aetna Medicare Advantage	$176.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.28
Rate for Payer: Cigna Commercial	$294.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.23
Rate for Payer: Oxford Commercial	$117.87
Rate for Payer: Qualcare PPO/HMO/WC	$88.40
Rate for Payer: UnitedHealthcare Commercial	$117.87
Rate for Payer: UnitedHealthcare Community & State	$18.62
Rate for Payer: Wellpoint Medicaid Managed Care	$16.74

PRO AIR HFA

Facility

$589.33

Service Code	NDC 59310057922
Hospital Charge Code	6063943276
Hospital Revenue Code	250
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$88.40
Rate for Payer: Qualcare PPO/HMO/WC	$88.40

Know your out-of-pocket cost for care.

All Charges