Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PROLACTIN

Facility

$179.25

Service Code	HCPCS 84146
Hospital Charge Code	39900417
Hospital Revenue Code	301
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Medicare Advantage	$62.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$70.30
Rate for Payer: Cigna Commercial	$89.62
Rate for Payer: Cigna Medicare Advantage	$19.38
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.89
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Medicare Advantage	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.09

PROLACTIN

Facility

$179.25

Service Code	HCPCS 84146
Hospital Charge Code	39900417
Hospital Revenue Code	301
Min. Negotiated Rate	$26.89
Max. Negotiated Rate	$26.89
Rate for Payer: Qualcare PPO/HMO/WC	$26.89

PROLACTIN DILUTION STUDY

Facility

$335.21

Service Code	HCPCS 84146
Hospital Charge Code	401184146B
Hospital Revenue Code	301
Min. Negotiated Rate	$50.28
Max. Negotiated Rate	$50.28
Rate for Payer: Qualcare PPO/HMO/WC	$50.28

PROLACTIN DILUTION STUDY

Facility

$335.21

Service Code	HCPCS 84146
Hospital Charge Code	401184146B
Hospital Revenue Code	301
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$167.60
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Medicare Advantage	$62.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$70.30
Rate for Payer: Cigna Commercial	$167.60
Rate for Payer: Cigna Medicare Advantage	$19.38
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.15
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.28
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Medicare Advantage	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$9.52

PROLACTIN&MONOMERIC I

Facility

$390.00

Service Code	HCPCS 84146
Hospital Charge Code	39990156A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROLACTIN&MONOMERIC I

Facility

$390.00

Service Code	HCPCS 84146
Hospital Charge Code	39990156A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Medicare Advantage	$62.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$70.30
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.38
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.38
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	$15.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Medicare Advantage	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PROLACTIN&MONOMERIC II

Facility

$390.00

Service Code	HCPCS 84146
Hospital Charge Code	39990156B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PROLACTIN&MONOMERIC II

Facility

$390.00

Service Code	HCPCS 84146
Hospital Charge Code	39990156B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Medicare Advantage	$62.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$70.30
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$19.38
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.38
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	$15.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Medicare Advantage	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

PROLACTIN TOTAL&MONOMERIC

Facility

$288.25

Service Code	HCPCS 84146
Hospital Charge Code	401184146A
Hospital Revenue Code	301
Min. Negotiated Rate	$43.24
Max. Negotiated Rate	$43.24
Rate for Payer: Qualcare PPO/HMO/WC	$43.24

PROLACTIN TOTAL&MONOMERIC

Facility

$288.25

Service Code	HCPCS 84146
Hospital Charge Code	401184146A
Hospital Revenue Code	301
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Medicare Advantage	$62.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19.38
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	$70.30
Rate for Payer: Cigna Commercial	$144.12
Rate for Payer: Cigna Medicare Advantage	$19.38
Rate for Payer: Clover Medicare Advantage	$18.41
Rate for Payer: EmblemHealth Commercial	$58.14
Rate for Payer: Humana Medicare Advantage	$19.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.24
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.38
Rate for Payer: Wellcare Medicare Advantage	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$8.19

PROLENE MESH

Facility

$299.00

Hospital Charge Code	270335105
Hospital Revenue Code	278
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$72.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

PROLENE MESH

Facility

$299.00

Hospital Charge Code	270335105
Hospital Revenue Code	278
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$149.50
Rate for Payer: Aetna Commercial	$113.62
Rate for Payer: Aetna Medicare Advantage	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.25
Rate for Payer: Cigna Commercial	$149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.36
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Community & State	$9.45
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

PROLIFT LATERAL 18X55X10 7DEG

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694228
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$18,750.00
Rate for Payer: Aetna Commercial	$14,250.00
Rate for Payer: Aetna Medicare Advantage	$11,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,562.50
Rate for Payer: Cigna Commercial	$18,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00
Rate for Payer: UnitedHealthcare Community & State	$1,185.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,065.00

PROLIFT LATERAL 18X55X10 7DEG

Facility

$37,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270694228
Hospital Revenue Code	278
Min. Negotiated Rate	$5,625.00
Max. Negotiated Rate	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,075.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,625.00

PROLITE MESH II

Facility

$152.70

Service Code	HCPCS C1781
Hospital Charge Code	270653387
Hospital Revenue Code	278
Min. Negotiated Rate	$22.91
Max. Negotiated Rate	$36.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.91

PROLITE MESH II

Facility

$152.70

Service Code	HCPCS C1781
Hospital Charge Code	270653387
Hospital Revenue Code	278
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$76.35
Rate for Payer: Aetna Commercial	$58.03
Rate for Payer: Aetna Medicare Advantage	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.94
Rate for Payer: Cigna Commercial	$76.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.95
Rate for Payer: Qualcare PPO/HMO/WC	$22.91
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.34

PROLIXIN 25 MG/ML VIAL

Facility

$167.25

Service Code	HCPCS J2680
Hospital Charge Code	87504145
Hospital Revenue Code	636
Min. Negotiated Rate	$25.09
Max. Negotiated Rate	$40.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.47
Rate for Payer: Qualcare PPO/HMO/WC	$25.09

PROLIXIN 25 MG/ML VIAL

Facility

$167.25

Service Code	HCPCS J2680
Hospital Charge Code	87504145
Hospital Revenue Code	636
Min. Negotiated Rate	$4.75
Max. Negotiated Rate	$83.62
Rate for Payer: Aetna Commercial	$63.55
Rate for Payer: Aetna Medicare Advantage	$50.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.65
Rate for Payer: Cigna Commercial	$83.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.47
Rate for Payer: Qualcare PPO/HMO/WC	$25.09
Rate for Payer: UnitedHealthcare Community & State	$5.29
Rate for Payer: Wellpoint Medicaid Managed Care	$4.75

PROLONG CROSSLINK #110031421

Facility

$9,250.00

Hospital Charge Code	270702535
Hospital Revenue Code	278
Min. Negotiated Rate	$262.70
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$292.30
Rate for Payer: Wellpoint Medicaid Managed Care	$262.70

PROLONG CROSSLINK #110031421

Facility

$9,250.00

Hospital Charge Code	270702535
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

PROLONGED SERV IP 1ST HOUR

Facility

$287.00

Service Code	HCPCS 99356
Hospital Charge Code	87502360
Hospital Revenue Code	510
Min. Negotiated Rate	$43.05
Max. Negotiated Rate	$43.05
Rate for Payer: Qualcare PPO/HMO/WC	$43.05

PROLONGED SERV IP 1ST HOUR

Facility

$287.00

Service Code	HCPCS 99356
Hospital Charge Code	87502360
Hospital Revenue Code	510
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$143.50
Rate for Payer: Aetna Commercial	$109.06
Rate for Payer: Aetna Medicare Advantage	$86.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.19
Rate for Payer: Cigna Commercial	$143.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.62
Rate for Payer: Qualcare PPO/HMO/WC	$43.05
Rate for Payer: UnitedHealthcare Community & State	$9.07
Rate for Payer: Wellpoint Medicaid Managed Care	$8.15

PROLYSTICA ENYMATIC 2 1/2GA

Facility

$756.67

Hospital Charge Code	270654038
Hospital Revenue Code	272
Min. Negotiated Rate	$113.50
Max. Negotiated Rate	$113.50
Rate for Payer: Qualcare PPO/HMO/WC	$113.50

PROLYSTICA ENYMATIC 2 1/2GA

Facility

$756.67

Hospital Charge Code	270654038
Hospital Revenue Code	272
Min. Negotiated Rate	$21.49
Max. Negotiated Rate	$378.33
Rate for Payer: Aetna Commercial	$287.53
Rate for Payer: Aetna Medicare Advantage	$227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.95
Rate for Payer: Cigna Commercial	$378.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.73
Rate for Payer: Oxford Commercial	$151.33
Rate for Payer: Qualcare PPO/HMO/WC	$113.50
Rate for Payer: UnitedHealthcare Commercial	$151.33
Rate for Payer: UnitedHealthcare Community & State	$23.91
Rate for Payer: Wellpoint Medicaid Managed Care	$21.49

PROMETHAZINE 12.5 MG SUPP

Facility

$118.66

Service Code	NDC 713053612
Hospital Charge Code	60627859
Hospital Revenue Code	250
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$59.33
Rate for Payer: Aetna Commercial	$45.09
Rate for Payer: Aetna Medicare Advantage	$35.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.26
Rate for Payer: Cigna Commercial	$59.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.85
Rate for Payer: Oxford Commercial	$23.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.80
Rate for Payer: UnitedHealthcare Commercial	$23.73
Rate for Payer: UnitedHealthcare Community & State	$3.75
Rate for Payer: Wellpoint Medicaid Managed Care	$3.37

Know your out-of-pocket cost for care.

All Charges