Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

pROSTHETIC TRAINING 15 MINUTES

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	74203077
Hospital Revenue Code	430
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

pROSTHETIC TRAINING 15 MINUTES

Facility

$189.00

Service Code	HCPCS 97761GO
Hospital Charge Code	74203077
Hospital Revenue Code	430
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.14
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.97
Rate for Payer: Wellpoint Medicaid Managed Care	$5.37

PROSTHETIC TRAINING 15 MINUTES

Facility

$174.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008360
Hospital Revenue Code	430
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$26.10
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

PROSTHETIC TRAINING 15 MINUTES

Facility

$174.00

Service Code	HCPCS 97761GO
Hospital Charge Code	1008360
Hospital Revenue Code	430
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.24
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.94

PROSTHETIC TRAIN UE/LE 15 MIN

Facility

$189.00

Service Code	HCPCS 97761GP
Hospital Charge Code	9100125
Hospital Revenue Code	420
Min. Negotiated Rate	$28.35
Max. Negotiated Rate	$28.35
Rate for Payer: Qualcare PPO/HMO/WC	$28.35

PROSTHETIC TRAIN UE/LE 15 MIN

Facility

$189.00

Service Code	HCPCS 97761GP
Hospital Charge Code	9100125
Hospital Revenue Code	420
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$71.82
Rate for Payer: Aetna Medicare Advantage	$56.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.20
Rate for Payer: Cigna Commercial	$94.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.14
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.35
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$5.97
Rate for Payer: Wellpoint Medicaid Managed Care	$5.37

PROSTHETIC TRNG 1ST 15 MIN CQ

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	409197761Q
Hospital Revenue Code	420
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$19.57
Rate for Payer: Qualcare PPO/HMO/WC	$19.57

PROSTHETIC TRNG 1ST 15 MIN CQ

Facility

$130.50

Service Code	HCPCS 97761GP
Hospital Charge Code	409197761Q
Hospital Revenue Code	420
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$49.59
Rate for Payer: Aetna Medicare Advantage	$39.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.28
Rate for Payer: Cigna Commercial	$65.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.93
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.57
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$4.12
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

PROSTHETIC TRNG EA 15 MIN CQ

Facility

$110.00

Service Code	HCPCS 97763GP
Hospital Charge Code	409197763Q
Hospital Revenue Code	420
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$41.80
Rate for Payer: Aetna Medicare Advantage	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.05
Rate for Payer: Cigna Commercial	$55.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.60
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

PROSTHETIC TRNG EA 15 MIN CQ

Facility

$110.00

Service Code	HCPCS 97763GP
Hospital Charge Code	409197763Q
Hospital Revenue Code	420
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

PROSTIM 10CC

Facility

$19,540.00

Hospital Charge Code	270339486
Hospital Revenue Code	278
Min. Negotiated Rate	$2,931.00
Max. Negotiated Rate	$4,728.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,908.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,728.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,931.00

PROSTIM 10CC

Facility

$19,540.00

Hospital Charge Code	270339486
Hospital Revenue Code	278
Min. Negotiated Rate	$554.94
Max. Negotiated Rate	$9,770.00
Rate for Payer: Aetna Commercial	$7,425.20
Rate for Payer: Aetna Medicare Advantage	$5,862.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,982.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,982.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,908.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,982.70
Rate for Payer: Cigna Commercial	$9,770.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,728.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,931.00
Rate for Payer: UnitedHealthcare Community & State	$617.46
Rate for Payer: Wellpoint Medicaid Managed Care	$554.94

PROSTIM 4CC

Facility

$10,500.00

Hospital Charge Code	270339485
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

PROSTIM 4CC

Facility

$10,500.00

Hospital Charge Code	270339485
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

PROSTIN E2 20MG VAG SUPP

Facility

$2,828.20

Service Code	NDC 9082703
Hospital Charge Code	60634520
Hospital Revenue Code	250
Min. Negotiated Rate	$80.32
Max. Negotiated Rate	$1,414.10
Rate for Payer: Aetna Commercial	$1,074.72
Rate for Payer: Aetna Medicare Advantage	$848.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$721.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$721.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$721.19
Rate for Payer: Cigna Commercial	$1,414.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$735.33
Rate for Payer: Oxford Commercial	$565.64
Rate for Payer: Qualcare PPO/HMO/WC	$424.23
Rate for Payer: UnitedHealthcare Commercial	$565.64
Rate for Payer: UnitedHealthcare Community & State	$89.37
Rate for Payer: Wellpoint Medicaid Managed Care	$80.32

PROSTIN E2 20MG VAG SUPP

Facility

$2,828.20

Service Code	NDC 9082703
Hospital Charge Code	60634520
Hospital Revenue Code	250
Min. Negotiated Rate	$424.23
Max. Negotiated Rate	$424.23
Rate for Payer: Qualcare PPO/HMO/WC	$424.23

PROSTOP SUBTALAR ARTHRO 8x14MM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270668411
Hospital Revenue Code	278
Min. Negotiated Rate	$155.49
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$173.01
Rate for Payer: Wellpoint Medicaid Managed Care	$155.49

PROSTOP SUBTALAR ARTHRO 8x14MM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270668411
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

PROTACK 174006

Facility

$1,324.22

Hospital Charge Code	270602489
Hospital Revenue Code	272
Min. Negotiated Rate	$198.63
Max. Negotiated Rate	$198.63
Rate for Payer: Qualcare PPO/HMO/WC	$198.63

PROTACK 174006

Facility

$1,324.22

Hospital Charge Code	270602489
Hospital Revenue Code	272
Min. Negotiated Rate	$37.61
Max. Negotiated Rate	$662.11
Rate for Payer: Aetna Commercial	$503.20
Rate for Payer: Aetna Medicare Advantage	$397.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.68
Rate for Payer: Cigna Commercial	$662.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$344.30
Rate for Payer: Oxford Commercial	$264.84
Rate for Payer: Qualcare PPO/HMO/WC	$198.63
Rate for Payer: UnitedHealthcare Commercial	$264.84
Rate for Payer: UnitedHealthcare Community & State	$41.85
Rate for Payer: Wellpoint Medicaid Managed Care	$37.61

PROTACK STAPLER 5MM (US SURG)

Facility

$866.00

Hospital Charge Code	270335428
Hospital Revenue Code	272
Min. Negotiated Rate	$129.90
Max. Negotiated Rate	$129.90
Rate for Payer: Qualcare PPO/HMO/WC	$129.90

PROTACK STAPLER 5MM (US SURG)

Facility

$866.00

Hospital Charge Code	270335428
Hospital Revenue Code	272
Min. Negotiated Rate	$24.59
Max. Negotiated Rate	$433.00
Rate for Payer: Aetna Commercial	$329.08
Rate for Payer: Aetna Medicare Advantage	$259.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$220.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$220.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$220.83
Rate for Payer: Cigna Commercial	$433.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.16
Rate for Payer: Oxford Commercial	$173.20
Rate for Payer: Qualcare PPO/HMO/WC	$129.90
Rate for Payer: UnitedHealthcare Commercial	$173.20
Rate for Payer: UnitedHealthcare Community & State	$27.37
Rate for Payer: Wellpoint Medicaid Managed Care	$24.59

PROTAMINE 50MG/5ML INJ

Facility

$72.36

Service Code	HCPCS J2720
Hospital Charge Code	6004717
Hospital Revenue Code	636
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$17.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

PROTAMINE 50MG/5ML INJ

Facility

$72.36

Service Code	HCPCS J2720
Hospital Charge Code	6004717
Hospital Revenue Code	636
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$36.18
Rate for Payer: Aetna Commercial	$27.50
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.45
Rate for Payer: Cigna Commercial	$36.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.51
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

PROTECTOR ALEXIS WND PROTECTOR

Facility

$270.00

Hospital Charge Code	270688645
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

Know your out-of-pocket cost for care.

All Charges