Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PROTHROMBIN TIME (PT)

Facility

$176.40

Service Code	HCPCS 85610
Hospital Charge Code	38478008
Hospital Revenue Code	305
Min. Negotiated Rate	$26.46
Max. Negotiated Rate	$26.46
Rate for Payer: Qualcare PPO/HMO/WC	$26.46

PROTHROMBIN TIME (PT)

Facility

$176.40

Service Code	HCPCS 85610
Hospital Charge Code	38478008
Hospital Revenue Code	305
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$11.67
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
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	$15.56
Rate for Payer: Cigna Commercial	$88.20
Rate for Payer: Cigna Medicare Advantage	$4.29
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.46
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Medicare Advantage	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$5.01

PROTHROMB ISOLAT EXTRAC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479507
Hospital Revenue Code	301
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

PROTHROMB ISOLAT EXTRAC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479507
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

PROTHRO MOLECULAR DIAG & INTER

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38479509
Hospital Revenue Code	301
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.30
Rate for Payer: Aetna Medicare Advantage	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.68
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

PROTHRO MOLECULAR DIAG & INTER

Facility

$85.00

Service Code	HCPCS 83912
Hospital Charge Code	38479509
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

PROTIEN S,TOTAL

Facility

$410.00

Service Code	HCPCS 85305
Hospital Charge Code	38479111
Hospital Revenue Code	305
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$31.58
Rate for Payer: Aetna Medicare Advantage	$37.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.12
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: Cigna Medicare Advantage	$11.61
Rate for Payer: Clover Medicare Advantage	$11.03
Rate for Payer: EmblemHealth Commercial	$34.83
Rate for Payer: Humana Medicare Advantage	$11.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.61
Rate for Payer: Wellcare Medicare Advantage	$11.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.64

PROTIEN S,TOTAL

Facility

$410.00

Service Code	HCPCS 85305
Hospital Charge Code	38479111
Hospital Revenue Code	305
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

PROTIME (PT)

Facility

$661.89

Service Code	HCPCS 85610
Hospital Charge Code	3002284
Hospital Revenue Code	305
Min. Negotiated Rate	$99.28
Max. Negotiated Rate	$99.28
Rate for Payer: Qualcare PPO/HMO/WC	$99.28

PROTIME (PT)

Facility

$661.89

Service Code	HCPCS 85610
Hospital Charge Code	3002284
Hospital Revenue Code	305
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$330.94
Rate for Payer: Aetna Commercial	$11.67
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.29
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	$15.56
Rate for Payer: Cigna Commercial	$330.94
Rate for Payer: Cigna Medicare Advantage	$4.29
Rate for Payer: Clover Medicare Advantage	$4.08
Rate for Payer: EmblemHealth Commercial	$12.87
Rate for Payer: Humana Medicare Advantage	$4.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.09
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.28
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.29
Rate for Payer: Wellcare Medicare Advantage	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$18.80

PROTOE SIZE SMALL

Facility

$3,440.00

Hospital Charge Code	270663473
Hospital Revenue Code	270
Min. Negotiated Rate	$97.70
Max. Negotiated Rate	$1,720.00
Rate for Payer: Aetna Commercial	$1,307.20
Rate for Payer: Aetna Medicare Advantage	$1,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$877.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$877.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$877.20
Rate for Payer: Cigna Commercial	$1,720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.40
Rate for Payer: Oxford Commercial	$688.00
Rate for Payer: Qualcare PPO/HMO/WC	$516.00
Rate for Payer: UnitedHealthcare Commercial	$688.00
Rate for Payer: UnitedHealthcare Community & State	$108.70
Rate for Payer: Wellpoint Medicaid Managed Care	$97.70

PROTOE SIZE SMALL

Facility

$3,440.00

Hospital Charge Code	270663473
Hospital Revenue Code	270
Min. Negotiated Rate	$516.00
Max. Negotiated Rate	$516.00
Rate for Payer: Qualcare PPO/HMO/WC	$516.00

PRO-TOE VO INSTRUMENT KIT

Facility

$1,300.00

Hospital Charge Code	270663199
Hospital Revenue Code	270
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

PRO-TOE VO INSTRUMENT KIT

Facility

$1,300.00

Hospital Charge Code	270663199
Hospital Revenue Code	270
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.00
Rate for Payer: Oxford Commercial	$260.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Commercial	$260.00
Rate for Payer: UnitedHealthcare Community & State	$41.08
Rate for Payer: Wellpoint Medicaid Managed Care	$36.92

PROTONIX 40MG SUSP.

Facility

$67.13

Service Code	NDC 8084402
Hospital Charge Code	60635725
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.56
Rate for Payer: Aetna Commercial	$25.51
Rate for Payer: Aetna Medicare Advantage	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.12
Rate for Payer: Cigna Commercial	$33.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.45
Rate for Payer: Oxford Commercial	$13.43
Rate for Payer: Qualcare PPO/HMO/WC	$10.07
Rate for Payer: UnitedHealthcare Commercial	$13.43
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

PROTONIX 40MG SUSP.

Facility

$67.13

Service Code	NDC 8084402
Hospital Charge Code	60635725
Hospital Revenue Code	250
Min. Negotiated Rate	$10.07
Max. Negotiated Rate	$10.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.07

PROVAY BLUE 0.5% 10MG/ML 10 ML

Facility

$1,867.02

Service Code	HCPCS Q9968
Hospital Charge Code	606390266
Hospital Revenue Code	636
Min. Negotiated Rate	$280.05
Max. Negotiated Rate	$451.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.82
Rate for Payer: Qualcare PPO/HMO/WC	$280.05

PROVAY BLUE 0.5% 10MG/ML 10 ML

Facility

$1,867.02

Service Code	HCPCS Q9968
Hospital Charge Code	606390266
Hospital Revenue Code	636
Min. Negotiated Rate	$9.78
Max. Negotiated Rate	$451.82
Rate for Payer: Aetna Commercial	$27.99
Rate for Payer: Aetna Medicare Advantage	$33.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.33
Rate for Payer: Cigna Medicare Advantage	$10.29
Rate for Payer: Clover Medicare Advantage	$9.78
Rate for Payer: EmblemHealth Commercial	$30.87
Rate for Payer: Humana Medicare Advantage	$10.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.82
Rate for Payer: Qualcare PPO/HMO/WC	$280.05
Rate for Payer: UnitedHealthcare Community & State	$59.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.29
Rate for Payer: Wellcare Medicare Advantage	$10.29
Rate for Payer: Wellpoint Medicaid Managed Care	$53.02

PROVENDA AMNIOTIC MEMBR 3X3CM

Facility

$13,180.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694280
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.00
Max. Negotiated Rate	$3,189.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,636.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,189.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.00

PROVENDA AMNIOTIC MEMBR 3X3CM

Facility

$13,180.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694280
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,189.56
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	$2,636.00
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	$3,189.56
Rate for Payer: Qualcare PPO/HMO/WC	$1,977.00
Rate for Payer: UnitedHealthcare Community & State	$416.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$374.31

PROVENTIL/2MG/TAB

Facility

$39.40

Service Code	NDC 53489017601
Hospital Charge Code	60633774
Hospital Revenue Code	250
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$5.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.91

PROVENTIL/2MG/TAB

Facility

$39.40

Service Code	NDC 53489017601
Hospital Charge Code	60633774
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$19.70
Rate for Payer: Aetna Commercial	$14.97
Rate for Payer: Aetna Medicare Advantage	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.05
Rate for Payer: Cigna Commercial	$19.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.24
Rate for Payer: Oxford Commercial	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.91
Rate for Payer: UnitedHealthcare Commercial	$7.88
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

PROVENTIL/4MG/TAB

Facility

$47.24

Service Code	NDC 51079065820
Hospital Charge Code	60633775
Hospital Revenue Code	250
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.09

PROVENTIL/4MG/TAB

Facility

$47.24

Service Code	NDC 51079065820
Hospital Charge Code	60633775
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$23.62
Rate for Payer: Aetna Commercial	$17.95
Rate for Payer: Aetna Medicare Advantage	$14.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.05
Rate for Payer: Cigna Commercial	$23.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.28
Rate for Payer: Oxford Commercial	$9.45
Rate for Payer: Qualcare PPO/HMO/WC	$7.09
Rate for Payer: UnitedHealthcare Commercial	$9.45
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

PROVISC INJ 10MG/.85ML SY

Facility

$1,471.86

Service Code	NDC 8065183085
Hospital Charge Code	60635662
Hospital Revenue Code	250
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$735.93
Rate for Payer: Aetna Commercial	$559.31
Rate for Payer: Aetna Medicare Advantage	$441.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.32
Rate for Payer: Cigna Commercial	$735.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.68
Rate for Payer: Oxford Commercial	$294.37
Rate for Payer: Qualcare PPO/HMO/WC	$220.78
Rate for Payer: UnitedHealthcare Commercial	$294.37
Rate for Payer: UnitedHealthcare Community & State	$46.51
Rate for Payer: Wellpoint Medicaid Managed Care	$41.80

Know your out-of-pocket cost for care.

All Charges