Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PROVISC INJ 10MG/.85ML SY

Facility

$1,471.86

Service Code	NDC 8065183085
Hospital Charge Code	60635662
Hospital Revenue Code	250
Min. Negotiated Rate	$220.78
Max. Negotiated Rate	$220.78
Rate for Payer: Qualcare PPO/HMO/WC	$220.78

PROVOX EXTRAFLOW HME(30 PCS)

Facility

$490.00

Hospital Charge Code	270688076
Hospital Revenue Code	278
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.58
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Community & State	$15.48
Rate for Payer: Wellpoint Medicaid Managed Care	$13.92

PROVOX EXTRAFLOW HME(30 PCS)

Facility

$490.00

Hospital Charge Code	270688076
Hospital Revenue Code	278
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$118.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$98.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.58
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

PROVOX LARYTUBE 10/55

Facility

$632.50

Hospital Charge Code	270688077
Hospital Revenue Code	272
Min. Negotiated Rate	$94.88
Max. Negotiated Rate	$94.88
Rate for Payer: Qualcare PPO/HMO/WC	$94.88

PROVOX LARYTUBE 10/55

Facility

$632.50

Hospital Charge Code	270688077
Hospital Revenue Code	272
Min. Negotiated Rate	$17.96
Max. Negotiated Rate	$316.25
Rate for Payer: Aetna Commercial	$240.35
Rate for Payer: Aetna Medicare Advantage	$189.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.29
Rate for Payer: Cigna Commercial	$316.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.45
Rate for Payer: Oxford Commercial	$126.50
Rate for Payer: Qualcare PPO/HMO/WC	$94.88
Rate for Payer: UnitedHealthcare Commercial	$126.50
Rate for Payer: UnitedHealthcare Community & State	$19.99
Rate for Payer: Wellpoint Medicaid Managed Care	$17.96

PROVOX SHOWER AID

Facility

$195.00

Hospital Charge Code	270688075
Hospital Revenue Code	272
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Qualcare PPO/HMO/WC	$29.25

PROVOX SHOWER AID

Facility

$195.00

Hospital Charge Code	270688075
Hospital Revenue Code	272
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$74.10
Rate for Payer: Aetna Medicare Advantage	$58.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.73
Rate for Payer: Cigna Commercial	$97.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.70
Rate for Payer: Oxford Commercial	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.25
Rate for Payer: UnitedHealthcare Commercial	$39.00
Rate for Payer: UnitedHealthcare Community & State	$6.16
Rate for Payer: Wellpoint Medicaid Managed Care	$5.54

PROVOX TUBEBRUSH 12MM (6 PCS)

Facility

$222.50

Hospital Charge Code	270688078
Hospital Revenue Code	272
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$33.38
Rate for Payer: Qualcare PPO/HMO/WC	$33.38

PROVOX TUBEBRUSH 12MM (6 PCS)

Facility

$222.50

Hospital Charge Code	270688078
Hospital Revenue Code	272
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$111.25
Rate for Payer: Aetna Commercial	$84.55
Rate for Payer: Aetna Medicare Advantage	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.74
Rate for Payer: Cigna Commercial	$111.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.85
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.38
Rate for Payer: UnitedHealthcare Commercial	$44.50
Rate for Payer: UnitedHealthcare Community & State	$7.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.32

PROVOX TUBEHOLDER

Facility

$110.00

Hospital Charge Code	270688079
Hospital Revenue Code	272
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$55.00
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) 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	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.50
Rate for Payer: UnitedHealthcare Commercial	$22.00
Rate for Payer: UnitedHealthcare Community & State	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

PROVOX TUBEHOLDER

Facility

$110.00

Hospital Charge Code	270688079
Hospital Revenue Code	272
Min. Negotiated Rate	$16.50
Max. Negotiated Rate	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.50

PROVOX VEGA PUNCTURE SET

Facility

$1,895.00

Hospital Charge Code	270688080
Hospital Revenue Code	272
Min. Negotiated Rate	$284.25
Max. Negotiated Rate	$284.25
Rate for Payer: Qualcare PPO/HMO/WC	$284.25

PROVOX VEGA PUNCTURE SET

Facility

$1,895.00

Hospital Charge Code	270688080
Hospital Revenue Code	272
Min. Negotiated Rate	$53.82
Max. Negotiated Rate	$947.50
Rate for Payer: Aetna Commercial	$720.10
Rate for Payer: Aetna Medicare Advantage	$568.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$483.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$483.23
Rate for Payer: Cigna Commercial	$947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$492.70
Rate for Payer: Oxford Commercial	$379.00
Rate for Payer: Qualcare PPO/HMO/WC	$284.25
Rate for Payer: UnitedHealthcare Commercial	$379.00
Rate for Payer: UnitedHealthcare Community & State	$59.88
Rate for Payer: Wellpoint Medicaid Managed Care	$53.82

PROXIMAL HUMERAL PLATE 3.5MM

Facility

$6,382.88

Service Code	HCPCS C1713
Hospital Charge Code	270705122
Hospital Revenue Code	278
Min. Negotiated Rate	$957.43
Max. Negotiated Rate	$1,544.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,276.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.66
Rate for Payer: Qualcare PPO/HMO/WC	$957.43

PROXIMAL HUMERAL PLATE 3.5MM

Facility

$6,382.88

Service Code	HCPCS C1713
Hospital Charge Code	270705122
Hospital Revenue Code	278
Min. Negotiated Rate	$181.27
Max. Negotiated Rate	$3,191.44
Rate for Payer: Aetna Commercial	$2,425.49
Rate for Payer: Aetna Medicare Advantage	$1,914.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,627.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,627.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,276.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,627.63
Rate for Payer: Cigna Commercial	$3,191.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,544.66
Rate for Payer: Qualcare PPO/HMO/WC	$957.43
Rate for Payer: UnitedHealthcare Community & State	$201.70
Rate for Payer: Wellpoint Medicaid Managed Care	$181.27

PROXIMAL IMPLANT_TONIER

Facility

$340.00

Hospital Charge Code	270339449
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$82.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: Qualcare PPO/HMO/WC	$51.00

PROXIMAL IMPLANT_TONIER

Facility

$340.00

Hospital Charge Code	270339449
Hospital Revenue Code	278
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$170.00
Rate for Payer: Aetna Commercial	$129.20
Rate for Payer: Aetna Medicare Advantage	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$86.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$86.70
Rate for Payer: Cigna Commercial	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.28
Rate for Payer: Qualcare PPO/HMO/WC	$51.00
Rate for Payer: UnitedHealthcare Community & State	$10.74
Rate for Payer: Wellpoint Medicaid Managed Care	$9.66

PROXIMATE 11 SKIN STAPLER

Facility

$83.00

Hospital Charge Code	270334612
Hospital Revenue Code	272
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$41.50
Rate for Payer: Aetna Commercial	$31.54
Rate for Payer: Aetna Medicare Advantage	$24.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.16
Rate for Payer: Cigna Commercial	$41.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.58
Rate for Payer: Oxford Commercial	$16.60
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
Rate for Payer: UnitedHealthcare Commercial	$16.60
Rate for Payer: UnitedHealthcare Community & State	$2.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

PROXIMATE 11 SKIN STAPLER

Facility

$47.00

Hospital Charge Code	270334604
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

PROXIMATE 11 SKIN STAPLER

Facility

$47.00

Hospital Charge Code	270334604
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.22
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

PROXIMATE 11 SKIN STAPLER

Facility

$83.00

Hospital Charge Code	270334612
Hospital Revenue Code	272
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

PROXIMATE CUTTER RELOAD 75

Facility

$566.00

Hospital Charge Code	270334713
Hospital Revenue Code	272
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

PROXIMATE CUTTER RELOAD 75

Facility

$566.00

Hospital Charge Code	270334713
Hospital Revenue Code	272
Min. Negotiated Rate	$16.07
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$215.08
Rate for Payer: Aetna Medicare Advantage	$169.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.33
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.16
Rate for Payer: Oxford Commercial	$113.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$113.20
Rate for Payer: UnitedHealthcare Community & State	$17.89
Rate for Payer: Wellpoint Medicaid Managed Care	$16.07

PROXIMATE LINEAR CUTTER 50MM

Facility

$762.00

Hospital Charge Code	270334732
Hospital Revenue Code	272
Min. Negotiated Rate	$21.64
Max. Negotiated Rate	$381.00
Rate for Payer: Aetna Commercial	$289.56
Rate for Payer: Aetna Medicare Advantage	$228.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.31
Rate for Payer: Cigna Commercial	$381.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.12
Rate for Payer: Oxford Commercial	$152.40
Rate for Payer: Qualcare PPO/HMO/WC	$114.30
Rate for Payer: UnitedHealthcare Commercial	$152.40
Rate for Payer: UnitedHealthcare Community & State	$24.08
Rate for Payer: Wellpoint Medicaid Managed Care	$21.64

PROXIMATE LINEAR CUTTER 50MM

Facility

$762.00

Hospital Charge Code	270334732
Hospital Revenue Code	272
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$114.30
Rate for Payer: Qualcare PPO/HMO/WC	$114.30

Know your out-of-pocket cost for care.

All Charges