Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PSA POST PROSTATECTOMY W HAMA

Facility

$390.00

Service Code	HCPCS 84153
Hospital Charge Code	39708029
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

PSA PSEUDO ANEURISM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	366836002
Hospital Revenue Code	361
Min. Negotiated Rate	$29.91
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,703.39
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.78
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.95
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$33.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$29.91

PSA PSEUDO ANEURISM INJ

Facility

$1,053.00

Service Code	HCPCS 36002
Hospital Charge Code	366836002
Hospital Revenue Code	361
Min. Negotiated Rate	$157.95
Max. Negotiated Rate	$157.95
Rate for Payer: Qualcare PPO/HMO/WC	$157.95

PSA,TOTAL

Facility

$126.45

Service Code	HCPCS 84153
Hospital Charge Code	39900124
Hospital Revenue Code	301
Min. Negotiated Rate	$18.97
Max. Negotiated Rate	$18.97
Rate for Payer: Qualcare PPO/HMO/WC	$18.97

PSA,TOTAL

Facility

$126.45

Service Code	HCPCS 84153
Hospital Charge Code	39900124
Hospital Revenue Code	301
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.02
Rate for Payer: Aetna Medicare Advantage	$59.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.71
Rate for Payer: Cigna Commercial	$63.23
Rate for Payer: Cigna Medicare Advantage	$18.39
Rate for Payer: Clover Medicare Advantage	$17.47
Rate for Payer: EmblemHealth Commercial	$55.17
Rate for Payer: Humana Medicare Advantage	$18.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.97
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.39
Rate for Payer: Wellcare Medicare Advantage	$18.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.59

PSEUDOANEURYSM INJ TRT

Facility

$2,873.16

Service Code	HCPCS 36002
Hospital Charge Code	16000732
Hospital Revenue Code	360
Min. Negotiated Rate	$430.97
Max. Negotiated Rate	$430.97
Rate for Payer: Qualcare PPO/HMO/WC	$430.97

PSEUDOANEURYSM INJ TRT

Facility

$2,873.16

Service Code	HCPCS 36002
Hospital Charge Code	16000732
Hospital Revenue Code	360
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,027.08
Rate for Payer: Aetna Medicare Advantage	$2,414.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,703.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$745.25
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	$2,703.39
Rate for Payer: Cigna Commercial	$1,493.86
Rate for Payer: Cigna Medicare Advantage	$745.25
Rate for Payer: Clover Medicare Advantage	$707.99
Rate for Payer: EmblemHealth Commercial	$2,235.75
Rate for Payer: Humana Medicare Advantage	$767.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$745.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.02
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$430.97
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$90.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$745.25
Rate for Payer: Wellcare Medicare Advantage	$745.25
Rate for Payer: Wellpoint Medicaid Managed Care	$81.60

PSEUDOEPHEDRINE 30 MG/5 ML LIQ

Facility

$4.00

Service Code	NDC 536185085
Hospital Charge Code	60628982
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PSEUDOEPHEDRINE 30 MG/5 ML LIQ

Facility

$4.00

Service Code	NDC 536185085
Hospital Charge Code	60628982
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

PSEUDOEPHEDRINE 30 MG TAB UD

Facility

$4.00

Service Code	NDC 904505359
Hospital Charge Code	60627465
Hospital Revenue Code	251
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

PSEUDOEPHEDRINE 30 MG TAB UD

Facility

$4.00

Service Code	NDC 904505359
Hospital Charge Code	60627465
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PSEUDOEPHEDRINE 60 MG TAB UD

Facility

$4.00

Service Code	NDC 904512559
Hospital Charge Code	60627467
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PSEUDOEPHEDRINE 60 MG TAB UD

Facility

$4.00

Service Code	NDC 904512559
Hospital Charge Code	60627467
Hospital Revenue Code	251
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

PSEUDOEPHEDRINE SOLN 15MG/5ML

Facility

$4.00

Service Code	NDC 50580053604
Hospital Charge Code	606390565
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PSEUDOEPHEDRINE SOLN 15MG/5ML

Facility

$4.00

Service Code	NDC 50580053604
Hospital Charge Code	606390565
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

PSF TRIATHLON PS RT #4

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270695677
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.42
Max. Negotiated Rate	$2,548.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42

PSF TRIATHLON PS RT #4

Facility

$10,529.45

Service Code	HCPCS C1776
Hospital Charge Code	270695677
Hospital Revenue Code	278
Min. Negotiated Rate	$299.04
Max. Negotiated Rate	$5,264.73
Rate for Payer: Aetna Commercial	$4,001.19
Rate for Payer: Aetna Medicare Advantage	$3,158.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,105.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.01
Rate for Payer: Cigna Commercial	$5,264.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.42
Rate for Payer: UnitedHealthcare Community & State	$332.73
Rate for Payer: Wellpoint Medicaid Managed Care	$299.04

PSG STUDY 4 OR MORE

Facility

$40,000.00

Service Code	HCPCS 95810
Hospital Charge Code	90000035
Hospital Revenue Code	920
Min. Negotiated Rate	$969.20
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,469.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,700.81
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PSG STUDY 4 OR MORE

Facility

$40,000.00

Service Code	HCPCS 95810
Hospital Charge Code	90000035
Hospital Revenue Code	920
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PSG W/CPAP OR BIPAP

Facility

$40,000.00

Service Code	HCPCS 95811
Hospital Charge Code	90000040
Hospital Revenue Code	920
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$6,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PSG W/CPAP OR BIPAP

Facility

$40,000.00

Service Code	HCPCS 95811
Hospital Charge Code	90000040
Hospital Revenue Code	920
Min. Negotiated Rate	$969.20
Max. Negotiated Rate	$18,046.00
Rate for Payer: Aetna Commercial	$2,774.97
Rate for Payer: Aetna Medicare Advantage	$3,305.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,700.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,020.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,469.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,700.81
Rate for Payer: Cigna Commercial	$2,044.99
Rate for Payer: Cigna Medicare Advantage	$1,020.21
Rate for Payer: Clover Medicare Advantage	$969.20
Rate for Payer: EmblemHealth Commercial	$3,060.63
Rate for Payer: Humana Medicare Advantage	$1,050.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,020.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,400.00
Rate for Payer: Oxford Commercial	$15,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Commercial	$18,046.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,020.21
Rate for Payer: Wellcare Medicare Advantage	$1,020.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PSN ALL POLY PAT PLY 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689982
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 29MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689982
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

PSN ALL POLY PAT PLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681302
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

PSN ALL POLY PAT PLY 32MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270681302
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

Know your out-of-pocket cost for care.

All Charges