Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EPINEPHRINE 1 MG/10ML SYRINGE

Facility

$15.61

Service Code	HCPCS J0169
Hospital Charge Code	60627448
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.34

EPINEPHRINE 1 MG/10ML SYRINGE

Facility

$15.61

Service Code	HCPCS J0169
Hospital Charge Code	60627448
Hospital Revenue Code	636
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.80
Rate for Payer: Aetna Commercial	$5.93
Rate for Payer: Aetna Medicare Advantage	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.98
Rate for Payer: Cigna Commercial	$7.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.34
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

EPINEPHRINE 1 MG/ML INJ

Facility

$9.72

Service Code	HCPCS J0169
Hospital Charge Code	60629143
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

EPINEPHRINE 1 MG/ML INJ

Facility

$9.72

Service Code	HCPCS J0169
Hospital Charge Code	60629143
Hospital Revenue Code	636
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna Commercial	$3.69
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.48
Rate for Payer: Cigna Commercial	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

EPINEPHRINE 30 MG/30 ML MDV

Facility

$158.70

Hospital Charge Code	60639494
Hospital Revenue Code	636
Min. Negotiated Rate	$23.80
Max. Negotiated Rate	$38.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.41
Rate for Payer: Qualcare PPO/HMO/WC	$23.80

EPINEPHRINE 30 MG/30 ML MDV

Facility

$158.70

Hospital Charge Code	60639494
Hospital Revenue Code	636
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$79.35
Rate for Payer: Aetna Commercial	$60.31
Rate for Payer: Aetna Medicare Advantage	$47.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.47
Rate for Payer: Cigna Commercial	$79.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.41
Rate for Payer: Qualcare PPO/HMO/WC	$23.80
Rate for Payer: UnitedHealthcare Community & State	$5.01
Rate for Payer: Wellpoint Medicaid Managed Care	$4.51

EPINEPHRINE 30 MG VIAL

Facility

$56.28

Service Code	HCPCS J0169
Hospital Charge Code	60627450
Hospital Revenue Code	636
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$13.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$8.44

EPINEPHRINE 30 MG VIAL

Facility

$56.28

Service Code	HCPCS J0169
Hospital Charge Code	60627450
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$28.14
Rate for Payer: Aetna Commercial	$21.39
Rate for Payer: Aetna Medicare Advantage	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.35
Rate for Payer: Cigna Commercial	$28.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$8.44
Rate for Payer: UnitedHealthcare Community & State	$1.78
Rate for Payer: Wellpoint Medicaid Managed Care	$1.60

EPINEPHRINE/LIDOCAINE HYDROC 2

Facility

$14.14

Service Code	NDC 409000710
Hospital Charge Code	6063943196
Hospital Revenue Code	250
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$2.12

EPINEPHRINE/LIDOCAINE HYDROC 2

Facility

$14.14

Service Code	NDC 409000710
Hospital Charge Code	6063943196
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$7.07
Rate for Payer: Aetna Commercial	$5.37
Rate for Payer: Aetna Medicare Advantage	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.61
Rate for Payer: Cigna Commercial	$7.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.68
Rate for Payer: Oxford Commercial	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.12
Rate for Payer: UnitedHealthcare Commercial	$2.83
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

EPIPEN 0.15MG/0.15ML INJ

Facility

$1,654.97

Service Code	NDC 115169549
Hospital Charge Code	6063943104
Hospital Revenue Code	250
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$827.49
Rate for Payer: Aetna Commercial	$628.89
Rate for Payer: Aetna Medicare Advantage	$496.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.02
Rate for Payer: Cigna Commercial	$827.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$430.29
Rate for Payer: Oxford Commercial	$330.99
Rate for Payer: Qualcare PPO/HMO/WC	$248.25
Rate for Payer: UnitedHealthcare Commercial	$330.99
Rate for Payer: UnitedHealthcare Community & State	$52.30
Rate for Payer: Wellpoint Medicaid Managed Care	$47.00

EPIPEN 0.15MG/0.15ML INJ

Facility

$1,654.97

Service Code	NDC 115169549
Hospital Charge Code	6063943104
Hospital Revenue Code	250
Min. Negotiated Rate	$248.25
Max. Negotiated Rate	$248.25
Rate for Payer: Qualcare PPO/HMO/WC	$248.25

EPIPEN 0.3MG/ML INJ

Facility

$1,612.89

Service Code	NDC 49502050002
Hospital Charge Code	6063943105
Hospital Revenue Code	250
Min. Negotiated Rate	$45.81
Max. Negotiated Rate	$806.45
Rate for Payer: Aetna Commercial	$612.90
Rate for Payer: Aetna Medicare Advantage	$483.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.29
Rate for Payer: Cigna Commercial	$806.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.35
Rate for Payer: Oxford Commercial	$322.58
Rate for Payer: Qualcare PPO/HMO/WC	$241.93
Rate for Payer: UnitedHealthcare Commercial	$322.58
Rate for Payer: UnitedHealthcare Community & State	$50.97
Rate for Payer: Wellpoint Medicaid Managed Care	$45.81

EPIPEN 0.3MG/ML INJ

Facility

$1,612.89

Service Code	NDC 49502050002
Hospital Charge Code	6063943105
Hospital Revenue Code	250
Min. Negotiated Rate	$241.93
Max. Negotiated Rate	$241.93
Rate for Payer: Qualcare PPO/HMO/WC	$241.93

EPISTAXIS WITH MCC

Facility

$61,531.49

Service Code	MSDRG 150
Min. Negotiated Rate	$18,735.55
Max. Negotiated Rate	$61,531.49
Rate for Payer: Aetna Commercial	$45,681.93
Rate for Payer: Aetna Medicare Advantage	$61,531.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36,293.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36,293.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$19,721.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36,293.55
Rate for Payer: Cigna Commercial	$29,683.13
Rate for Payer: Cigna Medicare Advantage	$19,721.63
Rate for Payer: Clover Medicare Advantage	$18,735.55
Rate for Payer: EmblemHealth Commercial	$59,164.89
Rate for Payer: Humana Medicare Advantage	$20,313.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$19,721.63
Rate for Payer: Oxford Commercial	$23,461.03
Rate for Payer: UnitedHealthcare Commercial	$31,403.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$19,721.63
Rate for Payer: Wellcare Medicare Advantage	$19,721.63

EPISTAXIS WITHOUT MCC

Facility

$42,654.30

Service Code	MSDRG 151
Min. Negotiated Rate	$12,933.08
Max. Negotiated Rate	$42,654.30
Rate for Payer: Aetna Commercial	$32,237.40
Rate for Payer: Aetna Medicare Advantage	$42,654.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,332.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,332.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,671.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,332.85
Rate for Payer: Cigna Commercial	$16,363.06
Rate for Payer: Cigna Medicare Advantage	$13,671.25
Rate for Payer: Clover Medicare Advantage	$12,987.69
Rate for Payer: EmblemHealth Commercial	$41,013.75
Rate for Payer: Humana Medicare Advantage	$14,081.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,671.25
Rate for Payer: Oxford Commercial	$12,933.08
Rate for Payer: UnitedHealthcare Commercial	$17,311.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,671.25
Rate for Payer: Wellcare Medicare Advantage	$13,671.25

EPOETIN ALFA 10,000 UNIT/ML ML

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	60635894
Hospital Revenue Code	635
Min. Negotiated Rate	$48.57
Max. Negotiated Rate	$855.05
Rate for Payer: Aetna Commercial	$649.84
Rate for Payer: Aetna Medicare Advantage	$513.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.08
Rate for Payer: Cigna Commercial	$855.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.63
Rate for Payer: Oxford Commercial	$342.02
Rate for Payer: Qualcare PPO/HMO/WC	$256.52
Rate for Payer: UnitedHealthcare Commercial	$342.02
Rate for Payer: UnitedHealthcare Community & State	$54.04
Rate for Payer: Wellpoint Medicaid Managed Care	$48.57

EPOETIN ALFA 10,000 UNIT/ML ML

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	60635894
Hospital Revenue Code	635
Min. Negotiated Rate	$256.52
Max. Negotiated Rate	$256.52
Rate for Payer: Qualcare PPO/HMO/WC	$256.52

EPOETIN ALFA 10,000 UNITS/1MLE

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	606361051
Hospital Revenue Code	635
Min. Negotiated Rate	$256.52
Max. Negotiated Rate	$256.52
Rate for Payer: Qualcare PPO/HMO/WC	$256.52

EPOETIN ALFA 10,000 UNITS/1MLE

Facility

$1,710.11

Service Code	NDC 59676031002
Hospital Charge Code	606361051
Hospital Revenue Code	635
Min. Negotiated Rate	$48.57
Max. Negotiated Rate	$855.05
Rate for Payer: Aetna Commercial	$649.84
Rate for Payer: Aetna Medicare Advantage	$513.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.08
Rate for Payer: Cigna Commercial	$855.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.63
Rate for Payer: Oxford Commercial	$342.02
Rate for Payer: Qualcare PPO/HMO/WC	$256.52
Rate for Payer: UnitedHealthcare Commercial	$342.02
Rate for Payer: UnitedHealthcare Community & State	$54.04
Rate for Payer: Wellpoint Medicaid Managed Care	$48.57

EPOETIN ALFA 20000 UNIT/ML INJ

Facility

$3,420.22

Service Code	NDC 59676032004
Hospital Charge Code	60632231
Hospital Revenue Code	634
Min. Negotiated Rate	$97.13
Max. Negotiated Rate	$1,710.11
Rate for Payer: Aetna Commercial	$1,299.68
Rate for Payer: Aetna Medicare Advantage	$1,026.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$872.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$872.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$872.16
Rate for Payer: Cigna Commercial	$1,710.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$889.26
Rate for Payer: Oxford Commercial	$684.04
Rate for Payer: Qualcare PPO/HMO/WC	$513.03
Rate for Payer: UnitedHealthcare Commercial	$684.04
Rate for Payer: UnitedHealthcare Community & State	$108.08
Rate for Payer: Wellpoint Medicaid Managed Care	$97.13

EPOETIN ALFA 20000 UNIT/ML INJ

Facility

$3,420.22

Service Code	NDC 59676032004
Hospital Charge Code	60632231
Hospital Revenue Code	634
Min. Negotiated Rate	$513.03
Max. Negotiated Rate	$513.03
Rate for Payer: Qualcare PPO/HMO/WC	$513.03

EPOETIN ALFA 2000 U/ML INJ

Facility

$310.81

Service Code	NDC 59676030200
Hospital Charge Code	60635891
Hospital Revenue Code	634
Min. Negotiated Rate	$8.83
Max. Negotiated Rate	$155.41
Rate for Payer: Aetna Commercial	$118.11
Rate for Payer: Aetna Medicare Advantage	$93.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.26
Rate for Payer: Cigna Commercial	$155.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.81
Rate for Payer: Oxford Commercial	$62.16
Rate for Payer: Qualcare PPO/HMO/WC	$46.62
Rate for Payer: UnitedHealthcare Commercial	$62.16
Rate for Payer: UnitedHealthcare Community & State	$9.82
Rate for Payer: Wellpoint Medicaid Managed Care	$8.83

EPOETIN ALFA 2000 U/ML INJ

Facility

$310.81

Service Code	NDC 59676030200
Hospital Charge Code	60635891
Hospital Revenue Code	634
Min. Negotiated Rate	$46.62
Max. Negotiated Rate	$46.62
Rate for Payer: Qualcare PPO/HMO/WC	$46.62

EPOETINALFA 3000 U/ML INJ

Facility

$466.25

Service Code	NDC 59676030300
Hospital Charge Code	60635892
Hospital Revenue Code	634
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$233.12
Rate for Payer: Aetna Commercial	$177.18
Rate for Payer: Aetna Medicare Advantage	$139.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$118.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$118.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$118.89
Rate for Payer: Cigna Commercial	$233.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.22
Rate for Payer: Oxford Commercial	$93.25
Rate for Payer: Qualcare PPO/HMO/WC	$69.94
Rate for Payer: UnitedHealthcare Commercial	$93.25
Rate for Payer: UnitedHealthcare Community & State	$14.73
Rate for Payer: Wellpoint Medicaid Managed Care	$13.24

Know your out-of-pocket cost for care.

All Charges