Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EPOETINALFA 3000 U/ML INJ

Facility

$466.25

Service Code	NDC 59676030300
Hospital Charge Code	60635892
Hospital Revenue Code	634
Min. Negotiated Rate	$69.94
Max. Negotiated Rate	$69.94
Rate for Payer: Qualcare PPO/HMO/WC	$69.94

EPOETIN ALFA 40000 UNIT/ML INJ

Facility

$6,840.43

Service Code	NDC 59676034001
Hospital Charge Code	60632230
Hospital Revenue Code	635
Min. Negotiated Rate	$1,026.06
Max. Negotiated Rate	$1,026.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.06

EPOETIN ALFA 40000 UNIT/ML INJ

Facility

$6,840.43

Service Code	NDC 59676034001
Hospital Charge Code	60632230
Hospital Revenue Code	635
Min. Negotiated Rate	$194.27
Max. Negotiated Rate	$3,420.22
Rate for Payer: Aetna Commercial	$2,599.36
Rate for Payer: Aetna Medicare Advantage	$2,052.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,744.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,744.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,744.31
Rate for Payer: Cigna Commercial	$3,420.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.51
Rate for Payer: Oxford Commercial	$1,368.09
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.06
Rate for Payer: UnitedHealthcare Commercial	$1,368.09
Rate for Payer: UnitedHealthcare Community & State	$216.16
Rate for Payer: Wellpoint Medicaid Managed Care	$194.27

EPOETINALFA 4000 U/ML ML

Facility

$621.63

Service Code	NDC 59676030401
Hospital Charge Code	60635893
Hospital Revenue Code	634
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$310.81
Rate for Payer: Aetna Commercial	$236.22
Rate for Payer: Aetna Medicare Advantage	$186.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$158.52
Rate for Payer: Cigna Commercial	$310.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$161.62
Rate for Payer: Oxford Commercial	$124.33
Rate for Payer: Qualcare PPO/HMO/WC	$93.24
Rate for Payer: UnitedHealthcare Commercial	$124.33
Rate for Payer: UnitedHealthcare Community & State	$19.64
Rate for Payer: Wellpoint Medicaid Managed Care	$17.65

EPOETINALFA 4000 U/ML ML

Facility

$621.63

Service Code	NDC 59676030401
Hospital Charge Code	60635893
Hospital Revenue Code	634
Min. Negotiated Rate	$93.24
Max. Negotiated Rate	$93.24
Rate for Payer: Qualcare PPO/HMO/WC	$93.24

EPOETIN ALFA-EPBX 40000IU VIAL

Facility

$3,048.50

Service Code	NDC 69130904
Hospital Charge Code	606390476
Hospital Revenue Code	635
Min. Negotiated Rate	$86.58
Max. Negotiated Rate	$1,524.25
Rate for Payer: Aetna Commercial	$1,158.43
Rate for Payer: Aetna Medicare Advantage	$914.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.37
Rate for Payer: Cigna Commercial	$1,524.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$792.61
Rate for Payer: Oxford Commercial	$609.70
Rate for Payer: Qualcare PPO/HMO/WC	$457.27
Rate for Payer: UnitedHealthcare Commercial	$609.70
Rate for Payer: UnitedHealthcare Community & State	$96.33
Rate for Payer: Wellpoint Medicaid Managed Care	$86.58

EPOETIN ALFA-EPBX 40000IU VIAL

Facility

$3,048.50

Service Code	NDC 69130904
Hospital Charge Code	606390476
Hospital Revenue Code	635
Min. Negotiated Rate	$457.27
Max. Negotiated Rate	$457.27
Rate for Payer: Qualcare PPO/HMO/WC	$457.27

EPOETIN ALFAEPFX20000U/ML ESRD

Facility

$1,768.80

Service Code	NDC 69131110
Hospital Charge Code	606390457
Hospital Revenue Code	635
Min. Negotiated Rate	$265.32
Max. Negotiated Rate	$265.32
Rate for Payer: Qualcare PPO/HMO/WC	$265.32

EPOETIN ALFAEPFX20000U/ML ESRD

Facility

$1,768.80

Service Code	NDC 69131110
Hospital Charge Code	606390457
Hospital Revenue Code	635
Min. Negotiated Rate	$50.23
Max. Negotiated Rate	$884.40
Rate for Payer: Aetna Commercial	$672.14
Rate for Payer: Aetna Medicare Advantage	$530.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.04
Rate for Payer: Cigna Commercial	$884.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$459.89
Rate for Payer: Oxford Commercial	$353.76
Rate for Payer: Qualcare PPO/HMO/WC	$265.32
Rate for Payer: UnitedHealthcare Commercial	$353.76
Rate for Payer: UnitedHealthcare Community & State	$55.89
Rate for Payer: Wellpoint Medicaid Managed Care	$50.23

EPSON SALTS/4OZ

Facility

$5.43

Service Code	NDC 869060243
Hospital Charge Code	60634759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare Advantage	$1.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.38
Rate for Payer: Cigna Commercial	$2.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.41
Rate for Payer: Oxford Commercial	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.81
Rate for Payer: UnitedHealthcare Commercial	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

EPSON SALTS/4OZ

Facility

$5.43

Service Code	NDC 869060243
Hospital Charge Code	60634759
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Qualcare PPO/HMO/WC	$0.81

EPSTEIN-BARR VCA AB IGM

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39900372
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.80
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

EPSTEIN-BARR VCA AB IGM

Facility

$390.00

Service Code	HCPCS 86665
Hospital Charge Code	39900372
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VIRUS AB PNL I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990095A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VIRUS AB PNL I

Facility

$390.00

Service Code	HCPCS 86664
Hospital Charge Code	39990095A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.59
Rate for Payer: Aetna Medicare Advantage	$49.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.29
Rate for Payer: Clover Medicare Advantage	$14.53
Rate for Payer: EmblemHealth Commercial	$45.87
Rate for Payer: Humana Medicare Advantage	$15.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.29
Rate for Payer: Wellcare Medicare Advantage	$15.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

EPSTEIN-BARR VIRUS AB PNL II

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

EPSTEIN-BARR VIRUS AB PNL II

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VIRUS AB PNL III

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

EPSTEIN-BARR VIRUS AB PNL III

Facility

$390.00

Service Code	HCPCS 8666591
Hospital Charge Code	39990095C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EPSTEIN-BARR VIRUS ANTI, EA,IG

Facility

$245.00

Service Code	HCPCS 86256
Hospital Charge Code	38476102
Hospital Revenue Code	302
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$36.75
Rate for Payer: Qualcare PPO/HMO/WC	$36.75

EPSTEIN-BARR VIRUS ANTI, EA,IG

Facility

$245.00

Service Code	HCPCS 86256
Hospital Charge Code	38476102
Hospital Revenue Code	302
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$122.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.70
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$6.96

EPSTEIN-BARR VIRUS ANTI,EA IGG

Facility

$156.00

Service Code	HCPCS 86663
Hospital Charge Code	38476105
Hospital Revenue Code	302
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

EPSTEIN-BARR VIRUS ANTI,EA IGG

Facility

$156.00

Service Code	HCPCS 86663
Hospital Charge Code	38476105
Hospital Revenue Code	302
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.69
Rate for Payer: Aetna Medicare Advantage	$42.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.59
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: Cigna Medicare Advantage	$13.12
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Medicare Advantage	$13.12
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

EPSTEIN-BARR VIRUS ANTI,VCA, I

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38476111
Hospital Revenue Code	302
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$49.34
Rate for Payer: Aetna Medicare Advantage	$58.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.80
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.14
Rate for Payer: Clover Medicare Advantage	$17.23
Rate for Payer: EmblemHealth Commercial	$54.42
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.14
Rate for Payer: Wellcare Medicare Advantage	$18.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.79

EPSTEIN-BARR VIRUS ANTI,VCA, I

Facility

$239.00

Service Code	HCPCS 86665
Hospital Charge Code	38476111
Hospital Revenue Code	302
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

Know your out-of-pocket cost for care.

All Charges