Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4515517
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4527517
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4832517
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4517517
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4517517
Hospital Revenue Code	916
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4504517
Hospital Revenue Code	916
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4504517
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4822517
Hospital Revenue Code	916
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4509517
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4824517
Hospital Revenue Code	916
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$764.93
Rate for Payer: Aetna Commercial	$573.57
Rate for Payer: Aetna Medicare Advantage	$683.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$764.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$210.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$764.93
Rate for Payer: Cigna Commercial	$422.69
Rate for Payer: Cigna Medicare Advantage	$210.87
Rate for Payer: Clover Medicare Advantage	$200.33
Rate for Payer: EmblemHealth Commercial	$632.61
Rate for Payer: Humana Medicare Advantage	$217.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$210.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.87
Rate for Payer: Wellcare Medicare Advantage	$210.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$113.84
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

FAMILY TX W PT 50 MIN CHILD

Facility

$1,500.00

Service Code	HCPCS 90847
Hospital Charge Code	4824517
Hospital Revenue Code	916
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

FAMOTIDINE 20 MG/ 2ML INJ

Facility

$5.16

Service Code	NDC 641602201
Hospital Charge Code	60629059
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

FAMOTIDINE 20 MG/ 2ML INJ

Facility

$5.16

Service Code	NDC 641602201
Hospital Charge Code	60629059
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$1.96
Rate for Payer: Aetna Medicare Advantage	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.32
Rate for Payer: Cigna Commercial	$2.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.03
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

FAMOTIDINE 20 MG TAB

Facility

$11.59

Service Code	NDC 187442010
Hospital Charge Code	60629349
Hospital Revenue Code	250
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.74

FAMOTIDINE 20 MG TAB

Facility

$11.59

Service Code	NDC 187442010
Hospital Charge Code	60629349
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.79
Rate for Payer: Aetna Commercial	$4.40
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.96
Rate for Payer: Cigna Commercial	$5.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.01
Rate for Payer: Oxford Commercial	$2.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.74
Rate for Payer: UnitedHealthcare Commercial	$2.32
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

FAMOTIDINE 40MG/ 4ML VIAL

Facility

$14.02

Hospital Charge Code	606390072
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

FAMOTIDINE 40MG/ 4ML VIAL

Facility

$14.02

Hospital Charge Code	606390072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$7.01
Rate for Payer: Aetna Commercial	$5.33
Rate for Payer: Aetna Medicare Advantage	$4.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.58
Rate for Payer: Cigna Commercial	$7.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.65
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

FAMOTIDINE 40MG/5ML

Facility

$509.75

Hospital Charge Code	6063943107
Hospital Revenue Code	250
Min. Negotiated Rate	$76.46
Max. Negotiated Rate	$76.46
Rate for Payer: Qualcare PPO/HMO/WC	$76.46

FAMOTIDINE 40MG/5ML

Facility

$509.75

Hospital Charge Code	6063943107
Hospital Revenue Code	250
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$254.88
Rate for Payer: Aetna Commercial	$193.71
Rate for Payer: Aetna Medicare Advantage	$152.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$129.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$129.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$129.99
Rate for Payer: Cigna Commercial	$254.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.53
Rate for Payer: Oxford Commercial	$101.95
Rate for Payer: Qualcare PPO/HMO/WC	$76.46
Rate for Payer: UnitedHealthcare Commercial	$101.95
Rate for Payer: UnitedHealthcare Community & State	$16.11
Rate for Payer: Wellpoint Medicaid Managed Care	$14.48

FAMOTIDINE 40 MG/5 ML ORAL SUS

Facility

$118.46

Service Code	NDC 68382044405
Hospital Charge Code	6063943199
Hospital Revenue Code	250
Min. Negotiated Rate	$17.77
Max. Negotiated Rate	$17.77
Rate for Payer: Qualcare PPO/HMO/WC	$17.77

FAMOTIDINE 40 MG/5 ML ORAL SUS

Facility

$118.46

Service Code	NDC 68382044405
Hospital Charge Code	6063943199
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$59.23
Rate for Payer: Aetna Commercial	$45.01
Rate for Payer: Aetna Medicare Advantage	$35.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.21
Rate for Payer: Cigna Commercial	$59.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.80
Rate for Payer: Oxford Commercial	$23.69
Rate for Payer: Qualcare PPO/HMO/WC	$17.77
Rate for Payer: UnitedHealthcare Commercial	$23.69
Rate for Payer: UnitedHealthcare Community & State	$3.74
Rate for Payer: Wellpoint Medicaid Managed Care	$3.36

FAMOTIDINE IVPB 20MG/50ML ISO

Facility

$31.36

Service Code	NDC 338519741
Hospital Charge Code	60629161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$15.68
Rate for Payer: Aetna Commercial	$11.92
Rate for Payer: Aetna Medicare Advantage	$9.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.00
Rate for Payer: Cigna Commercial	$15.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.15
Rate for Payer: Oxford Commercial	$6.27
Rate for Payer: Qualcare PPO/HMO/WC	$4.70
Rate for Payer: UnitedHealthcare Commercial	$6.27
Rate for Payer: UnitedHealthcare Community & State	$0.99
Rate for Payer: Wellpoint Medicaid Managed Care	$0.89

FAMOTIDINE IVPB 20MG/50ML ISO

Facility

$31.36

Service Code	NDC 338519741
Hospital Charge Code	60629161
Hospital Revenue Code	250
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$4.70
Rate for Payer: Qualcare PPO/HMO/WC	$4.70

FAM SES ADLT WO PT/30MIN MCAID

Facility

$750.00

Service Code	HCPCS 90846
Hospital Charge Code	4822605
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

FAM SES ADLT WO PT/30MIN MCAID

Facility

$750.00

Service Code	HCPCS 90846
Hospital Charge Code	4504605
Hospital Revenue Code	914
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges