Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

G7 SCREW 6.5MM X 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680634
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

G7 SCREW 6.5MM X 30MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680634
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SCREW 6.5MM X 40MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680635
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

G7 SCREW 6.5MM X 40MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270680635
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SCREW 6.5MM X 45MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681044
Hospital Revenue Code	278
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

G7 SCREW 6.5MM X 45MM

Facility

$125.00

Service Code	HCPCS C1713
Hospital Charge Code	270681044
Hospital Revenue Code	278
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$30.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.25
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

G7 SUCTION CUP STERILE

Facility

$390.00

Hospital Charge Code	270686370
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

G7 SUCTION CUP STERILE

Facility

$390.00

Hospital Charge Code	270686370
Hospital Revenue Code	272
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	$78.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$78.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

G7 VIT E FRDM CONST LNR 36MM F

Facility

$24,995.00

Hospital Charge Code	270702525
Hospital Revenue Code	278
Min. Negotiated Rate	$709.86
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$789.84
Rate for Payer: Wellpoint Medicaid Managed Care	$709.86

G7 VIT E FRDM CONST LNR 36MM F

Facility

$24,995.00

Hospital Charge Code	270702525
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

G7 VIT E HIGH WALL LNR 36MM F

Facility

$12,000.00

Hospital Charge Code	270702411
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

G7 VIT E HIGH WALL LNR 36MM F

Facility

$12,000.00

Hospital Charge Code	270702411
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

GA67 CITRATE 6.0 MCI

Facility

$204.87

Service Code	HCPCS A9566
Hospital Charge Code	4509073
Hospital Revenue Code	343
Min. Negotiated Rate	$30.73
Max. Negotiated Rate	$30.73
Rate for Payer: Qualcare PPO/HMO/WC	$30.73

GA67 CITRATE 6.0 MCI

Facility

$204.87

Service Code	HCPCS A9566
Hospital Charge Code	4509073
Hospital Revenue Code	343
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$102.44
Rate for Payer: Aetna Commercial	$77.85
Rate for Payer: Aetna Medicare Advantage	$61.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.24
Rate for Payer: Cigna Commercial	$102.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.27
Rate for Payer: Qualcare PPO/HMO/WC	$30.73
Rate for Payer: UnitedHealthcare Community & State	$6.47
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

GABAPENTIN

Facility

$390.00

Service Code	HCPCS 80171
Hospital Charge Code	39900503
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GABAPENTIN

Facility

$390.00

Service Code	HCPCS 80171
Hospital Charge Code	39900503
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$58.94
Rate for Payer: Aetna Medicare Advantage	$70.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.61
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$21.67
Rate for Payer: Clover Medicare Advantage	$20.59
Rate for Payer: EmblemHealth Commercial	$65.01
Rate for Payer: Humana Medicare Advantage	$22.32
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21.67
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	$17.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.67
Rate for Payer: Wellcare Medicare Advantage	$21.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GABAPENTIN 100 MG CAP

Facility

$5.96

Service Code	NDC 63739067510
Hospital Charge Code	60627750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.98
Rate for Payer: Aetna Commercial	$2.26
Rate for Payer: Aetna Medicare Advantage	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.52
Rate for Payer: Cigna Commercial	$2.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.55
Rate for Payer: Oxford Commercial	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.19
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

GABAPENTIN 100 MG CAP

Facility

$5.96

Service Code	NDC 63739067510
Hospital Charge Code	60627750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

GABAPENTIN 250MG/5ML SOL

Facility

$20.23

Service Code	NDC 71201247
Hospital Charge Code	60632259
Hospital Revenue Code	250
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$3.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.03

GABAPENTIN 250MG/5ML SOL

Facility

$20.23

Service Code	NDC 71201247
Hospital Charge Code	60632259
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$10.12
Rate for Payer: Aetna Commercial	$7.69
Rate for Payer: Aetna Medicare Advantage	$6.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.16
Rate for Payer: Cigna Commercial	$10.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.26
Rate for Payer: Oxford Commercial	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.03
Rate for Payer: UnitedHealthcare Commercial	$4.05
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

GABAPENTIN 300 MG CAP

Facility

$27.94

Service Code	NDC 71080540
Hospital Charge Code	6017750
Hospital Revenue Code	250
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

GABAPENTIN 300 MG CAP

Facility

$27.94

Service Code	NDC 71080540
Hospital Charge Code	6017750
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$13.97
Rate for Payer: Aetna Commercial	$10.62
Rate for Payer: Aetna Medicare Advantage	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.12
Rate for Payer: Cigna Commercial	$13.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.26
Rate for Payer: Oxford Commercial	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$5.59
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

GABAPENTIN 400 MG CAP

Facility

$32.43

Service Code	NDC 71080640
Hospital Charge Code	6017768
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$16.21
Rate for Payer: Aetna Commercial	$12.32
Rate for Payer: Aetna Medicare Advantage	$9.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.27
Rate for Payer: Cigna Commercial	$16.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.43
Rate for Payer: Oxford Commercial	$6.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Commercial	$6.49
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

GABAPENTIN 400 MG CAP

Facility

$32.43

Service Code	NDC 71080640
Hospital Charge Code	6017768
Hospital Revenue Code	250
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

GABAPENTIN (NEURONTIN)

Facility

$239.00

Service Code	HCPCS 80299
Hospital Charge Code	38473126
Hospital Revenue Code	301
Min. Negotiated Rate	$6.79
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$119.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$6.79

Know your out-of-pocket cost for care.

All Charges