Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GABAPENTIN (NEURONTIN)

Facility

$239.00

Service Code	HCPCS 80299
Hospital Charge Code	38473126
Hospital Revenue Code	301
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$35.85
Rate for Payer: Qualcare PPO/HMO/WC	$35.85

GABAPENTIN (NEURONTIN) 600MG T

Facility

$16.95

Service Code	NDC 59762502301
Hospital Charge Code	60630132
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.47
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna Medicare Advantage	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.32
Rate for Payer: Cigna Commercial	$8.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.41
Rate for Payer: Oxford Commercial	$3.39
Rate for Payer: Qualcare PPO/HMO/WC	$2.54
Rate for Payer: UnitedHealthcare Commercial	$3.39
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

GABAPENTIN (NEURONTIN) 600MG T

Facility

$16.95

Service Code	NDC 59762502301
Hospital Charge Code	60630132
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$2.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.54

GAD-65 AB

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	39900515
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$64.11
Rate for Payer: Aetna Medicare Advantage	$76.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23.57
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	$85.50
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$23.57
Rate for Payer: Clover Medicare Advantage	$22.39
Rate for Payer: EmblemHealth Commercial	$70.71
Rate for Payer: Humana Medicare Advantage	$24.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23.57
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	$18.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.57
Rate for Payer: Wellcare Medicare Advantage	$23.57
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GAD-65 AB

Facility

$390.00

Service Code	HCPCS 86341
Hospital Charge Code	39900515
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GAD-65 AB

Facility

$112.00

Service Code	HCPCS 83519
Hospital Charge Code	38477008
Hospital Revenue Code	301
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

GAD-65 AB

Facility

$112.00

Service Code	HCPCS 83519
Hospital Charge Code	38477008
Hospital Revenue Code	301
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
Rate for Payer: Cigna Commercial	$56.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.12
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

GAD65 NEURO SYNDROME AB

Facility

$815.50

Service Code	HCPCS 83516
Hospital Charge Code	3038554
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$407.75
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$407.75
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$212.03
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$122.33
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$23.16

GAD65 NEURO SYNDROME AB

Facility

$815.50

Service Code	HCPCS 83516
Hospital Charge Code	3038554
Hospital Revenue Code	301
Min. Negotiated Rate	$122.33
Max. Negotiated Rate	$122.33
Rate for Payer: Qualcare PPO/HMO/WC	$122.33

GADODIAMIDE 287MG/ML 15ML VIAL

Facility

$596.37

Service Code	NDC 407069005
Hospital Charge Code	60630242
Hospital Revenue Code	255
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$298.19
Rate for Payer: Aetna Commercial	$226.62
Rate for Payer: Aetna Medicare Advantage	$178.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.07
Rate for Payer: Cigna Commercial	$298.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.06
Rate for Payer: Oxford Commercial	$119.27
Rate for Payer: Qualcare PPO/HMO/WC	$89.46
Rate for Payer: UnitedHealthcare Commercial	$119.27
Rate for Payer: UnitedHealthcare Community & State	$18.85
Rate for Payer: Wellpoint Medicaid Managed Care	$16.94

GADODIAMIDE 287MG/ML 15ML VIAL

Facility

$596.37

Service Code	NDC 407069005
Hospital Charge Code	60630242
Hospital Revenue Code	255
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$89.46
Rate for Payer: Qualcare PPO/HMO/WC	$89.46

GADOLINIUM/OMNISCAN/ MRI C AGN

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	2008075
Hospital Revenue Code	636
Min. Negotiated Rate	$105.53
Max. Negotiated Rate	$170.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.25
Rate for Payer: Qualcare PPO/HMO/WC	$105.53

GADOLINIUM/OMNISCAN/ MRI C AGN

Facility

$703.50

Service Code	NDC 407069020
Hospital Charge Code	2008075
Hospital Revenue Code	636
Min. Negotiated Rate	$19.98
Max. Negotiated Rate	$351.75
Rate for Payer: Aetna Commercial	$267.33
Rate for Payer: Aetna Medicare Advantage	$211.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$179.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$179.39
Rate for Payer: Cigna Commercial	$351.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$170.25
Rate for Payer: Qualcare PPO/HMO/WC	$105.53
Rate for Payer: UnitedHealthcare Community & State	$22.23
Rate for Payer: Wellpoint Medicaid Managed Care	$19.98

GADOTERIDOL 15ML

Facility

$247.70

Service Code	NDC 270111102
Hospital Charge Code	606390368
Hospital Revenue Code	255
Min. Negotiated Rate	$37.16
Max. Negotiated Rate	$37.16
Rate for Payer: Qualcare PPO/HMO/WC	$37.16

GADOTERIDOL 15ML

Facility

$247.70

Service Code	NDC 270111102
Hospital Charge Code	606390368
Hospital Revenue Code	255
Min. Negotiated Rate	$7.03
Max. Negotiated Rate	$123.85
Rate for Payer: Aetna Commercial	$94.13
Rate for Payer: Aetna Medicare Advantage	$74.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.16
Rate for Payer: Cigna Commercial	$123.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.40
Rate for Payer: Oxford Commercial	$49.54
Rate for Payer: Qualcare PPO/HMO/WC	$37.16
Rate for Payer: UnitedHealthcare Commercial	$49.54
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.03

GADOTERIDOL 20ML

Facility

$330.31

Service Code	NDC 270111103
Hospital Charge Code	606390369
Hospital Revenue Code	255
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$165.16
Rate for Payer: Aetna Commercial	$125.52
Rate for Payer: Aetna Medicare Advantage	$99.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$84.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$84.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$84.23
Rate for Payer: Cigna Commercial	$165.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.88
Rate for Payer: Oxford Commercial	$66.06
Rate for Payer: Qualcare PPO/HMO/WC	$49.55
Rate for Payer: UnitedHealthcare Commercial	$66.06
Rate for Payer: UnitedHealthcare Community & State	$10.44
Rate for Payer: Wellpoint Medicaid Managed Care	$9.38

GADOTERIDOL 20ML

Facility

$330.31

Service Code	NDC 270111103
Hospital Charge Code	606390369
Hospital Revenue Code	255
Min. Negotiated Rate	$49.55
Max. Negotiated Rate	$49.55
Rate for Payer: Qualcare PPO/HMO/WC	$49.55

GADOXETATE 181.43MG/ML 10ML

Facility

$109.75

Service Code	NDC 50419032005
Hospital Charge Code	606390437
Hospital Revenue Code	255
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$54.88
Rate for Payer: Aetna Commercial	$41.70
Rate for Payer: Aetna Medicare Advantage	$32.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.99
Rate for Payer: Cigna Commercial	$54.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.54
Rate for Payer: Oxford Commercial	$21.95
Rate for Payer: Qualcare PPO/HMO/WC	$16.46
Rate for Payer: UnitedHealthcare Commercial	$21.95
Rate for Payer: UnitedHealthcare Community & State	$3.47
Rate for Payer: Wellpoint Medicaid Managed Care	$3.12

GADOXETATE 181.43MG/ML 10ML

Facility

$109.75

Service Code	NDC 50419032005
Hospital Charge Code	606390437
Hospital Revenue Code	255
Min. Negotiated Rate	$16.46
Max. Negotiated Rate	$16.46
Rate for Payer: Qualcare PPO/HMO/WC	$16.46

GAIRDIA ANTIGEN

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38479084
Hospital Revenue Code	306
Min. Negotiated Rate	$26.70
Max. Negotiated Rate	$26.70
Rate for Payer: Qualcare PPO/HMO/WC	$26.70

GAIRDIA ANTIGEN

Facility

$178.00

Service Code	HCPCS 87328
Hospital Charge Code	38479084
Hospital Revenue Code	306
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.59
Rate for Payer: Aetna Medicare Advantage	$44.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.13
Rate for Payer: Cigna Commercial	$89.00
Rate for Payer: Cigna Medicare Advantage	$13.82
Rate for Payer: Clover Medicare Advantage	$13.13
Rate for Payer: EmblemHealth Commercial	$41.46
Rate for Payer: Humana Medicare Advantage	$14.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.28
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.82
Rate for Payer: Wellcare Medicare Advantage	$13.82
Rate for Payer: Wellpoint Medicaid Managed Care	$5.06

GAIT TRAINING EA 15 MIN CQ

Facility

$412.61

Service Code	HCPCS 97116GP
Hospital Charge Code	409197116Q
Hospital Revenue Code	420
Min. Negotiated Rate	$61.89
Max. Negotiated Rate	$61.89
Rate for Payer: Qualcare PPO/HMO/WC	$61.89

GAIT TRAINING EA 15 MIN CQ

Facility

$412.61

Service Code	HCPCS 97116GP
Hospital Charge Code	409197116Q
Hospital Revenue Code	420
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$156.79
Rate for Payer: Aetna Medicare Advantage	$123.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$105.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$105.22
Rate for Payer: Cigna Commercial	$206.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.28
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.89
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$13.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.72

GALANTAMINE 4 MG TAB

Facility

$18.36

Service Code	NDC 10147088106
Hospital Charge Code	60629188
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

GALANTAMINE 4 MG TAB

Facility

$18.36

Service Code	NDC 10147088106
Hospital Charge Code	60629188
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$6.98
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.68
Rate for Payer: Cigna Commercial	$9.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.77
Rate for Payer: Oxford Commercial	$3.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Commercial	$3.67
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

Know your out-of-pocket cost for care.

All Charges