Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GALANTAMINE 8MG TAB

Facility

$10.45

Service Code	NDC 63739070833
Hospital Charge Code	606390065
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

GALANTAMINE 8MG TAB

Facility

$10.45

Service Code	NDC 63739070833
Hospital Charge Code	606390065
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.72
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

GALLACTOSE

Facility

$79.00

Service Code	HCPCS 82760
Hospital Charge Code	38477101
Hospital Revenue Code	301
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$30.46
Rate for Payer: Aetna Medicare Advantage	$36.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.63
Rate for Payer: Cigna Commercial	$39.50
Rate for Payer: Cigna Medicare Advantage	$11.20
Rate for Payer: Clover Medicare Advantage	$10.64
Rate for Payer: EmblemHealth Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$11.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.20
Rate for Payer: Wellcare Medicare Advantage	$11.20
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

GALLACTOSE

Facility

$79.00

Service Code	HCPCS 82760
Hospital Charge Code	38477101
Hospital Revenue Code	301
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

GALLIUM GA-68 DOTATATE 0.1MCI

Facility

$277.77

Service Code	HCPCS A9587
Hospital Charge Code	80000055
Hospital Revenue Code	343
Min. Negotiated Rate	$7.89
Max. Negotiated Rate	$180.03
Rate for Payer: Aetna Commercial	$134.99
Rate for Payer: Aetna Medicare Advantage	$160.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$49.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.03
Rate for Payer: Cigna Medicare Advantage	$34.74
Rate for Payer: Clover Medicare Advantage	$47.15
Rate for Payer: EmblemHealth Commercial	$148.89
Rate for Payer: Humana Medicare Advantage	$51.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$49.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.22
Rate for Payer: Qualcare PPO/HMO/WC	$41.67
Rate for Payer: UnitedHealthcare Community & State	$8.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.63
Rate for Payer: Wellcare Medicare Advantage	$49.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.89

GALLIUM GA-68 DOTATATE 0.1MCI

Facility

$277.77

Service Code	HCPCS A9587
Hospital Charge Code	80000055
Hospital Revenue Code	343
Min. Negotiated Rate	$41.67
Max. Negotiated Rate	$41.67
Rate for Payer: Qualcare PPO/HMO/WC	$41.67

GALLIUM GA68 ILLUCCIX PER 1MCI

Facility

$4,712.86

Service Code	HCPCS A9596
Hospital Charge Code	80000054
Hospital Revenue Code	343
Min. Negotiated Rate	$706.93
Max. Negotiated Rate	$706.93
Rate for Payer: Qualcare PPO/HMO/WC	$706.93

GALLIUM GA68 ILLUCCIX PER 1MCI

Facility

$4,712.86

Service Code	HCPCS A9596
Hospital Charge Code	80000054
Hospital Revenue Code	343
Min. Negotiated Rate	$133.85
Max. Negotiated Rate	$1,735.83
Rate for Payer: Aetna Commercial	$1,301.57
Rate for Payer: Aetna Medicare Advantage	$1,550.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,735.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,735.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$478.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$337.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,735.83
Rate for Payer: Cigna Medicare Advantage	$334.96
Rate for Payer: Clover Medicare Advantage	$454.59
Rate for Payer: EmblemHealth Commercial	$1,435.56
Rate for Payer: Humana Medicare Advantage	$492.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$478.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.34
Rate for Payer: Qualcare PPO/HMO/WC	$706.93
Rate for Payer: UnitedHealthcare Community & State	$148.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$478.52
Rate for Payer: Wellcare Medicare Advantage	$478.52
Rate for Payer: Wellpoint Medicaid Managed Care	$133.85

GAMMA 4 LAG SCREW 10.5X80MM

Facility

$3,780.00

Service Code	HCPCS C1713
Hospital Charge Code	270705041
Hospital Revenue Code	278
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$914.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$756.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$914.76
Rate for Payer: Qualcare PPO/HMO/WC	$567.00

GAMMA 4 LAG SCREW 10.5X80MM

Facility

$3,780.00

Service Code	HCPCS C1713
Hospital Charge Code	270705041
Hospital Revenue Code	278
Min. Negotiated Rate	$107.35
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna Commercial	$1,436.40
Rate for Payer: Aetna Medicare Advantage	$1,134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$963.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$963.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$756.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$963.90
Rate for Payer: Cigna Commercial	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$914.76
Rate for Payer: Qualcare PPO/HMO/WC	$567.00
Rate for Payer: UnitedHealthcare Community & State	$119.45
Rate for Payer: Wellpoint Medicaid Managed Care	$107.35

GAMMA GLUTAMYLTRANSFERASE

Facility

$336.00

Service Code	HCPCS 82977
Hospital Charge Code	38472290
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial	$19.58
Rate for Payer: Aetna Medicare Advantage	$23.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.12
Rate for Payer: Cigna Commercial	$168.00
Rate for Payer: Cigna Medicare Advantage	$7.20
Rate for Payer: Clover Medicare Advantage	$6.84
Rate for Payer: EmblemHealth Commercial	$21.60
Rate for Payer: Humana Medicare Advantage	$7.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20
Rate for Payer: Wellcare Medicare Advantage	$7.20
Rate for Payer: Wellpoint Medicaid Managed Care	$9.54

GAMMA GLUTAMYLTRANSFERASE

Facility

$336.00

Service Code	HCPCS 82977
Hospital Charge Code	38472290
Hospital Revenue Code	301
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$50.40
Rate for Payer: Qualcare PPO/HMO/WC	$50.40

GANGLIOSDEGQ1BANTI(IGG)EIA(SE)

Facility

$159.73

Service Code	HCPCS 83520
Hospital Charge Code	4013835209
Hospital Revenue Code	301
Min. Negotiated Rate	$23.96
Max. Negotiated Rate	$23.96
Rate for Payer: Qualcare PPO/HMO/WC	$23.96

GANGLIOSDEGQ1BANTI(IGG)EIA(SE)

Facility

$159.73

Service Code	HCPCS 83520
Hospital Charge Code	4013835209
Hospital Revenue Code	301
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$79.86
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.53
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.96
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

GARAMYCIN/3.5GM

Facility

$112.96

Service Code	NDC 17478082735
Hospital Charge Code	60633034
Hospital Revenue Code	250
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$16.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.94

GARAMYCIN/3.5GM

Facility

$112.96

Service Code	NDC 17478082735
Hospital Charge Code	60633034
Hospital Revenue Code	250
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$56.48
Rate for Payer: Aetna Commercial	$42.92
Rate for Payer: Aetna Medicare Advantage	$33.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.80
Rate for Payer: Cigna Commercial	$56.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.37
Rate for Payer: Oxford Commercial	$22.59
Rate for Payer: Qualcare PPO/HMO/WC	$16.94
Rate for Payer: UnitedHealthcare Commercial	$22.59
Rate for Payer: UnitedHealthcare Community & State	$3.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.21

GARAMYCIN OPHTH/5ML

Facility

$126.70

Service Code	NDC 24208058060
Hospital Charge Code	60635874
Hospital Revenue Code	259
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$63.35
Rate for Payer: Aetna Commercial	$48.15
Rate for Payer: Aetna Medicare Advantage	$38.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.31
Rate for Payer: Cigna Commercial	$63.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.94
Rate for Payer: Oxford Commercial	$25.34
Rate for Payer: Qualcare PPO/HMO/WC	$19.00
Rate for Payer: UnitedHealthcare Commercial	$25.34
Rate for Payer: UnitedHealthcare Community & State	$4.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3.60

GARAMYCIN OPHTH/5ML

Facility

$126.70

Service Code	NDC 24208058060
Hospital Charge Code	60635874
Hospital Revenue Code	259
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$19.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.00

GARDASIL 0.5ML VACCINE VIAL

Facility

$1,183.35

Service Code	HCPCS 90649
Hospital Charge Code	6000430
Hospital Revenue Code	636
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$591.67
Rate for Payer: Aetna Commercial	$449.67
Rate for Payer: Aetna Medicare Advantage	$355.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.75
Rate for Payer: Cigna Commercial	$591.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.37
Rate for Payer: Qualcare PPO/HMO/WC	$177.50
Rate for Payer: UnitedHealthcare Community & State	$37.39
Rate for Payer: Wellpoint Medicaid Managed Care	$33.61

GARDASIL 0.5ML VACCINE VIAL

Facility

$1,183.35

Service Code	HCPCS 90649
Hospital Charge Code	6000430
Hospital Revenue Code	636
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$286.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.37
Rate for Payer: Qualcare PPO/HMO/WC	$177.50

GARDASIL VIAL HPV

Facility

$273.00

Service Code	HCPCS 90713
Hospital Charge Code	83652563
Hospital Revenue Code	636
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$136.50
Rate for Payer: Aetna Commercial	$103.74
Rate for Payer: Aetna Medicare Advantage	$81.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.61
Rate for Payer: Cigna Commercial	$136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95
Rate for Payer: UnitedHealthcare Community & State	$8.63
Rate for Payer: Wellpoint Medicaid Managed Care	$7.75

GARDASIL VIAL HPV

Facility

$1,210.49

Service Code	HCPCS 90649
Hospital Charge Code	83652307
Hospital Revenue Code	636
Min. Negotiated Rate	$34.38
Max. Negotiated Rate	$605.25
Rate for Payer: Aetna Commercial	$459.99
Rate for Payer: Aetna Medicare Advantage	$363.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$308.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$308.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$139.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$308.67
Rate for Payer: Cigna Commercial	$605.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.94
Rate for Payer: Qualcare PPO/HMO/WC	$181.57
Rate for Payer: UnitedHealthcare Community & State	$38.25
Rate for Payer: Wellpoint Medicaid Managed Care	$34.38

GARDASIL VIAL HPV

Facility

$273.00

Service Code	HCPCS 90713
Hospital Charge Code	83652563
Hospital Revenue Code	636
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$66.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.07
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

GARDASIL VIAL HPV

Facility

$1,210.49

Service Code	HCPCS 90649
Hospital Charge Code	83652307
Hospital Revenue Code	636
Min. Negotiated Rate	$181.57
Max. Negotiated Rate	$292.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.94
Rate for Payer: Qualcare PPO/HMO/WC	$181.57

GASTRECTOMY P DIST; W ROUX-EN

Facility

$23,535.00

Service Code	HCPCS 43633
Hospital Charge Code	1600000636
Hospital Revenue Code	360
Min. Negotiated Rate	$668.39
Max. Negotiated Rate	$11,767.50
Rate for Payer: Aetna Commercial	$8,943.30
Rate for Payer: Aetna Medicare Advantage	$7,060.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,001.43
Rate for Payer: Cigna Commercial	$11,767.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,119.10
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$743.71
Rate for Payer: Wellpoint Medicaid Managed Care	$668.39

Know your out-of-pocket cost for care.

All Charges