Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GENTAMICIN SULFATE PEDIAT

Facility

$7.30

Service Code	NDC 63323017302
Hospital Charge Code	60633044
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

GENTAMICIN SULFATE PEDIAT

Facility

$7.30

Service Code	NDC 63323017302
Hospital Charge Code	60633044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.90
Rate for Payer: Oxford Commercial	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.46
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

GENTAMYCIN 120MG/100ML PREMIX

Facility

$27.34

Service Code	HCPCS J1580
Hospital Charge Code	606390499
Hospital Revenue Code	636
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.67
Rate for Payer: Aetna Commercial	$10.39
Rate for Payer: Aetna Medicare Advantage	$8.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.97
Rate for Payer: Cigna Commercial	$13.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.10
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

GENTAMYCIN 120MG/100ML PREMIX

Facility

$27.34

Service Code	HCPCS J1580
Hospital Charge Code	606390499
Hospital Revenue Code	636
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$6.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.10

GENTAMYCIN IVPB 60MG/50ML NS

Facility

$25.19

Service Code	HCPCS J1580
Hospital Charge Code	60627236
Hospital Revenue Code	636
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$12.60
Rate for Payer: Aetna Commercial	$9.57
Rate for Payer: Aetna Medicare Advantage	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$12.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

GENTAMYCIN IVPB 60MG/50ML NS

Facility

$25.19

Service Code	HCPCS J1580
Hospital Charge Code	60627236
Hospital Revenue Code	636
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$6.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

GENTAMYCIN IVPB 80MG/50ML NS

Facility

$26.67

Service Code	HCPCS J1580
Hospital Charge Code	60627239
Hospital Revenue Code	636
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.34
Rate for Payer: Aetna Commercial	$10.13
Rate for Payer: Aetna Medicare Advantage	$8.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.80
Rate for Payer: Cigna Commercial	$13.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

GENTAMYCIN IVPB 80MG/50ML NS

Facility

$26.67

Service Code	HCPCS J1580
Hospital Charge Code	60627239
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.00

GENTAMYCIN PEAK

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479093
Hospital Revenue Code	301
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

GENTAMYCIN PEAK

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479093
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.55
Rate for Payer: Aetna Medicare Advantage	$53.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.42
Rate for Payer: Cigna Commercial	$89.50
Rate for Payer: Cigna Medicare Advantage	$16.38
Rate for Payer: Clover Medicare Advantage	$15.56
Rate for Payer: EmblemHealth Commercial	$49.14
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.38
Rate for Payer: Wellcare Medicare Advantage	$16.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.08

GENTAMYCIN trough

Facility

$390.00

Service Code	HCPCS 80170
Hospital Charge Code	39900461
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.55
Rate for Payer: Aetna Medicare Advantage	$53.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.42
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.38
Rate for Payer: Clover Medicare Advantage	$15.56
Rate for Payer: EmblemHealth Commercial	$49.14
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.38
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	$13.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.38
Rate for Payer: Wellcare Medicare Advantage	$16.38
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GENTAMYCIN trough

Facility

$390.00

Service Code	HCPCS 80170
Hospital Charge Code	39900461
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GENTAMYCIN TROUGH

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479095
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$44.55
Rate for Payer: Aetna Medicare Advantage	$53.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.42
Rate for Payer: Cigna Commercial	$89.50
Rate for Payer: Cigna Medicare Advantage	$16.38
Rate for Payer: Clover Medicare Advantage	$15.56
Rate for Payer: EmblemHealth Commercial	$49.14
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.38
Rate for Payer: Wellcare Medicare Advantage	$16.38
Rate for Payer: Wellpoint Medicaid Managed Care	$5.08

GENTAMYCIN TROUGH

Facility

$179.00

Service Code	HCPCS 80170
Hospital Charge Code	38479095
Hospital Revenue Code	301
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

GENTIAN VIOLET 1%

Facility

$54.40

Service Code	NDC 395100592
Hospital Charge Code	60634492
Hospital Revenue Code	250
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$8.16
Rate for Payer: Qualcare PPO/HMO/WC	$8.16

GENTIAN VIOLET 1%

Facility

$54.40

Service Code	NDC 395100592
Hospital Charge Code	60634492
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna Commercial	$20.67
Rate for Payer: Aetna Medicare Advantage	$16.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.87
Rate for Payer: Cigna Commercial	$27.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.14
Rate for Payer: Oxford Commercial	$10.88
Rate for Payer: Qualcare PPO/HMO/WC	$8.16
Rate for Payer: UnitedHealthcare Commercial	$10.88
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

GEODON,40MG CAP

Facility

$102.64

Service Code	NDC 49005460
Hospital Charge Code	60635421
Hospital Revenue Code	250
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$15.40
Rate for Payer: Qualcare PPO/HMO/WC	$15.40

GEODON,40MG CAP

Facility

$102.64

Service Code	NDC 49005460
Hospital Charge Code	60635421
Hospital Revenue Code	250
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$51.32
Rate for Payer: Aetna Commercial	$39.00
Rate for Payer: Aetna Medicare Advantage	$30.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.17
Rate for Payer: Cigna Commercial	$51.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.69
Rate for Payer: Oxford Commercial	$20.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.40
Rate for Payer: UnitedHealthcare Commercial	$20.53
Rate for Payer: UnitedHealthcare Community & State	$3.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.91

GERI PREV MED.COUNSLNG,INTERVW

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	83652497
Hospital Revenue Code	510
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$7.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.65

GERI PREV MED.COUNSLNG,INTERVW

Facility

$51.00

Service Code	HCPCS 99401
Hospital Charge Code	83652497
Hospital Revenue Code	510
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$19.38
Rate for Payer: Aetna Medicare Advantage	$15.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.01
Rate for Payer: Cigna Commercial	$25.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.26
Rate for Payer: Qualcare PPO/HMO/WC	$7.65
Rate for Payer: UnitedHealthcare Community & State	$1.61
Rate for Payer: Wellpoint Medicaid Managed Care	$1.45

GERI PSYCH PRIVATE

Facility

$18,000.00

Hospital Charge Code	100824
Hospital Revenue Code	114
Min. Negotiated Rate	$1,854.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

GERI PSYCH SEMI-PRIVATE

Facility

$18,000.00

Hospital Charge Code	100826
Hospital Revenue Code	124
Min. Negotiated Rate	$1,854.00
Max. Negotiated Rate	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,854.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,360.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,700.00

GERITOL PER ML

Facility

$4.00

Service Code	NDC 46017001112
Hospital Charge Code	606390439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

GERITOL PER ML

Facility

$4.00

Service Code	NDC 46017001112
Hospital Charge Code	606390439
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GFRG AUTOL FAT LIPO EA ADDL

Facility

$8,265.00

Service Code	HCPCS 15774
Hospital Charge Code	1600000627
Hospital Revenue Code	360
Min. Negotiated Rate	$1,239.75
Max. Negotiated Rate	$1,239.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,239.75

Know your out-of-pocket cost for care.

All Charges