Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLIPIZIDE 5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017402
Hospital Charge Code	60628233
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.88
Rate for Payer: Aetna Commercial	$2.95
Rate for Payer: Aetna Medicare Advantage	$2.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.98
Rate for Payer: Cigna Commercial	$3.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.02
Rate for Payer: Oxford Commercial	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.17
Rate for Payer: UnitedHealthcare Commercial	$1.55
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

GLIPIZIDE 5 MG SR TAB

Facility

$7.77

Service Code	NDC 49017402
Hospital Charge Code	60628233
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$1.17

GLIPIZIDE 5 MG TAB UD

Facility

$4.00

Service Code	NDC 51079081020
Hospital Charge Code	60628234
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

GLIPIZIDE 5 MG TAB UD

Facility

$4.00

Service Code	NDC 51079081020
Hospital Charge Code	60628234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLOCOSE 1/2 HR

Facility

$203.00

Service Code	HCPCS 82952
Hospital Charge Code	38479022
Hospital Revenue Code	301
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.22
Rate for Payer: Cigna Commercial	$101.50
Rate for Payer: Cigna Medicare Advantage	$3.92
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$30.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Medicare Advantage	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$5.77

GLOCOSE 1/2 HR

Facility

$203.00

Service Code	HCPCS 82952
Hospital Charge Code	38479022
Hospital Revenue Code	301
Min. Negotiated Rate	$30.45
Max. Negotiated Rate	$30.45
Rate for Payer: Qualcare PPO/HMO/WC	$30.45

GLOCOSE,5HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479026
Hospital Revenue Code	301
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

GLOCOSE,5HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479026
Hospital Revenue Code	301
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$201.50
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.22
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: Cigna Medicare Advantage	$3.92
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Medicare Advantage	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$11.45

GLOCOSE,6HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479027
Hospital Revenue Code	301
Min. Negotiated Rate	$60.45
Max. Negotiated Rate	$60.45
Rate for Payer: Qualcare PPO/HMO/WC	$60.45

GLOCOSE,6HR

Facility

$403.00

Service Code	HCPCS 82952
Hospital Charge Code	38479027
Hospital Revenue Code	301
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$201.50
Rate for Payer: Aetna Commercial	$10.66
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.22
Rate for Payer: Cigna Commercial	$201.50
Rate for Payer: Cigna Medicare Advantage	$3.92
Rate for Payer: Clover Medicare Advantage	$3.72
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Humana Medicare Advantage	$4.04
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.92
Rate for Payer: Wellcare Medicare Advantage	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$11.45

G-LOK 25MM LOOP

Facility

$1,781.25

Hospital Charge Code	270676528
Hospital Revenue Code	272
Min. Negotiated Rate	$267.19
Max. Negotiated Rate	$267.19
Rate for Payer: Qualcare PPO/HMO/WC	$267.19

G-LOK 25MM LOOP

Facility

$1,781.25

Hospital Charge Code	270676528
Hospital Revenue Code	272
Min. Negotiated Rate	$50.59
Max. Negotiated Rate	$890.62
Rate for Payer: Aetna Commercial	$676.88
Rate for Payer: Aetna Medicare Advantage	$534.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$454.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$454.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$454.22
Rate for Payer: Cigna Commercial	$890.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$463.12
Rate for Payer: Oxford Commercial	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$267.19
Rate for Payer: UnitedHealthcare Commercial	$356.25
Rate for Payer: UnitedHealthcare Community & State	$56.29
Rate for Payer: Wellpoint Medicaid Managed Care	$50.59

GLOMERULAR BASE,MEMBRANE

Facility

$417.00

Service Code	HCPCS 83520
Hospital Charge Code	38476192
Hospital Revenue Code	301
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

GLOMERULAR BASE,MEMBRANE

Facility

$417.00

Service Code	HCPCS 83520
Hospital Charge Code	38476192
Hospital Revenue Code	301
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$208.50
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	$208.50
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	$108.42
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
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	$11.84

GLOVE DISPENSER ACRYLIC SIDE L

Facility

$242.50

Hospital Charge Code	270665323
Hospital Revenue Code	270
Min. Negotiated Rate	$36.38
Max. Negotiated Rate	$36.38
Rate for Payer: Qualcare PPO/HMO/WC	$36.38

GLOVE DISPENSER ACRYLIC SIDE L

Facility

$242.50

Hospital Charge Code	270665323
Hospital Revenue Code	270
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$121.25
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare Advantage	$72.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.84
Rate for Payer: Cigna Commercial	$121.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.05
Rate for Payer: Oxford Commercial	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.38
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

GLOVE SURG GAMMEX WHITE SX 7.5

Facility

$7.70

Hospital Charge Code	270060940
Hospital Revenue Code	272
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

GLOVE SURG GAMMEX WHITE SX 7.5

Facility

$7.70

Hospital Charge Code	270060940
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

GLOVE SZ 6 1/2 TRIFLEX ORTHO

Facility

$203.80

Hospital Charge Code	270665432
Hospital Revenue Code	270
Min. Negotiated Rate	$30.57
Max. Negotiated Rate	$30.57
Rate for Payer: Qualcare PPO/HMO/WC	$30.57

GLOVE SZ 6 1/2 TRIFLEX ORTHO

Facility

$203.80

Hospital Charge Code	270665432
Hospital Revenue Code	270
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$101.90
Rate for Payer: Aetna Commercial	$77.44
Rate for Payer: Aetna Medicare Advantage	$61.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.97
Rate for Payer: Cigna Commercial	$101.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.99
Rate for Payer: Oxford Commercial	$40.76
Rate for Payer: Qualcare PPO/HMO/WC	$30.57
Rate for Payer: UnitedHealthcare Commercial	$40.76
Rate for Payer: UnitedHealthcare Community & State	$6.44
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

GLOVE SZ 7 1/2 TRIFLEX ORTHO

Facility

$203.80

Hospital Charge Code	270665430
Hospital Revenue Code	270
Min. Negotiated Rate	$30.57
Max. Negotiated Rate	$30.57
Rate for Payer: Qualcare PPO/HMO/WC	$30.57

GLOVE SZ 7 1/2 TRIFLEX ORTHO

Facility

$203.80

Hospital Charge Code	270665430
Hospital Revenue Code	270
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$101.90
Rate for Payer: Aetna Commercial	$77.44
Rate for Payer: Aetna Medicare Advantage	$61.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.97
Rate for Payer: Cigna Commercial	$101.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.99
Rate for Payer: Oxford Commercial	$40.76
Rate for Payer: Qualcare PPO/HMO/WC	$30.57
Rate for Payer: UnitedHealthcare Commercial	$40.76
Rate for Payer: UnitedHealthcare Community & State	$6.44
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

GLOVE SZ 7 TRIFLEX ORTHO

Facility

$203.80

Hospital Charge Code	270665431
Hospital Revenue Code	270
Min. Negotiated Rate	$30.57
Max. Negotiated Rate	$30.57
Rate for Payer: Qualcare PPO/HMO/WC	$30.57

GLOVE SZ 7 TRIFLEX ORTHO

Facility

$203.80

Hospital Charge Code	270665431
Hospital Revenue Code	270
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$101.90
Rate for Payer: Aetna Commercial	$77.44
Rate for Payer: Aetna Medicare Advantage	$61.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.97
Rate for Payer: Cigna Commercial	$101.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.99
Rate for Payer: Oxford Commercial	$40.76
Rate for Payer: Qualcare PPO/HMO/WC	$30.57
Rate for Payer: UnitedHealthcare Commercial	$40.76
Rate for Payer: UnitedHealthcare Community & State	$6.44
Rate for Payer: Wellpoint Medicaid Managed Care	$5.79

GLUCAGON

Facility

$98.20

Service Code	HCPCS 82943
Hospital Charge Code	39900085
Hospital Revenue Code	301
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$38.87
Rate for Payer: Aetna Medicare Advantage	$46.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.84
Rate for Payer: Cigna Commercial	$49.10
Rate for Payer: Cigna Medicare Advantage	$14.29
Rate for Payer: Clover Medicare Advantage	$13.58
Rate for Payer: EmblemHealth Commercial	$42.87
Rate for Payer: Humana Medicare Advantage	$14.72
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.53
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.73
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.29
Rate for Payer: Wellcare Medicare Advantage	$14.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.79

Know your out-of-pocket cost for care.

All Charges