Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLUC TOLERANCE TEST EACH ADDI

Facility

$390.00

Service Code	HCPCS 82952
Hospital Charge Code	3001402
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GLUE MASTISOL VIAL

Facility

$13.65

Hospital Charge Code	270600756
Hospital Revenue Code	270
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

GLUE MASTISOL VIAL

Facility

$13.65

Hospital Charge Code	270600756
Hospital Revenue Code	270
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

GLUTEN IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900521
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GLUTEN IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	39900521
Hospital Revenue Code	305
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GLUTOSE 15- ORAL GLUCOSE GEL

Facility

$10.59

Service Code	NDC 574007015
Hospital Charge Code	60630105
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.59

GLUTOSE 15- ORAL GLUCOSE GEL

Facility

$10.59

Service Code	NDC 574007015
Hospital Charge Code	60630105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.29
Rate for Payer: Aetna Commercial	$4.02
Rate for Payer: Aetna Medicare Advantage	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.70
Rate for Payer: Cigna Commercial	$5.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.75
Rate for Payer: Oxford Commercial	$2.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.59
Rate for Payer: UnitedHealthcare Commercial	$2.12
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

GLUTOSE 5 GEL 12.5 GM ORAL

Facility

$17.35

Service Code	NDC 574006924
Hospital Charge Code	606390291
Hospital Revenue Code	250
Min. Negotiated Rate	$2.60
Max. Negotiated Rate	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$2.60

GLUTOSE 5 GEL 12.5 GM ORAL

Facility

$17.35

Service Code	NDC 574006924
Hospital Charge Code	606390291
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$8.68
Rate for Payer: Aetna Commercial	$6.59
Rate for Payer: Aetna Medicare Advantage	$5.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.42
Rate for Payer: Cigna Commercial	$8.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.51
Rate for Payer: Oxford Commercial	$3.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.60
Rate for Payer: UnitedHealthcare Commercial	$3.47
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

GLYBURIDE 2.5 MG TAB

Facility

$4.00

Service Code	NDC 51079087220
Hospital Charge Code	60628235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLYBURIDE 2.5 MG TAB

Facility

$4.00

Service Code	NDC 51079087220
Hospital Charge Code	60628235
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

GLYBURIDE 5 MG TAB

Facility

$4.00

Service Code	NDC 51079087320
Hospital Charge Code	60628236
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

GLYBURIDE 5 MG TAB

Facility

$4.00

Service Code	NDC 51079087320
Hospital Charge Code	60628236
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

GLYBURIDE MICRONIZED 3 MG TAB

Facility

$4.42

Service Code	NDC 93803501
Hospital Charge Code	60628623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.15
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

GLYBURIDE MICRONIZED 3 MG TAB

Facility

$4.42

Service Code	NDC 93803501
Hospital Charge Code	60628623
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

GLYCERIN 72% 1ML

Facility

$143.65

Service Code	NDC 73198010310
Hospital Charge Code	6063943381
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$71.83
Rate for Payer: Aetna Commercial	$54.59
Rate for Payer: Aetna Medicare Advantage	$43.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.63
Rate for Payer: Cigna Commercial	$71.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.35
Rate for Payer: Oxford Commercial	$28.73
Rate for Payer: Qualcare PPO/HMO/WC	$21.55
Rate for Payer: UnitedHealthcare Commercial	$28.73
Rate for Payer: UnitedHealthcare Community & State	$4.54
Rate for Payer: Wellpoint Medicaid Managed Care	$4.08

GLYCERIN 72% 1ML

Facility

$143.65

Service Code	NDC 73198010310
Hospital Charge Code	6063943381
Hospital Revenue Code	250
Min. Negotiated Rate	$21.55
Max. Negotiated Rate	$21.55
Rate for Payer: Qualcare PPO/HMO/WC	$21.55

GLYCERIN ADULT SUPP

Facility

$5.23

Service Code	NDC 713010109
Hospital Charge Code	6022495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.62
Rate for Payer: Aetna Commercial	$1.99
Rate for Payer: Aetna Medicare Advantage	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.33
Rate for Payer: Cigna Commercial	$2.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.36
Rate for Payer: Oxford Commercial	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.78
Rate for Payer: UnitedHealthcare Commercial	$1.05
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

GLYCERIN ADULT SUPP

Facility

$5.23

Service Code	NDC 713010109
Hospital Charge Code	6022495
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.78

GLYCERIN PEDIATRIC SUPP

Facility

$5.09

Service Code	NDC 713010209
Hospital Charge Code	60628129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

GLYCERIN PEDIATRIC SUPP

Facility

$5.09

Service Code	NDC 713010209
Hospital Charge Code	60628129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$1.93
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.32
Rate for Payer: Oxford Commercial	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$1.02
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

GLYCOHEMOGLOBIN (HgbA1C)

Facility

$469.00

Service Code	HCPCS 83036
Hospital Charge Code	38472392
Hospital Revenue Code	301
Min. Negotiated Rate	$70.35
Max. Negotiated Rate	$70.35
Rate for Payer: Qualcare PPO/HMO/WC	$70.35

GLYCOHEMOGLOBIN (HgbA1C)

Facility

$469.00

Service Code	HCPCS 83036
Hospital Charge Code	38472392
Hospital Revenue Code	301
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$234.50
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna Medicare Advantage	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.22
Rate for Payer: Cigna Commercial	$234.50
Rate for Payer: Cigna Medicare Advantage	$9.71
Rate for Payer: Clover Medicare Advantage	$9.22
Rate for Payer: EmblemHealth Commercial	$29.13
Rate for Payer: Humana Medicare Advantage	$10.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.71
Rate for Payer: Wellcare Medicare Advantage	$9.71
Rate for Payer: Wellpoint Medicaid Managed Care	$13.32

GLYCOMARK

Facility

$667.59

Service Code	HCPCS 84378
Hospital Charge Code	39900136
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$333.80
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	$10.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$333.80
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	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
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	$18.96

GLYCOMARK

Facility

$667.59

Service Code	HCPCS 84378
Hospital Charge Code	39900136
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

Know your out-of-pocket cost for care.

All Charges