Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GLYCOMARK SUGAR SINGLE

Facility

$81.00

Service Code	HCPCS 84378
Hospital Charge Code	38478085
Hospital Revenue Code	301
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$12.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.15

GLYCOMARK SUGAR SINGLE

Facility

$81.00

Service Code	HCPCS 84378
Hospital Charge Code	38478085
Hospital Revenue Code	301
Min. Negotiated Rate	$2.30
Max. Negotiated Rate	$156.00
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	$40.50
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	$21.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.15
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	$2.30

GLYCOPYRROLATE 0.2MG/1ML

Facility

$40.06

Hospital Charge Code	606380019
Hospital Revenue Code	250
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$6.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01

GLYCOPYRROLATE 0.2MG/1ML

Facility

$40.06

Hospital Charge Code	606380019
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.03
Rate for Payer: Aetna Commercial	$15.22
Rate for Payer: Aetna Medicare Advantage	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.22
Rate for Payer: Cigna Commercial	$20.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.42
Rate for Payer: Oxford Commercial	$8.01
Rate for Payer: Qualcare PPO/HMO/WC	$6.01
Rate for Payer: UnitedHealthcare Commercial	$8.01
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

GLYCOPYRROLATE 0.2 MG/ML INJ

Facility

$108.88

Service Code	NDC 517460125
Hospital Charge Code	60627431
Hospital Revenue Code	250
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$16.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.33

GLYCOPYRROLATE 0.2 MG/ML INJ

Facility

$108.88

Service Code	NDC 517460125
Hospital Charge Code	60627431
Hospital Revenue Code	250
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$54.44
Rate for Payer: Aetna Commercial	$41.37
Rate for Payer: Aetna Medicare Advantage	$32.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.76
Rate for Payer: Cigna Commercial	$54.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.31
Rate for Payer: Oxford Commercial	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$16.33
Rate for Payer: UnitedHealthcare Commercial	$21.78
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.09

GLYCOPYRROLATE 1 MG/5ML INJ

Facility

$73.70

Service Code	NDC 517460525
Hospital Charge Code	60627432
Hospital Revenue Code	250
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Qualcare PPO/HMO/WC	$11.05

GLYCOPYRROLATE 1 MG/5ML INJ

Facility

$73.70

Service Code	NDC 517460525
Hospital Charge Code	60627432
Hospital Revenue Code	250
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$36.85
Rate for Payer: Aetna Commercial	$28.01
Rate for Payer: Aetna Medicare Advantage	$22.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$36.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.16
Rate for Payer: Oxford Commercial	$14.74
Rate for Payer: Qualcare PPO/HMO/WC	$11.05
Rate for Payer: UnitedHealthcare Commercial	$14.74
Rate for Payer: UnitedHealthcare Community & State	$2.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

GLYNASE/1.5MG/U/D

Facility

$4.82

Service Code	NDC 9034101
Hospital Charge Code	60634936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$1.83
Rate for Payer: Aetna Medicare Advantage	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.23
Rate for Payer: Cigna Commercial	$2.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.25
Rate for Payer: Oxford Commercial	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.72
Rate for Payer: UnitedHealthcare Commercial	$0.96
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

GLYNASE/1.5MG/U/D

Facility

$4.82

Service Code	NDC 9034101
Hospital Charge Code	60634936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$0.72
Rate for Payer: Qualcare PPO/HMO/WC	$0.72

GLYNASE 6MG TAB

Facility

$22.58

Service Code	NDC 9344901
Hospital Charge Code	60635201
Hospital Revenue Code	250
Min. Negotiated Rate	$3.39
Max. Negotiated Rate	$3.39
Rate for Payer: Qualcare PPO/HMO/WC	$3.39

GLYNASE 6MG TAB

Facility

$22.58

Service Code	NDC 9344901
Hospital Charge Code	60635201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.29
Rate for Payer: Aetna Commercial	$8.58
Rate for Payer: Aetna Medicare Advantage	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.76
Rate for Payer: Cigna Commercial	$11.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.87
Rate for Payer: Oxford Commercial	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$3.39
Rate for Payer: UnitedHealthcare Commercial	$4.52
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

GM1 AB (IGG,M)I

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990010A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GM1 AB (IGG,M)I

Facility

$390.00

Service Code	HCPCS 8352091
Hospital Charge Code	39990010A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GM1 AB (IGG,M) II

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39990010B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GM1 AB (IGG,M) II

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39990010B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GMK FEMUR HINGE CEMENTED LEFT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687697
Hospital Revenue Code	278
Min. Negotiated Rate	$1,320.88
Max. Negotiated Rate	$23,255.00
Rate for Payer: Aetna Commercial	$17,673.80
Rate for Payer: Aetna Medicare Advantage	$13,953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,860.05
Rate for Payer: Cigna Commercial	$23,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50
Rate for Payer: UnitedHealthcare Community & State	$1,469.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1,320.88

GMK FEMUR HINGE CEMENTED LEFT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687697
Hospital Revenue Code	278
Min. Negotiated Rate	$6,976.50
Max. Negotiated Rate	$11,255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50

GMK FEMUR HINGE CEMENTED RIGHT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687951
Hospital Revenue Code	278
Min. Negotiated Rate	$6,976.50
Max. Negotiated Rate	$11,255.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50

GMK FEMUR HINGE CEMENTED RIGHT

Facility

$46,510.00

Service Code	HCPCS C1776
Hospital Charge Code	270687951
Hospital Revenue Code	278
Min. Negotiated Rate	$1,320.88
Max. Negotiated Rate	$23,255.00
Rate for Payer: Aetna Commercial	$17,673.80
Rate for Payer: Aetna Medicare Advantage	$13,953.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,860.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,302.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,860.05
Rate for Payer: Cigna Commercial	$23,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,255.42
Rate for Payer: Qualcare PPO/HMO/WC	$6,976.50
Rate for Payer: UnitedHealthcare Community & State	$1,469.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1,320.88

GMK HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687963
Hospital Revenue Code	278
Min. Negotiated Rate	$423.30
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$5,663.90
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75
Rate for Payer: UnitedHealthcare Community & State	$471.00
Rate for Payer: Wellpoint Medicaid Managed Care	$423.30

GMK HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687963
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

GMK-HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687969
Hospital Revenue Code	278
Min. Negotiated Rate	$423.30
Max. Negotiated Rate	$7,452.50
Rate for Payer: Aetna Commercial	$5,663.90
Rate for Payer: Aetna Medicare Advantage	$4,471.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,800.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,800.78
Rate for Payer: Cigna Commercial	$7,452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75
Rate for Payer: UnitedHealthcare Community & State	$471.00
Rate for Payer: Wellpoint Medicaid Managed Care	$423.30

GMK-HINGE INSERT 20MM S4

Facility

$14,905.00

Service Code	HCPCS C1776
Hospital Charge Code	270687969
Hospital Revenue Code	278
Min. Negotiated Rate	$2,235.75
Max. Negotiated Rate	$3,607.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,981.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.01
Rate for Payer: Qualcare PPO/HMO/WC	$2,235.75

GMK STEM EXTEN 11mmx30mm

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679835
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$665.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

Know your out-of-pocket cost for care.

All Charges