Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ALPHA SUBUNIT

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	401182397
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$38.41
Rate for Payer: Aetna Medicare Advantage	$45.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.22
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.12
Rate for Payer: Clover Medicare Advantage	$13.41
Rate for Payer: EmblemHealth Commercial	$42.36
Rate for Payer: Humana Medicare Advantage	$14.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.12
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	$11.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.12
Rate for Payer: Wellcare Medicare Advantage	$14.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ALPHA SUBUNIT

Facility

$390.00

Service Code	HCPCS 82397
Hospital Charge Code	401182397
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ALPHA THALASSEMIA, DNA

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900019
Hospital Revenue Code	310
Min. Negotiated Rate	$65.97
Max. Negotiated Rate	$1,161.50
Rate for Payer: Aetna Commercial	$278.15
Rate for Payer: Aetna Medicare Advantage	$331.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$370.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$370.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$102.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$370.95
Rate for Payer: Cigna Commercial	$1,161.50
Rate for Payer: Cigna Medicare Advantage	$102.26
Rate for Payer: Clover Medicare Advantage	$97.15
Rate for Payer: EmblemHealth Commercial	$306.78
Rate for Payer: Humana Medicare Advantage	$105.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$102.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$81.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$102.26
Rate for Payer: Wellcare Medicare Advantage	$102.26
Rate for Payer: Wellpoint Medicaid Managed Care	$65.97

ALPHA THALASSEMIA, DNA

Facility

$2,323.00

Service Code	HCPCS 81257
Hospital Charge Code	39900019
Hospital Revenue Code	310
Min. Negotiated Rate	$348.45
Max. Negotiated Rate	$348.45
Rate for Payer: Qualcare PPO/HMO/WC	$348.45

ALPRAZOLAM 0.25 MG TAB

Facility

$4.29

Service Code	NDC 51079078820
Hospital Charge Code	60627839
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.64

ALPRAZOLAM 0.25 MG TAB

Facility

$4.29

Service Code	NDC 51079078820
Hospital Charge Code	60627839
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.15
Rate for Payer: Aetna Commercial	$1.63
Rate for Payer: Aetna Medicare Advantage	$1.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.09
Rate for Payer: Cigna Commercial	$2.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.12
Rate for Payer: Oxford Commercial	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.64
Rate for Payer: UnitedHealthcare Commercial	$0.86
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

ALPRAZOLAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 68084067201
Hospital Charge Code	6020036
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

ALPRAZOLAM 0.5 MG TAB

Facility

$5.36

Service Code	NDC 68084067201
Hospital Charge Code	6020036
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

ALPRAZOLAM (XANAX)

Facility

$588.25

Service Code	HCPCS 80346
Hospital Charge Code	38477218
Hospital Revenue Code	301
Min. Negotiated Rate	$88.24
Max. Negotiated Rate	$88.24
Rate for Payer: Qualcare PPO/HMO/WC	$88.24

ALPRAZOLAM (XANAX)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473090
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

ALPRAZOLAM (XANAX)

Facility

$588.25

Service Code	HCPCS 80346
Hospital Charge Code	38477218
Hospital Revenue Code	301
Min. Negotiated Rate	$16.71
Max. Negotiated Rate	$294.12
Rate for Payer: Aetna Commercial	$223.53
Rate for Payer: Aetna Medicare Advantage	$176.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$150.00
Rate for Payer: Cigna Commercial	$294.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$88.24
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$16.71

ALPRAZOLAM (XANAX)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473090
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

ALTEPLASE 10 MG INJ

Facility

$6,119.24

Service Code	HCPCS J2997
Hospital Charge Code	60627538
Hospital Revenue Code	636
Min. Negotiated Rate	$917.89
Max. Negotiated Rate	$1,480.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.86
Rate for Payer: Qualcare PPO/HMO/WC	$917.89

ALTEPLASE 10 MG INJ

Facility

$6,119.24

Service Code	HCPCS J2997
Hospital Charge Code	60627538
Hospital Revenue Code	636
Min. Negotiated Rate	$90.34
Max. Negotiated Rate	$1,480.86
Rate for Payer: Aetna Commercial	$258.64
Rate for Payer: Aetna Medicare Advantage	$308.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.94
Rate for Payer: Cigna Medicare Advantage	$95.09
Rate for Payer: Clover Medicare Advantage	$90.34
Rate for Payer: EmblemHealth Commercial	$285.27
Rate for Payer: Humana Medicare Advantage	$97.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,480.86
Rate for Payer: Qualcare PPO/HMO/WC	$917.89
Rate for Payer: UnitedHealthcare Community & State	$193.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.09
Rate for Payer: Wellcare Medicare Advantage	$95.09
Rate for Payer: Wellpoint Medicaid Managed Care	$173.79

ALTEPLASE 2 MG INJ

Facility

$972.57

Service Code	HCPCS J2997
Hospital Charge Code	60629169
Hospital Revenue Code	636
Min. Negotiated Rate	$27.62
Max. Negotiated Rate	$344.94
Rate for Payer: Aetna Commercial	$258.64
Rate for Payer: Aetna Medicare Advantage	$308.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.94
Rate for Payer: Cigna Medicare Advantage	$95.09
Rate for Payer: Clover Medicare Advantage	$90.34
Rate for Payer: EmblemHealth Commercial	$285.27
Rate for Payer: Humana Medicare Advantage	$97.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.36
Rate for Payer: Qualcare PPO/HMO/WC	$145.89
Rate for Payer: UnitedHealthcare Community & State	$30.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.09
Rate for Payer: Wellcare Medicare Advantage	$95.09
Rate for Payer: Wellpoint Medicaid Managed Care	$27.62

ALTEPLASE 2 MG INJ

Facility

$972.57

Service Code	HCPCS J2997
Hospital Charge Code	60629169
Hospital Revenue Code	636
Min. Negotiated Rate	$145.89
Max. Negotiated Rate	$235.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.36
Rate for Payer: Qualcare PPO/HMO/WC	$145.89

ALTEPLASE 50 MG INJ

Facility

$14,412.04

Service Code	HCPCS J2997
Hospital Charge Code	60629290
Hospital Revenue Code	636
Min. Negotiated Rate	$90.34
Max. Negotiated Rate	$3,487.71
Rate for Payer: Aetna Commercial	$258.64
Rate for Payer: Aetna Medicare Advantage	$308.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$95.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.94
Rate for Payer: Cigna Medicare Advantage	$95.09
Rate for Payer: Clover Medicare Advantage	$90.34
Rate for Payer: EmblemHealth Commercial	$285.27
Rate for Payer: Humana Medicare Advantage	$97.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$95.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,487.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,161.81
Rate for Payer: UnitedHealthcare Community & State	$455.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.09
Rate for Payer: Wellcare Medicare Advantage	$95.09
Rate for Payer: Wellpoint Medicaid Managed Care	$409.30

ALTEPLASE 50 MG INJ

Facility

$14,412.04

Service Code	HCPCS J2997
Hospital Charge Code	60629290
Hospital Revenue Code	636
Min. Negotiated Rate	$2,161.81
Max. Negotiated Rate	$3,487.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,487.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,161.81

ALTERATION IN CONSCIOUSNESS

Facility

$25,430.57

Service Code	APR-DRG 0524
Min. Negotiated Rate	$24,931.93
Max. Negotiated Rate	$25,430.57
Rate for Payer: UnitedHealthcare Community & State	$24,931.93
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,430.57
Rate for Payer: Wellpoint Medicaid Managed Care	$24,931.93

ALTERATION IN CONSCIOUSNESS

Facility

$12,347.30

Service Code	APR-DRG 0523
Min. Negotiated Rate	$12,105.20
Max. Negotiated Rate	$12,347.30
Rate for Payer: UnitedHealthcare Community & State	$12,105.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,347.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12,105.20

ALTERATION IN CONSCIOUSNESS

Facility

$9,221.15

Service Code	APR-DRG 0522
Min. Negotiated Rate	$9,040.34
Max. Negotiated Rate	$9,221.15
Rate for Payer: UnitedHealthcare Community & State	$9,040.34
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,221.15
Rate for Payer: Wellpoint Medicaid Managed Care	$9,040.34

ALTERATION IN CONSCIOUSNESS

Facility

$7,814.01

Service Code	APR-DRG 0521
Min. Negotiated Rate	$7,660.79
Max. Negotiated Rate	$7,814.01
Rate for Payer: UnitedHealthcare Community & State	$7,660.79
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,814.01
Rate for Payer: Wellpoint Medicaid Managed Care	$7,660.79

ALTIPLY LYOPH AMNIO MEM 2X4CM

Facility

$9,987.50

Service Code	HCPCS C1762
Hospital Charge Code	270703810
Hospital Revenue Code	278
Min. Negotiated Rate	$1,498.12
Max. Negotiated Rate	$2,416.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,416.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.12

ALTIPLY LYOPH AMNIO MEM 2X4CM

Facility

$9,987.50

Service Code	HCPCS C1762
Hospital Charge Code	270703810
Hospital Revenue Code	278
Min. Negotiated Rate	$283.64
Max. Negotiated Rate	$4,993.75
Rate for Payer: Aetna Commercial	$3,795.25
Rate for Payer: Aetna Medicare Advantage	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,546.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,546.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,997.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,546.81
Rate for Payer: Cigna Commercial	$4,993.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,416.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,498.12
Rate for Payer: UnitedHealthcare Community & State	$315.61
Rate for Payer: Wellpoint Medicaid Managed Care	$283.64

ALT - SGPT

Facility

$667.59

Service Code	HCPCS 84460
Hospital Charge Code	3002458
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