Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ALT - SGPT

Facility

$667.59

Service Code	HCPCS 84460
Hospital Charge Code	3002458
Hospital Revenue Code	301
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$14.42
Rate for Payer: Aetna Medicare Advantage	$17.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.23
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$5.30
Rate for Payer: Clover Medicare Advantage	$5.04
Rate for Payer: EmblemHealth Commercial	$15.90
Rate for Payer: Humana Medicare Advantage	$5.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.30
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	$4.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.30
Rate for Payer: Wellcare Medicare Advantage	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ALUMINUM

Facility

$280.00

Service Code	HCPCS 82108
Hospital Charge Code	38472071
Hospital Revenue Code	301
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.31
Rate for Payer: Aetna Medicare Advantage	$82.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.43
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: Cigna Medicare Advantage	$25.48
Rate for Payer: Clover Medicare Advantage	$24.21
Rate for Payer: EmblemHealth Commercial	$76.44
Rate for Payer: Humana Medicare Advantage	$26.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.48
Rate for Payer: Wellcare Medicare Advantage	$25.48
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

ALUMINUM

Facility

$280.00

Service Code	HCPCS 82108
Hospital Charge Code	38472071
Hospital Revenue Code	301
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

ALUMINUM CANE

Facility

$87.00

Hospital Charge Code	84202095
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$33.06
Rate for Payer: Aetna Medicare Advantage	$26.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.18
Rate for Payer: Cigna Commercial	$43.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.62
Rate for Payer: Oxford Commercial	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Commercial	$17.40
Rate for Payer: UnitedHealthcare Community & State	$2.75
Rate for Payer: Wellpoint Medicaid Managed Care	$2.47

ALUMINUM CANE

Facility

$87.00

Hospital Charge Code	84202095
Hospital Revenue Code	270
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

ALUMINUM HYDROXIDE GEL CO

Facility

$27.94

Service Code	NDC 17856009103
Hospital Charge Code	60632427
Hospital Revenue Code	250
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$13.97
Rate for Payer: Aetna Commercial	$10.62
Rate for Payer: Aetna Medicare Advantage	$8.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.12
Rate for Payer: Cigna Commercial	$13.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.26
Rate for Payer: Oxford Commercial	$5.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.19
Rate for Payer: UnitedHealthcare Commercial	$5.59
Rate for Payer: UnitedHealthcare Community & State	$0.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.79

ALUMINUM HYDROXIDE GEL CO

Facility

$27.94

Service Code	NDC 17856009103
Hospital Charge Code	60632427
Hospital Revenue Code	250
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$4.19
Rate for Payer: Qualcare PPO/HMO/WC	$4.19

ALUMINUM,SERUM

Facility

$390.00

Service Code	HCPCS 82108
Hospital Charge Code	39900040
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$69.31
Rate for Payer: Aetna Medicare Advantage	$82.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.43
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.48
Rate for Payer: Clover Medicare Advantage	$24.21
Rate for Payer: EmblemHealth Commercial	$76.44
Rate for Payer: Humana Medicare Advantage	$26.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.48
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	$20.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.48
Rate for Payer: Wellcare Medicare Advantage	$25.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ALUMINUM,SERUM

Facility

$390.00

Service Code	HCPCS 82108
Hospital Charge Code	39900040
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ALUM-MAG HYDROXIDE/SIMETHICONE

Facility

$25.39

Service Code	NDC 121176130
Hospital Charge Code	60629303
Hospital Revenue Code	250
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$3.81
Rate for Payer: Qualcare PPO/HMO/WC	$3.81

ALUM-MAG HYDROXIDE/SIMETHICONE

Facility

$25.39

Service Code	NDC 121176130
Hospital Charge Code	60629303
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna Commercial	$9.65
Rate for Payer: Aetna Medicare Advantage	$7.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.47
Rate for Payer: Cigna Commercial	$12.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.60
Rate for Payer: Oxford Commercial	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.81
Rate for Payer: UnitedHealthcare Commercial	$5.08
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	160000251
Hospital Revenue Code	360
Min. Negotiated Rate	$1,563.21
Max. Negotiated Rate	$1,563.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	160000251
Hospital Revenue Code	360
Min. Negotiated Rate	$295.97
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,960.13
Rate for Payer: Aetna Medicare Advantage	$3,126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,657.46
Rate for Payer: Cigna Commercial	$5,210.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,709.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$329.32
Rate for Payer: Wellpoint Medicaid Managed Care	$295.97

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	1600000614
Hospital Revenue Code	360
Min. Negotiated Rate	$295.97
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,960.13
Rate for Payer: Aetna Medicare Advantage	$3,126.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,657.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,657.46
Rate for Payer: Cigna Commercial	$5,210.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,709.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$329.32
Rate for Payer: Wellpoint Medicaid Managed Care	$295.97

ALYS CPLX SP/PN NPGT W/PRGRM

Facility

$10,421.40

Service Code	HCPCS 47120
Hospital Charge Code	1600000614
Hospital Revenue Code	360
Min. Negotiated Rate	$1,563.21
Max. Negotiated Rate	$1,563.21
Rate for Payer: Qualcare PPO/HMO/WC	$1,563.21

AMANTADINE 100 MG CAP

Facility

$6.50

Service Code	NDC 52959000710
Hospital Charge Code	60628566
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

AMANTADINE 100 MG CAP

Facility

$6.50

Service Code	NDC 52959000710
Hospital Charge Code	60628566
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

AMANTADINE ORAL 100MG 10MLDOSE

Facility

$33.10

Service Code	NDC 121064610
Hospital Charge Code	606390422
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$4.96
Rate for Payer: Qualcare PPO/HMO/WC	$4.96

AMANTADINE ORAL 100MG 10MLDOSE

Facility

$33.10

Service Code	NDC 121064610
Hospital Charge Code	606390422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$16.55
Rate for Payer: Aetna Commercial	$12.58
Rate for Payer: Aetna Medicare Advantage	$9.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.44
Rate for Payer: Cigna Commercial	$16.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.61
Rate for Payer: Oxford Commercial	$6.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.96
Rate for Payer: UnitedHealthcare Commercial	$6.62
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

AMARYL 1MG TAB

Facility

$8.04

Service Code	NDC 39022110
Hospital Charge Code	60635513
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.09
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

AMARYL 1MG TAB

Facility

$8.04

Service Code	NDC 39022110
Hospital Charge Code	60635513
Hospital Revenue Code	250
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

AMAXILLO FACEAL FRACTURE KIT

Facility

$212.00

Hospital Charge Code	270332022
Hospital Revenue Code	272
Min. Negotiated Rate	$31.80
Max. Negotiated Rate	$31.80
Rate for Payer: Qualcare PPO/HMO/WC	$31.80

AMAXILLO FACEAL FRACTURE KIT

Facility

$212.00

Hospital Charge Code	270332022
Hospital Revenue Code	272
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$106.00
Rate for Payer: Aetna Commercial	$80.56
Rate for Payer: Aetna Medicare Advantage	$63.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.06
Rate for Payer: Cigna Commercial	$106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.12
Rate for Payer: Oxford Commercial	$42.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.80
Rate for Payer: UnitedHealthcare Commercial	$42.40
Rate for Payer: UnitedHealthcare Community & State	$6.70
Rate for Payer: Wellpoint Medicaid Managed Care	$6.02

AMBICOR PENILE PROTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687019
Hospital Revenue Code	278
Min. Negotiated Rate	$10,443.75
Max. Negotiated Rate	$16,849.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75

AMBICOR PENILE PROTHESIS

Facility

$69,625.00

Service Code	HCPCS C1813
Hospital Charge Code	270687019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,977.35
Max. Negotiated Rate	$34,812.50
Rate for Payer: Aetna Commercial	$26,457.50
Rate for Payer: Aetna Medicare Advantage	$20,887.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,754.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,754.38
Rate for Payer: Cigna Commercial	$34,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,849.25
Rate for Payer: Qualcare PPO/HMO/WC	$10,443.75
Rate for Payer: UnitedHealthcare Community & State	$2,200.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1,977.35

Know your out-of-pocket cost for care.

All Charges