Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMBIENT HIPVAC 50IFS

Facility

$1,975.00

Hospital Charge Code	270679418
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

AMBIENT HIPVAC 50IFS

Facility

$1,975.00

Hospital Charge Code	270679418
Hospital Revenue Code	272
Min. Negotiated Rate	$56.09
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.50
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$395.00
Rate for Payer: UnitedHealthcare Community & State	$62.41
Rate for Payer: Wellpoint Medicaid Managed Care	$56.09

AMBIODISK AMNIOT MEMBRANE 15MM

Facility

$3,100.00

Service Code	HCPCS C1762
Hospital Charge Code	270665138
Hospital Revenue Code	278
Min. Negotiated Rate	$88.04
Max. Negotiated Rate	$1,550.00
Rate for Payer: Aetna Commercial	$1,178.00
Rate for Payer: Aetna Medicare Advantage	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$790.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$790.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$620.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$790.50
Rate for Payer: Cigna Commercial	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.20
Rate for Payer: Qualcare PPO/HMO/WC	$465.00
Rate for Payer: UnitedHealthcare Community & State	$97.96
Rate for Payer: Wellpoint Medicaid Managed Care	$88.04

AMBIODISK AMNIOT MEMBRANE 15MM

Facility

$3,100.00

Service Code	HCPCS C1762
Hospital Charge Code	270665138
Hospital Revenue Code	278
Min. Negotiated Rate	$465.00
Max. Negotiated Rate	$750.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$620.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$750.20
Rate for Payer: Qualcare PPO/HMO/WC	$465.00

AMBISOME 50MG INJECTION

Facility

$1,391.66

Service Code	HCPCS J0289
Hospital Charge Code	606350938
Hospital Revenue Code	636
Min. Negotiated Rate	$21.67
Max. Negotiated Rate	$336.78
Rate for Payer: Aetna Commercial	$62.04
Rate for Payer: Aetna Medicare Advantage	$73.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.74
Rate for Payer: Cigna Medicare Advantage	$22.81
Rate for Payer: Clover Medicare Advantage	$21.67
Rate for Payer: EmblemHealth Commercial	$68.43
Rate for Payer: Humana Medicare Advantage	$23.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.78
Rate for Payer: Qualcare PPO/HMO/WC	$208.75
Rate for Payer: UnitedHealthcare Community & State	$43.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.81
Rate for Payer: Wellcare Medicare Advantage	$22.81
Rate for Payer: Wellpoint Medicaid Managed Care	$39.52

AMBISOME 50MG INJECTION

Facility

$1,391.66

Service Code	HCPCS J0289
Hospital Charge Code	606350938
Hospital Revenue Code	636
Min. Negotiated Rate	$208.75
Max. Negotiated Rate	$336.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$336.78
Rate for Payer: Qualcare PPO/HMO/WC	$208.75

AMB RESP AND TRMT NO TRANSPORT

Facility

$300.00

Hospital Charge Code	26000515
Hospital Revenue Code	540
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$3,644.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$3,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$3,644.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

AMB RESP AND TRMT NO TRANSPORT

Facility

$300.00

Hospital Charge Code	26000515
Hospital Revenue Code	540
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

AMBU AURA GAIN SZ 4

Facility

$75.00

Hospital Charge Code	270684105
Hospital Revenue Code	272
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

AMBU AURA GAIN SZ 4

Facility

$75.00

Hospital Charge Code	270684105
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

AMEBIC (E.HISTOLYTICA) ANTIBOD

Facility

$324.00

Service Code	HCPCS 86753
Hospital Charge Code	38476151
Hospital Revenue Code	302
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

AMEBIC (E.HISTOLYTICA) ANTIBOD

Facility

$324.00

Service Code	HCPCS 86753
Hospital Charge Code	38476151
Hospital Revenue Code	302
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$33.70
Rate for Payer: Aetna Medicare Advantage	$40.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.94
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$12.39
Rate for Payer: Clover Medicare Advantage	$11.77
Rate for Payer: EmblemHealth Commercial	$37.17
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.39
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	$9.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.39
Rate for Payer: Wellcare Medicare Advantage	$12.39
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

AMICA PROBE 14GX400MM

Facility

$12,000.00

Hospital Charge Code	270703724
Hospital Revenue Code	279
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,120.00
Rate for Payer: Oxford Commercial	$2,400.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Commercial	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

AMICA PROBE 14GX400MM

Facility

$12,000.00

Hospital Charge Code	270703724
Hospital Revenue Code	279
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

AMIKACIN

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900316
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.70
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
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	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

AMIKACIN

Facility

$180.00

Service Code	HCPCS 80150
Hospital Charge Code	38472074
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

AMIKACIN

Facility

$180.00

Service Code	HCPCS 80150
Hospital Charge Code	38472074
Hospital Revenue Code	301
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.70
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

AMIKACIN

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900316
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIKACIN 500 MG/2ML INJ

Facility

$98.56

Service Code	HCPCS J0278
Hospital Charge Code	6007645
Hospital Revenue Code	636
Min. Negotiated Rate	$14.78
Max. Negotiated Rate	$23.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.78

AMIKACIN 500 MG/2ML INJ

Facility

$98.56

Service Code	HCPCS J0278
Hospital Charge Code	6007645
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$49.28
Rate for Payer: Aetna Commercial	$37.45
Rate for Payer: Aetna Medicare Advantage	$29.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.13
Rate for Payer: Cigna Commercial	$49.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.78
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

AMIKACIN,PEAK

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900315
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIKACIN,PEAK

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900315
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.70
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
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	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

AMIKACIN,TROUGH

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900003
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIKACIN,TROUGH

Facility

$390.00

Service Code	HCPCS 80150
Hospital Charge Code	39900003
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.70
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
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	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

AMIKIN/250MG/1ML

Facility

$197.05

Service Code	NDC 703904003
Hospital Charge Code	60632432
Hospital Revenue Code	250
Min. Negotiated Rate	$29.56
Max. Negotiated Rate	$29.56
Rate for Payer: Qualcare PPO/HMO/WC	$29.56

Know your out-of-pocket cost for care.

All Charges