Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GUAIFENESN DM 100-10MG 5ML UD

Facility

$4.36

Service Code	NDC 121063805
Hospital Charge Code	60627998
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

GUAIFENESN DM TAB 600-30MG

Facility

$4.49

Service Code	NDC 63824005634
Hospital Charge Code	60627988
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.14
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.67
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

GUAIFENESN DM TAB 600-30MG

Facility

$4.49

Service Code	NDC 63824005634
Hospital Charge Code	60627988
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.67

GUAIFENESN SYRUP ML

Facility

$4.49

Service Code	NDC 61787006204
Hospital Charge Code	6023147
Hospital Revenue Code	251
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.67

GUAIFENESN SYRUP ML

Facility

$4.49

Service Code	NDC 61787006204
Hospital Charge Code	6023147
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.14
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.17
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.67
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

GUANFACINE HYDROCHLORIDE 1 MG

Facility

$78.12

Service Code	NDC 54092051302
Hospital Charge Code	6063943203
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$39.06
Rate for Payer: Aetna Commercial	$29.69
Rate for Payer: Aetna Medicare Advantage	$23.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.92
Rate for Payer: Cigna Commercial	$39.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.31
Rate for Payer: Oxford Commercial	$15.62
Rate for Payer: Qualcare PPO/HMO/WC	$11.72
Rate for Payer: UnitedHealthcare Commercial	$15.62
Rate for Payer: UnitedHealthcare Community & State	$2.47
Rate for Payer: Wellpoint Medicaid Managed Care	$2.22

GUANFACINE HYDROCHLORIDE 1 MG

Facility

$78.12

Service Code	NDC 54092051302
Hospital Charge Code	6063943203
Hospital Revenue Code	250
Min. Negotiated Rate	$11.72
Max. Negotiated Rate	$11.72
Rate for Payer: Qualcare PPO/HMO/WC	$11.72

GUARD K-WIRE PINK 0.078 IN

Facility

$8.94

Hospital Charge Code	270680462
Hospital Revenue Code	272
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.34

GUARD K-WIRE PINK 0.078 IN

Facility

$8.94

Hospital Charge Code	270680462
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.47
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Aetna Medicare Advantage	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.28
Rate for Payer: Cigna Commercial	$4.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.32
Rate for Payer: Oxford Commercial	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.34
Rate for Payer: UnitedHealthcare Commercial	$1.79
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

GUARDUS OVERTUBE

Facility

$376.00

Hospital Charge Code	270325687
Hospital Revenue Code	272
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$188.00
Rate for Payer: Aetna Commercial	$142.88
Rate for Payer: Aetna Medicare Advantage	$112.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.88
Rate for Payer: Cigna Commercial	$188.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.76
Rate for Payer: Oxford Commercial	$75.20
Rate for Payer: Qualcare PPO/HMO/WC	$56.40
Rate for Payer: UnitedHealthcare Commercial	$75.20
Rate for Payer: UnitedHealthcare Community & State	$11.88
Rate for Payer: Wellpoint Medicaid Managed Care	$10.68

GUARDUS OVERTUBE

Facility

$376.00

Hospital Charge Code	270325687
Hospital Revenue Code	272
Min. Negotiated Rate	$56.40
Max. Negotiated Rate	$56.40
Rate for Payer: Qualcare PPO/HMO/WC	$56.40

GUDEIWIRE CHCE PT 185C 3893101

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653632S
Hospital Revenue Code	278
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$163.40
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Community & State	$13.59
Rate for Payer: Wellpoint Medicaid Managed Care	$12.21

GUDEIWIRE CHCE PT 185C 3893101

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653632
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUDEIWIRE CHCE PT 185C 3893101

Facility

$773.00

Service Code	HCPCS C1769
Hospital Charge Code	270653632N
Hospital Revenue Code	278
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$386.50
Rate for Payer: Aetna Commercial	$293.74
Rate for Payer: Aetna Medicare Advantage	$231.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.12
Rate for Payer: Cigna Commercial	$386.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.07
Rate for Payer: Qualcare PPO/HMO/WC	$115.95
Rate for Payer: UnitedHealthcare Community & State	$24.43
Rate for Payer: Wellpoint Medicaid Managed Care	$21.95

GUDEIWIRE CHCE PT 185C 3893101

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653632
Hospital Revenue Code	278
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$215.00
Rate for Payer: Aetna Commercial	$163.40
Rate for Payer: Aetna Medicare Advantage	$129.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.65
Rate for Payer: Cigna Commercial	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50
Rate for Payer: UnitedHealthcare Community & State	$13.59
Rate for Payer: Wellpoint Medicaid Managed Care	$12.21

GUDEIWIRE CHCE PT 185C 3893101

Facility

$773.00

Service Code	HCPCS C1769
Hospital Charge Code	270653632N
Hospital Revenue Code	278
Min. Negotiated Rate	$115.95
Max. Negotiated Rate	$187.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$154.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.07
Rate for Payer: Qualcare PPO/HMO/WC	$115.95

GUDEIWIRE CHCE PT 185C 3893101

Facility

$430.00

Service Code	HCPCS C1769
Hospital Charge Code	270653632S
Hospital Revenue Code	278
Min. Negotiated Rate	$64.50
Max. Negotiated Rate	$104.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$86.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.06
Rate for Payer: Qualcare PPO/HMO/WC	$64.50

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	2309093
Hospital Revenue Code	333
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	2309093
Hospital Revenue Code	333
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	85000896
Hospital Revenue Code	333
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

GUIDANCE FOR RADIAJ TX DLVR

Facility

$400.00

Service Code	HCPCS 77387
Hospital Charge Code	85000896
Hospital Revenue Code	333
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

GUID CHCE X/SPPRT 182cm1216101

Facility

$2,500.00

Service Code	HCPCS C1769
Hospital Charge Code	270639577
Hospital Revenue Code	278
Min. Negotiated Rate	$71.00
Max. Negotiated Rate	$1,250.00
Rate for Payer: Aetna Commercial	$950.00
Rate for Payer: Aetna Medicare Advantage	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$637.50
Rate for Payer: Cigna Commercial	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00
Rate for Payer: UnitedHealthcare Community & State	$79.00
Rate for Payer: Wellpoint Medicaid Managed Care	$71.00

GUID CHCE X/SPPRT 182cm1216101

Facility

$2,500.00

Service Code	HCPCS C1769
Hospital Charge Code	270639577
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$605.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$605.00
Rate for Payer: Qualcare PPO/HMO/WC	$375.00

GUIDE 035x180cm ROADRUNN

Facility

$239.70

Service Code	HCPCS C1769
Hospital Charge Code	270679802N
Hospital Revenue Code	278
Min. Negotiated Rate	$35.95
Max. Negotiated Rate	$58.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.01
Rate for Payer: Qualcare PPO/HMO/WC	$35.95

GUIDE 035x180cm ROADRUNN

Facility

$215.00

Service Code	HCPCS C1769
Hospital Charge Code	270679802
Hospital Revenue Code	278
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$52.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$52.03
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

Know your out-of-pocket cost for care.

All Charges