Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMINOPHYLLIN INJ/500MG

Facility

$97.69

Service Code	NDC 409592201
Hospital Charge Code	60634285
Hospital Revenue Code	250
Min. Negotiated Rate	$14.65
Max. Negotiated Rate	$14.65
Rate for Payer: Qualcare PPO/HMO/WC	$14.65

AMINOPHYLLIN INJ/500MG

Facility

$97.69

Service Code	NDC 409592201
Hospital Charge Code	60634285
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$48.84
Rate for Payer: Aetna Commercial	$37.12
Rate for Payer: Aetna Medicare Advantage	$29.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.91
Rate for Payer: Cigna Commercial	$48.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.40
Rate for Payer: Oxford Commercial	$19.54
Rate for Payer: Qualcare PPO/HMO/WC	$14.65
Rate for Payer: UnitedHealthcare Commercial	$19.54
Rate for Payer: UnitedHealthcare Community & State	$3.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

AMIODARONE 150MG/3 ML VIAL

Facility

$16.88

Service Code	HCPCS J0282
Hospital Charge Code	60628882
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

AMIODARONE 150MG/3 ML VIAL

Facility

$16.88

Service Code	HCPCS J0282
Hospital Charge Code	60628882
Hospital Revenue Code	636
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$4.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

AMIODARONE 200 MG TAB

Facility

$49.78

Service Code	NDC 68382022714
Hospital Charge Code	60627545
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$24.89
Rate for Payer: Aetna Commercial	$18.92
Rate for Payer: Aetna Medicare Advantage	$14.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.69
Rate for Payer: Cigna Commercial	$24.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.94
Rate for Payer: Oxford Commercial	$9.96
Rate for Payer: Qualcare PPO/HMO/WC	$7.47
Rate for Payer: UnitedHealthcare Commercial	$9.96
Rate for Payer: UnitedHealthcare Community & State	$1.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1.41

AMIODARONE 200 MG TAB

Facility

$49.78

Service Code	NDC 68382022714
Hospital Charge Code	60627545
Hospital Revenue Code	250
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$7.47
Rate for Payer: Qualcare PPO/HMO/WC	$7.47

AMIODARONE/DEX 150 MG/100 ML P

Facility

$263.18

Service Code	NDC 43066015010
Hospital Charge Code	60630087
Hospital Revenue Code	250
Min. Negotiated Rate	$39.48
Max. Negotiated Rate	$39.48
Rate for Payer: Qualcare PPO/HMO/WC	$39.48

AMIODARONE/DEX 150 MG/100 ML P

Facility

$263.18

Service Code	NDC 43066015010
Hospital Charge Code	60630087
Hospital Revenue Code	250
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$131.59
Rate for Payer: Aetna Commercial	$100.01
Rate for Payer: Aetna Medicare Advantage	$78.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.11
Rate for Payer: Cigna Commercial	$131.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.43
Rate for Payer: Oxford Commercial	$52.64
Rate for Payer: Qualcare PPO/HMO/WC	$39.48
Rate for Payer: UnitedHealthcare Commercial	$52.64
Rate for Payer: UnitedHealthcare Community & State	$8.32
Rate for Payer: Wellpoint Medicaid Managed Care	$7.47

AMIODARONE & METABOLITE

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	39990002EX
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

AMIODARONE & METABOLITE

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	39990002EX
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.39
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
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	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

AMIODARONE & METABOLITE I

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990002A
Hospital Revenue Code	301
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$10.94
Rate for Payer: Qualcare PPO/HMO/WC	$10.94

AMIODARONE & METABOLITE I

Facility

$72.95

Service Code	HCPCS 80299
Hospital Charge Code	39990002A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$156.00
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	$36.48
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	$18.97
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.94
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	$2.07

AMIODARONE & METABOLITE II

Facility

$124.10

Service Code	HCPCS 82492
Hospital Charge Code	39990002B
Hospital Revenue Code	301
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$47.16
Rate for Payer: Aetna Medicare Advantage	$37.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.65
Rate for Payer: Cigna Commercial	$62.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.27
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.61
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.92
Rate for Payer: Wellpoint Medicaid Managed Care	$3.52

AMIODARONE & METABOLITE II

Facility

$124.10

Service Code	HCPCS 82492
Hospital Charge Code	39990002B
Hospital Revenue Code	301
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$18.61

AMISTEM COLLARED #6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680130
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM COLLARED #6

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680130
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM FEM COLLARED TI SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697483
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM FEM COLLARED TI SZ 5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697483
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM H COLLARED STANDARD#5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680108
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM H COLLARED STANDARD#5

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680108
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM-H CTD SZ0 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680381
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

AMISTEM-H CTD SZ0 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680381
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

AMISTEM-H CTD SZ1 CEMENTLESS

Facility

$11,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270670739
Hospital Revenue Code	278
Min. Negotiated Rate	$1,722.00
Max. Negotiated Rate	$2,778.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,296.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,722.00

AMISTEM-H CTD SZ1 CEMENTLESS

Facility

$11,480.00

Service Code	HCPCS C1776
Hospital Charge Code	270670739
Hospital Revenue Code	278
Min. Negotiated Rate	$326.03
Max. Negotiated Rate	$5,740.00
Rate for Payer: Aetna Commercial	$4,362.40
Rate for Payer: Aetna Medicare Advantage	$3,444.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,927.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,296.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,927.40
Rate for Payer: Cigna Commercial	$5,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,778.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,722.00
Rate for Payer: UnitedHealthcare Community & State	$362.77
Rate for Payer: Wellpoint Medicaid Managed Care	$326.03

AMISTEM-H CTD SZ1 CMNTLSS COLL

Facility

$8,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270678452
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

Know your out-of-pocket cost for care.

All Charges