Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMLODIPINE 2.5 MG TAB

Facility

$30.42

Service Code	NDC 58151035377
Hospital Charge Code	6008841
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.91
Rate for Payer: Oxford Commercial	$6.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$6.08
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

AMLODIPINE 5 MG TAB

Facility

$30.42

Service Code	NDC 58151035488
Hospital Charge Code	6008833
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.91
Rate for Payer: Oxford Commercial	$6.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$6.08
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

AMLODIPINE 5 MG TAB

Facility

$30.42

Service Code	NDC 58151035488
Hospital Charge Code	6008833
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$4.56

AMLODIPINE 5MG TAB (NORVASC)

Facility

$2.00

Hospital Charge Code	83652593
Hospital Revenue Code	637
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

AMLODIPINE 5MG TAB (NORVASC)

Facility

$2.00

Hospital Charge Code	83652593
Hospital Revenue Code	637
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

AMMONIA

Facility

$140.00

Service Code	HCPCS 82140
Hospital Charge Code	38472095
Hospital Revenue Code	301
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$39.63
Rate for Payer: Aetna Medicare Advantage	$47.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$70.00
Rate for Payer: Cigna Medicare Advantage	$14.57
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.57
Rate for Payer: Wellcare Medicare Advantage	$14.57
Rate for Payer: Wellpoint Medicaid Managed Care	$3.98

AMMONIA

Facility

$140.00

Service Code	HCPCS 82140
Hospital Charge Code	38472095
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.00

AMMONIA

Facility

$390.00

Service Code	HCPCS 82140
Hospital Charge Code	39990241A
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.63
Rate for Payer: Aetna Medicare Advantage	$47.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.57
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.57
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	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.57
Rate for Payer: Wellcare Medicare Advantage	$14.57
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

AMMONIA

Facility

$390.00

Service Code	HCPCS 82140
Hospital Charge Code	39990241A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Ammonia inhalant

Facility

$1.79

Hospital Charge Code	6063943304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.27

Ammonia inhalant

Facility

$1.79

Hospital Charge Code	6063943304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.90
Rate for Payer: Aetna Commercial	$0.68
Rate for Payer: Aetna Medicare Advantage	$0.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.46
Rate for Payer: Cigna Commercial	$0.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.47
Rate for Payer: Oxford Commercial	$0.36
Rate for Payer: Qualcare PPO/HMO/WC	$0.27
Rate for Payer: UnitedHealthcare Commercial	$0.36
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

AMMONIA PLASMA

Facility

$667.59

Service Code	HCPCS 82140
Hospital Charge Code	3000254
Hospital Revenue Code	301
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$39.63
Rate for Payer: Aetna Medicare Advantage	$47.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$14.57
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.57
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	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.57
Rate for Payer: Wellcare Medicare Advantage	$14.57
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

AMMONIA PLASMA

Facility

$667.59

Service Code	HCPCS 82140
Hospital Charge Code	3000254
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

AMMONIUM ALUM PWD

Facility

$55.88

Service Code	NDC 395004996
Hospital Charge Code	606390255
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$27.94
Rate for Payer: Aetna Commercial	$21.23
Rate for Payer: Aetna Medicare Advantage	$16.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.25
Rate for Payer: Cigna Commercial	$27.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.53
Rate for Payer: Oxford Commercial	$11.18
Rate for Payer: Qualcare PPO/HMO/WC	$8.38
Rate for Payer: UnitedHealthcare Commercial	$11.18
Rate for Payer: UnitedHealthcare Community & State	$1.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1.59

AMMONIUM ALUM PWD

Facility

$55.88

Service Code	NDC 395004996
Hospital Charge Code	606390255
Hospital Revenue Code	250
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$8.38
Rate for Payer: Qualcare PPO/HMO/WC	$8.38

AMMONIUM LACTATE CRE

Facility

$256.61

Service Code	NDC 45802049383
Hospital Charge Code	60628825
Hospital Revenue Code	250
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$128.31
Rate for Payer: Aetna Commercial	$97.51
Rate for Payer: Aetna Medicare Advantage	$76.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.44
Rate for Payer: Cigna Commercial	$128.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.72
Rate for Payer: Oxford Commercial	$51.32
Rate for Payer: Qualcare PPO/HMO/WC	$38.49
Rate for Payer: UnitedHealthcare Commercial	$51.32
Rate for Payer: UnitedHealthcare Community & State	$8.11
Rate for Payer: Wellpoint Medicaid Managed Care	$7.29

AMMONIUM LACTATE CRE

Facility

$256.61

Service Code	NDC 45802049383
Hospital Charge Code	60628825
Hospital Revenue Code	250
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$38.49
Rate for Payer: Qualcare PPO/HMO/WC	$38.49

AMMONIUM LACTATE LOT 12%

Facility

$80.74

Service Code	NDC 245002322
Hospital Charge Code	60628449
Hospital Revenue Code	250
Min. Negotiated Rate	$12.11
Max. Negotiated Rate	$12.11
Rate for Payer: Qualcare PPO/HMO/WC	$12.11

AMMONIUM LACTATE LOT 12%

Facility

$80.74

Service Code	NDC 245002322
Hospital Charge Code	60628449
Hospital Revenue Code	250
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$40.37
Rate for Payer: Aetna Commercial	$30.68
Rate for Payer: Aetna Medicare Advantage	$24.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.59
Rate for Payer: Cigna Commercial	$40.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.99
Rate for Payer: Oxford Commercial	$16.15
Rate for Payer: Qualcare PPO/HMO/WC	$12.11
Rate for Payer: UnitedHealthcare Commercial	$16.15
Rate for Payer: UnitedHealthcare Community & State	$2.55
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

AMNIOCENTESIS TRAY

Facility

$125.00

Hospital Charge Code	270331703
Hospital Revenue Code	272
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

AMNIOCENTESIS TRAY

Facility

$125.00

Hospital Charge Code	270331703
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

AMNIOCENTESIS-U/S GUIDANCE

Facility

$1,033.00

Service Code	HCPCS 76946
Hospital Charge Code	83653120
Hospital Revenue Code	402
Min. Negotiated Rate	$154.95
Max. Negotiated Rate	$154.95
Rate for Payer: Qualcare PPO/HMO/WC	$154.95

AMNIOCENTESIS-U/S GUIDANCE

Facility

$1,033.00

Service Code	HCPCS 76946
Hospital Charge Code	83653120
Hospital Revenue Code	402
Min. Negotiated Rate	$29.34
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$392.54
Rate for Payer: Aetna Medicare Advantage	$309.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.42
Rate for Payer: Cigna Commercial	$516.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.58
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$154.95
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$32.64
Rate for Payer: Wellpoint Medicaid Managed Care	$29.34

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	83653215
Hospital Revenue Code	402
Min. Negotiated Rate	$24.37
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$326.04
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.08
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$24.37

AMNIOCENTESIS-U/S GUIDE ADDTL

Facility

$858.00

Service Code	HCPCS 76946
Hospital Charge Code	74308370
Hospital Revenue Code	402
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

Know your out-of-pocket cost for care.

All Charges