Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HALDOL 50MG/ML VIAL

Facility

$394.45

Service Code	HCPCS J1631
Hospital Charge Code	87504140
Hospital Revenue Code	636
Min. Negotiated Rate	$59.17
Max. Negotiated Rate	$95.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.46
Rate for Payer: Qualcare PPO/HMO/WC	$59.17

HALDOL 50MG/ML VIAL

Facility

$394.45

Service Code	HCPCS J1631
Hospital Charge Code	87504140
Hospital Revenue Code	636
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$197.22
Rate for Payer: Aetna Commercial	$149.89
Rate for Payer: Aetna Medicare Advantage	$118.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.58
Rate for Payer: Cigna Commercial	$197.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.46
Rate for Payer: Qualcare PPO/HMO/WC	$59.17
Rate for Payer: UnitedHealthcare Community & State	$12.46
Rate for Payer: Wellpoint Medicaid Managed Care	$11.20

HALF PIN 2.5mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680473
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

HALF PIN 2.5mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680473
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

HALF PIN 3.0mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680476
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

HALF PIN 3.0mmx80mm 15mm

Facility

$500.00

Hospital Charge Code	270680476
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

HALF PIN SD 4/5 40MM

Facility

$1,191.80

Service Code	HCPCS C1713
Hospital Charge Code	270700693
Hospital Revenue Code	278
Min. Negotiated Rate	$33.85
Max. Negotiated Rate	$595.90
Rate for Payer: Aetna Commercial	$452.88
Rate for Payer: Aetna Medicare Advantage	$357.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.91
Rate for Payer: Cigna Commercial	$595.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.42
Rate for Payer: Qualcare PPO/HMO/WC	$178.77
Rate for Payer: UnitedHealthcare Community & State	$37.66
Rate for Payer: Wellpoint Medicaid Managed Care	$33.85

HALF PIN SD 4/5 40MM

Facility

$1,191.80

Service Code	HCPCS C1713
Hospital Charge Code	270700693
Hospital Revenue Code	278
Min. Negotiated Rate	$178.77
Max. Negotiated Rate	$288.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$288.42
Rate for Payer: Qualcare PPO/HMO/WC	$178.77

HALF RING MAXFRAME 180 MM DIA

Facility

$2,603.45

Hospital Charge Code	270683950
Hospital Revenue Code	272
Min. Negotiated Rate	$73.94
Max. Negotiated Rate	$1,301.72
Rate for Payer: Aetna Commercial	$989.31
Rate for Payer: Aetna Medicare Advantage	$781.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$663.88
Rate for Payer: Cigna Commercial	$1,301.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$676.90
Rate for Payer: Oxford Commercial	$520.69
Rate for Payer: Qualcare PPO/HMO/WC	$390.52
Rate for Payer: UnitedHealthcare Commercial	$520.69
Rate for Payer: UnitedHealthcare Community & State	$82.27
Rate for Payer: Wellpoint Medicaid Managed Care	$73.94

HALF RING MAXFRAME 180 MM DIA

Facility

$2,603.45

Hospital Charge Code	270683950
Hospital Revenue Code	272
Min. Negotiated Rate	$390.52
Max. Negotiated Rate	$390.52
Rate for Payer: Qualcare PPO/HMO/WC	$390.52

HALLUX VALGUS COMP

Facility

$13,626.00

Hospital Charge Code	270335644
Hospital Revenue Code	278
Min. Negotiated Rate	$2,043.90
Max. Negotiated Rate	$3,297.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.90

HALLUX VALGUS COMP

Facility

$13,626.00

Hospital Charge Code	270335644
Hospital Revenue Code	278
Min. Negotiated Rate	$386.98
Max. Negotiated Rate	$6,813.00
Rate for Payer: Aetna Commercial	$5,177.88
Rate for Payer: Aetna Medicare Advantage	$4,087.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,474.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,474.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,725.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,474.63
Rate for Payer: Cigna Commercial	$6,813.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.49
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.90
Rate for Payer: UnitedHealthcare Community & State	$430.58
Rate for Payer: Wellpoint Medicaid Managed Care	$386.98

HALOPERIDOL 0.5 MG TAB

Facility

$4.00

Service Code	NDC 781139113
Hospital Charge Code	60627800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HALOPERIDOL 0.5 MG TAB

Facility

$4.00

Service Code	NDC 781139113
Hospital Charge Code	60627800
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HALOPERIDOL 100 MG/ML INJ

Facility

$1,214.38

Service Code	HCPCS J1631
Hospital Charge Code	6011035
Hospital Revenue Code	636
Min. Negotiated Rate	$34.49
Max. Negotiated Rate	$607.19
Rate for Payer: Aetna Commercial	$461.46
Rate for Payer: Aetna Medicare Advantage	$364.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.67
Rate for Payer: Cigna Commercial	$607.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.88
Rate for Payer: Qualcare PPO/HMO/WC	$182.16
Rate for Payer: UnitedHealthcare Community & State	$38.37
Rate for Payer: Wellpoint Medicaid Managed Care	$34.49

HALOPERIDOL 100 MG/ML INJ

Facility

$1,214.38

Service Code	HCPCS J1631
Hospital Charge Code	6011035
Hospital Revenue Code	636
Min. Negotiated Rate	$182.16
Max. Negotiated Rate	$293.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$293.88
Rate for Payer: Qualcare PPO/HMO/WC	$182.16

HALOPERIDOL 10 MG TAB

Facility

$11.99

Service Code	NDC 781139713
Hospital Charge Code	60627801
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

HALOPERIDOL 10 MG TAB

Facility

$11.99

Service Code	NDC 781139713
Hospital Charge Code	60627801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.12
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

HALOPERIDOL 1 MG TAB

Facility

$4.00

Service Code	NDC 781139213
Hospital Charge Code	60627802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HALOPERIDOL 1 MG TAB

Facility

$4.00

Service Code	NDC 781139213
Hospital Charge Code	60627802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HALOPERIDOL 2 MG TAB

Facility

$4.02

Service Code	NDC 781139313
Hospital Charge Code	60627803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HALOPERIDOL 2 MG TAB

Facility

$4.02

Service Code	NDC 781139313
Hospital Charge Code	60627803
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.01
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare Advantage	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.03
Rate for Payer: Cigna Commercial	$2.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.05
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HALOPERIDOL 5 MG/ML INJ

Facility

$8.84

Service Code	HCPCS J1630
Hospital Charge Code	60627805
Hospital Revenue Code	636
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.42
Rate for Payer: Aetna Commercial	$3.36
Rate for Payer: Aetna Medicare Advantage	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.25
Rate for Payer: Cigna Commercial	$4.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

HALOPERIDOL 5 MG/ML INJ

Facility

$8.84

Service Code	HCPCS J1630
Hospital Charge Code	60627805
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

HALOPERIDOL 5 MG TAB

Facility

$6.50

Service Code	NDC 781139613
Hospital Charge Code	6022529
Hospital Revenue Code	251
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

Know your out-of-pocket cost for care.

All Charges