Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMNTIC MEMBRNE ALLOGRFT 1.25ML

Facility

$9,170.00

Hospital Charge Code	270662351
Hospital Revenue Code	278
Min. Negotiated Rate	$260.43
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: Wellpoint Medicaid Managed Care	$260.43

AMNTIC MEMBRNE ALLOGRFT 1.25ML

Facility

$9,170.00

Hospital Charge Code	270662351
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

AMOXAPINE,SERUM (ASENDIN)

Facility

$324.00

Service Code	HCPCS 82542
Hospital Charge Code	38473098
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

AMOXAPINE,SERUM (ASENDIN)

Facility

$324.00

Service Code	HCPCS 82542
Hospital Charge Code	38473098
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
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	$162.00
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	$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	$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	$9.20

AMOXICILLIN 250MG/5ML SUSPENSN

Facility

$4.00

Service Code	NDC 781604146
Hospital Charge Code	60631075
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMOXICILLIN 250MG/5ML SUSPENSN

Facility

$4.00

Service Code	NDC 781604146
Hospital Charge Code	60631075
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

AMOXICILLIN 250 MG CAP

Facility

$4.00

Service Code	NDC 781202001
Hospital Charge Code	60627281
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMOXICILLIN 250 MG CAP

Facility

$4.00

Service Code	NDC 781202001
Hospital Charge Code	60627281
Hospital Revenue Code	251
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

AMOXICILLIN 500 MG CAP UD

Facility

$4.00

Service Code	NDC 781261301
Hospital Charge Code	60629845
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMOXICILLIN 500 MG CAP UD

Facility

$4.00

Service Code	NDC 781261301
Hospital Charge Code	60629845
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

AMOXICILLIN CLAV SSP 250MG/5ML

Facility

$9.72

Service Code	NDC 43598020451
Hospital Charge Code	60627286
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna Commercial	$3.69
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.48
Rate for Payer: Cigna Commercial	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.53
Rate for Payer: Oxford Commercial	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

AMOXICILLIN CLAV SSP 250MG/5ML

Facility

$9.72

Service Code	NDC 43598020451
Hospital Charge Code	60627286
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

AMOXICILLIN CLAV TAB 250MG

Facility

$39.66

Service Code	NDC 781187431
Hospital Charge Code	60627285
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$5.95

AMOXICILLIN CLAV TAB 250MG

Facility

$39.66

Service Code	NDC 781187431
Hospital Charge Code	60627285
Hospital Revenue Code	250
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$19.83
Rate for Payer: Aetna Commercial	$15.07
Rate for Payer: Aetna Medicare Advantage	$11.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.11
Rate for Payer: Cigna Commercial	$19.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.31
Rate for Payer: Oxford Commercial	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.95
Rate for Payer: UnitedHealthcare Commercial	$7.93
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

AMOXICILLIN CLAV TAB 500MG

Facility

$25.33

Service Code	NDC 43598020614
Hospital Charge Code	60627287
Hospital Revenue Code	250
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$3.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.80

AMOXICILLIN CLAV TAB 500MG

Facility

$25.33

Service Code	NDC 43598020614
Hospital Charge Code	60627287
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$12.66
Rate for Payer: Aetna Commercial	$9.63
Rate for Payer: Aetna Medicare Advantage	$7.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.46
Rate for Payer: Cigna Commercial	$12.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.59
Rate for Payer: Oxford Commercial	$5.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.80
Rate for Payer: UnitedHealthcare Commercial	$5.07
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

AMOXICILLIN CLAV TAB 875MG

Facility

$103.52

Service Code	NDC 43598002114
Hospital Charge Code	60627288
Hospital Revenue Code	250
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$51.76
Rate for Payer: Aetna Commercial	$39.34
Rate for Payer: Aetna Medicare Advantage	$31.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.40
Rate for Payer: Cigna Commercial	$51.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.92
Rate for Payer: Oxford Commercial	$20.70
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Commercial	$20.70
Rate for Payer: UnitedHealthcare Community & State	$3.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

AMOXICILLIN CLAV TAB 875MG

Facility

$103.52

Service Code	NDC 43598002114
Hospital Charge Code	60627288
Hospital Revenue Code	250
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$15.53
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

AMOXICILLIN CLAVULANATE 400MG

Facility

$4.69

Service Code	NDC 781610452
Hospital Charge Code	60628957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

AMOXICILLIN CLAVULANATE 400MG

Facility

$4.69

Service Code	NDC 781610452
Hospital Charge Code	60628957
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.22
Rate for Payer: Oxford Commercial	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.94
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

AMOXICILLIN SSP 250MG/5ML 80ML

Facility

$4.00

Service Code	NDC 781604155
Hospital Charge Code	6009351
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

AMOXICILLIN SSP 250MG/5ML 80ML

Facility

$4.00

Service Code	NDC 781604155
Hospital Charge Code	6009351
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMOXIL/125MG/5ML

Facility

$4.00

Service Code	NDC 781603946
Hospital Charge Code	60632449
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMOXIL/125MG/5ML

Facility

$4.00

Service Code	NDC 781603946
Hospital Charge Code	60632449
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

AMPHETAMINE CONFIRM,URINE

Facility

$106.80

Service Code	HCPCS 80324
Hospital Charge Code	39900325
Hospital Revenue Code	301
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$16.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.02

Know your out-of-pocket cost for care.

All Charges