Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AMPHETAMINES,URINE

Facility

$106.80

Service Code	HCPCS 80324
Hospital Charge Code	39900041
Hospital Revenue Code	301
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$16.02
Rate for Payer: Qualcare PPO/HMO/WC	$16.02

AMPHETAMINES,URINE

Facility

$106.80

Service Code	HCPCS 80324
Hospital Charge Code	39900041
Hospital Revenue Code	301
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$40.58
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.23
Rate for Payer: Cigna Commercial	$53.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.77
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.02
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$17.62
Rate for Payer: Wellpoint Medicaid Managed Care	$3.03

AMPHIPHYSIN ANTIBODY TEST

Facility

$1,925.00

Service Code	HCPCS 84181
Hospital Charge Code	3038553
Hospital Revenue Code	301
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$288.75
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

AMPHIPHYSIN ANTIBODY TEST

Facility

$1,925.00

Service Code	HCPCS 84181
Hospital Charge Code	3038553
Hospital Revenue Code	301
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$46.32
Rate for Payer: Aetna Medicare Advantage	$55.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.78
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: Cigna Medicare Advantage	$17.03
Rate for Payer: Clover Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$51.09
Rate for Payer: Humana Medicare Advantage	$17.54
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$500.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.03
Rate for Payer: Wellcare Medicare Advantage	$17.03
Rate for Payer: Wellpoint Medicaid Managed Care	$54.67

AMPHOTER B LIPID CMP INJ 100MG

Facility

$1,608.00

Service Code	HCPCS J0287
Hospital Charge Code	6016588
Hospital Revenue Code	636
Min. Negotiated Rate	$45.67
Max. Negotiated Rate	$804.00
Rate for Payer: Aetna Commercial	$611.04
Rate for Payer: Aetna Medicare Advantage	$482.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$410.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$410.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$410.04
Rate for Payer: Cigna Commercial	$804.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.14
Rate for Payer: Qualcare PPO/HMO/WC	$241.20
Rate for Payer: UnitedHealthcare Community & State	$50.81
Rate for Payer: Wellpoint Medicaid Managed Care	$45.67

AMPHOTER B LIPID CMP INJ 100MG

Facility

$1,608.00

Service Code	HCPCS J0287
Hospital Charge Code	6016588
Hospital Revenue Code	636
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$389.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.14
Rate for Payer: Qualcare PPO/HMO/WC	$241.20

AMPHOTERICIN B 50 MG INJ

Facility

$402.00

Service Code	HCPCS J0285
Hospital Charge Code	6000426
Hospital Revenue Code	636
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$152.76
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.28
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Community & State	$12.70
Rate for Payer: Wellpoint Medicaid Managed Care	$11.42

AMPHOTERICIN B 50 MG INJ

Facility

$402.00

Service Code	HCPCS J0285
Hospital Charge Code	6000426
Hospital Revenue Code	636
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$97.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.28
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

AMPICILLIN 250 MG CAP

Facility

$4.00

Service Code	NDC 781214401
Hospital Charge Code	60627298
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

AMPICILLIN 250 MG CAP

Facility

$4.00

Service Code	NDC 781214401
Hospital Charge Code	60627298
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

AMPICILLIN 500 MG CAP

Facility

$4.36

Service Code	NDC 781214501
Hospital Charge Code	60627300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.66
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.13
Rate for Payer: Oxford Commercial	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.65
Rate for Payer: UnitedHealthcare Commercial	$0.87
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

AMPICILLIN 500 MG CAP

Facility

$4.36

Service Code	NDC 781214501
Hospital Charge Code	60627300
Hospital Revenue Code	251
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

AMPICILLIN SODIUM 1 GM VIAL

Facility

$49.45

Service Code	HCPCS J0290
Hospital Charge Code	60627291
Hospital Revenue Code	636
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$11.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.97
Rate for Payer: Qualcare PPO/HMO/WC	$7.42

AMPICILLIN SODIUM 1 GM VIAL

Facility

$49.45

Service Code	HCPCS J0290
Hospital Charge Code	60627291
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$24.73
Rate for Payer: Aetna Commercial	$18.79
Rate for Payer: Aetna Medicare Advantage	$14.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.61
Rate for Payer: Cigna Commercial	$24.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.97
Rate for Payer: Qualcare PPO/HMO/WC	$7.42
Rate for Payer: UnitedHealthcare Community & State	$1.56
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

AMPICILLIN SODIUM 250 MG VIAL

Facility

$18.09

Service Code	HCPCS J0290
Hospital Charge Code	60627292
Hospital Revenue Code	636
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$4.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

AMPICILLIN SODIUM 250 MG VIAL

Facility

$18.09

Service Code	HCPCS J0290
Hospital Charge Code	60627292
Hospital Revenue Code	636
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$9.04
Rate for Payer: Aetna Commercial	$6.87
Rate for Payer: Aetna Medicare Advantage	$5.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.61
Rate for Payer: Cigna Commercial	$9.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

AMPICILLIN SODIUM 2 GM VIAL

Facility

$63.85

Service Code	HCPCS J0290
Hospital Charge Code	60627293
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$31.93
Rate for Payer: Aetna Commercial	$24.26
Rate for Payer: Aetna Medicare Advantage	$19.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.28
Rate for Payer: Cigna Commercial	$31.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.58
Rate for Payer: UnitedHealthcare Community & State	$2.02
Rate for Payer: Wellpoint Medicaid Managed Care	$1.81

AMPICILLIN SODIUM 2 GM VIAL

Facility

$63.85

Service Code	HCPCS J0290
Hospital Charge Code	60627293
Hospital Revenue Code	636
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$15.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.45
Rate for Payer: Qualcare PPO/HMO/WC	$9.58

AMPICILLIN SODIUM 500 MG VIAL

Facility

$19.77

Service Code	HCPCS J0290
Hospital Charge Code	60627295
Hospital Revenue Code	636
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$9.88
Rate for Payer: Aetna Commercial	$7.51
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

AMPICILLIN SODIUM 500 MG VIAL

Facility

$19.77

Service Code	HCPCS J0290
Hospital Charge Code	60627295
Hospital Revenue Code	636
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$4.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

AMPICILLIN SSP 250MG/5ML

Facility

$4.36

Service Code	NDC 67253018310
Hospital Charge Code	60627299
Hospital Revenue Code	251
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$0.65
Rate for Payer: Qualcare PPO/HMO/WC	$0.65

AMPICILLIN SSP 250MG/5ML

Facility

$4.36

Service Code	NDC 67253018310
Hospital Charge Code	60627299
Hospital Revenue Code	251
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$1.66
Rate for Payer: Aetna Medicare Advantage	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.11
Rate for Payer: Cigna Commercial	$2.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.13
Rate for Payer: Oxford Commercial	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.65
Rate for Payer: UnitedHealthcare Commercial	$0.87
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

AMPICILLIN/SULBACTAM

Facility

$70.82

Service Code	HCPCS J0295
Hospital Charge Code	6006571
Hospital Revenue Code	636
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$35.41
Rate for Payer: Aetna Commercial	$26.91
Rate for Payer: Aetna Medicare Advantage	$21.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.06
Rate for Payer: Cigna Commercial	$35.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.14
Rate for Payer: Qualcare PPO/HMO/WC	$10.62
Rate for Payer: UnitedHealthcare Community & State	$2.24
Rate for Payer: Wellpoint Medicaid Managed Care	$2.01

AMPICILLIN/SULBACTAM

Facility

$115.37

Service Code	HCPCS J0295
Hospital Charge Code	6007504
Hospital Revenue Code	636
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$57.69
Rate for Payer: Aetna Commercial	$43.84
Rate for Payer: Aetna Medicare Advantage	$34.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.42
Rate for Payer: Cigna Commercial	$57.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$17.31
Rate for Payer: UnitedHealthcare Community & State	$3.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

AMPICILLIN/SULBACTAM

Facility

$115.37

Service Code	HCPCS J0295
Hospital Charge Code	6007504
Hospital Revenue Code	636
Min. Negotiated Rate	$17.31
Max. Negotiated Rate	$27.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.92
Rate for Payer: Qualcare PPO/HMO/WC	$17.31

Know your out-of-pocket cost for care.

All Charges