Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IB KIT MINI PEEK FT JUMPSTART

Facility

$14,950.00

Service Code	HCPCS C1713
Hospital Charge Code	270696137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,242.50
Max. Negotiated Rate	$3,617.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,617.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,242.50

IBUPROFEN

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472482
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
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	$162.00
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	$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	$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	$9.20

IBUPROFEN

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472482
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

IBUPROFEN 100MG/5ML 120ML SUSP

Facility

$14.95

Hospital Charge Code	6063943356
Hospital Revenue Code	250
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.24

IBUPROFEN 100MG/5ML 120ML SUSP

Facility

$14.95

Hospital Charge Code	6063943356
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$7.47
Rate for Payer: Aetna Commercial	$5.68
Rate for Payer: Aetna Medicare Advantage	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.81
Rate for Payer: Cigna Commercial	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.89
Rate for Payer: Oxford Commercial	$2.99
Rate for Payer: Qualcare PPO/HMO/WC	$2.24
Rate for Payer: UnitedHealthcare Commercial	$2.99
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

IBUPROFEN 100 MG/5 ML SUS

Facility

$18.63

Service Code	NDC 68094049458
Hospital Charge Code	6009666
Hospital Revenue Code	250
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$2.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.79

IBUPROFEN 100 MG/5 ML SUS

Facility

$18.63

Service Code	NDC 68094049458
Hospital Charge Code	6009666
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.31
Rate for Payer: Aetna Commercial	$7.08
Rate for Payer: Aetna Medicare Advantage	$5.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.75
Rate for Payer: Cigna Commercial	$9.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.84
Rate for Payer: Oxford Commercial	$3.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.79
Rate for Payer: UnitedHealthcare Commercial	$3.73
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

IBUPROFEN 400 MG TAB

Facility

$4.00

Service Code	NDC 63739067210
Hospital Charge Code	6022552
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IBUPROFEN 400 MG TAB

Facility

$4.00

Service Code	NDC 63739067210
Hospital Charge Code	6022552
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

IBUPROFEN 400MG TAB

Facility

$2.00

Hospital Charge Code	83652567
Hospital Revenue Code	250
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

IBUPROFEN 400MG TAB

Facility

$2.00

Hospital Charge Code	83652567
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

IBUPROFEN 600 MG TAB

Facility

$4.00

Service Code	NDC 63739068410
Hospital Charge Code	60627683
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IBUPROFEN 600 MG TAB

Facility

$4.00

Service Code	NDC 63739068410
Hospital Charge Code	60627683
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

IBUPROFEN IV 100 MG/ML INJ

Facility

$105.26

Service Code	HCPCS J1741
Hospital Charge Code	60632224
Hospital Revenue Code	636
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$25.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.47
Rate for Payer: Qualcare PPO/HMO/WC	$15.79

IBUPROFEN IV 100 MG/ML INJ

Facility

$105.26

Service Code	HCPCS J1741
Hospital Charge Code	60632224
Hospital Revenue Code	636
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$52.63
Rate for Payer: Aetna Commercial	$40.00
Rate for Payer: Aetna Medicare Advantage	$31.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.84
Rate for Payer: Cigna Commercial	$52.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.47
Rate for Payer: Qualcare PPO/HMO/WC	$15.79
Rate for Payer: UnitedHealthcare Community & State	$3.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.99

IBUPROFEN (MOTRIN) 800MG TAB

Facility

$4.00

Service Code	NDC 68084077201
Hospital Charge Code	60630134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

IBUPROFEN (MOTRIN) 800MG TAB

Facility

$4.00

Service Code	NDC 68084077201
Hospital Charge Code	60630134
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

ICD DEFIB INTERROGATION

Facility

$231.20

Service Code	HCPCS 93289
Hospital Charge Code	5300160
Hospital Revenue Code	480
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$34.68
Rate for Payer: Qualcare PPO/HMO/WC	$34.68

ICD DEFIB INTERROGATION

Facility

$6,070.00

Service Code	HCPCS 93289
Hospital Charge Code	94053095
Hospital Revenue Code	480
Min. Negotiated Rate	$41.15
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,578.20
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$910.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$191.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$172.39

ICD DEFIB INTERROGATION

Facility

$6,070.00

Service Code	HCPCS 93289
Hospital Charge Code	94053095
Hospital Revenue Code	480
Min. Negotiated Rate	$910.50
Max. Negotiated Rate	$910.50
Rate for Payer: Qualcare PPO/HMO/WC	$910.50

ICD DEFIB INTERROGATION

Facility

$231.20

Service Code	HCPCS 93289
Hospital Charge Code	5300160
Hospital Revenue Code	480
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.11
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.68
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

ICD DEFIB INT W/PROG MULTIPLE

Facility

$231.20

Service Code	HCPCS 93284
Hospital Charge Code	5300163
Hospital Revenue Code	480
Min. Negotiated Rate	$34.68
Max. Negotiated Rate	$34.68
Rate for Payer: Qualcare PPO/HMO/WC	$34.68

ICD DEFIB INT W/PROG MULTIPLE

Facility

$231.20

Service Code	HCPCS 93284
Hospital Charge Code	5300163
Hospital Revenue Code	480
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.11
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$34.68
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$7.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$6.57

IC MOLDABLE STRIP 50MM FZ

Facility

$4,115.00

Hospital Charge Code	270671274
Hospital Revenue Code	278
Min. Negotiated Rate	$116.87
Max. Negotiated Rate	$2,057.50
Rate for Payer: Aetna Commercial	$1,563.70
Rate for Payer: Aetna Medicare Advantage	$1,234.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,049.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,049.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$823.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,049.33
Rate for Payer: Cigna Commercial	$2,057.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.83
Rate for Payer: Qualcare PPO/HMO/WC	$617.25
Rate for Payer: UnitedHealthcare Community & State	$130.03
Rate for Payer: Wellpoint Medicaid Managed Care	$116.87

IC MOLDABLE STRIP 50MM FZ

Facility

$4,115.00

Hospital Charge Code	270671274
Hospital Revenue Code	278
Min. Negotiated Rate	$617.25
Max. Negotiated Rate	$995.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$823.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$995.83
Rate for Payer: Qualcare PPO/HMO/WC	$617.25

Know your out-of-pocket cost for care.

All Charges