Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INJ ARIPIPRAZOLE ER 300 MG

Facility

$9,554.27

Service Code	HCPCS J0401
Hospital Charge Code	6063943338
Hospital Revenue Code	636
Min. Negotiated Rate	$1,433.14
Max. Negotiated Rate	$2,312.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,312.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,433.14

INJ ARIPIPRAZOLE ER 400 MG

Facility

$4.00

Service Code	HCPCS J0401
Hospital Charge Code	6063943339
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$26.37
Rate for Payer: Aetna Commercial	$19.77
Rate for Payer: Aetna Medicare Advantage	$23.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.37
Rate for Payer: Cigna Medicare Advantage	$7.27
Rate for Payer: Clover Medicare Advantage	$6.91
Rate for Payer: EmblemHealth Commercial	$21.81
Rate for Payer: Humana Medicare Advantage	$7.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.27
Rate for Payer: Wellcare Medicare Advantage	$7.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

INJ ARIPIPRAZOLE ER 400 MG

Facility

$4.00

Service Code	HCPCS J0401
Hospital Charge Code	6063943339
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

INJ ARIPRAZOLE 300 MG

Facility

$9,506.75

Hospital Charge Code	6063943343
Hospital Revenue Code	636
Min. Negotiated Rate	$269.99
Max. Negotiated Rate	$4,753.38
Rate for Payer: Aetna Commercial	$3,612.57
Rate for Payer: Aetna Medicare Advantage	$2,852.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,424.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,424.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,424.22
Rate for Payer: Cigna Commercial	$4,753.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,300.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.01
Rate for Payer: UnitedHealthcare Community & State	$300.41
Rate for Payer: Wellpoint Medicaid Managed Care	$269.99

INJ ARIPRAZOLE 300 MG

Facility

$9,506.75

Hospital Charge Code	6063943343
Hospital Revenue Code	636
Min. Negotiated Rate	$1,426.01
Max. Negotiated Rate	$2,300.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,300.63
Rate for Payer: Qualcare PPO/HMO/WC	$1,426.01

INJ A/S TRNSF EPID C/TH EA-LT

Facility

$2,073.00

Service Code	HCPCS 64480
Hospital Charge Code	1600000392
Hospital Revenue Code	360
Min. Negotiated Rate	$310.95
Max. Negotiated Rate	$310.95
Rate for Payer: Qualcare PPO/HMO/WC	$310.95

INJ A/S TRNSF EPID C/TH EA-LT

Facility

$2,073.00

Service Code	HCPCS 64480
Hospital Charge Code	1600000392
Hospital Revenue Code	360
Min. Negotiated Rate	$65.51
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$787.74
Rate for Payer: Aetna Medicare Advantage	$621.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$528.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$528.62
Rate for Payer: Cigna Commercial	$1,036.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$538.98
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$310.95
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$65.51

INJECT-INTRA-ARTERIL ONLY

Facility

$257.00

Service Code	HCPCS 96373
Hospital Charge Code	93500057
Hospital Revenue Code	260
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$38.55
Rate for Payer: Qualcare PPO/HMO/WC	$38.55

INJECT-INTRA-ARTERIL ONLY

Facility

$257.00

Service Code	HCPCS 96373
Hospital Charge Code	93500057
Hospital Revenue Code	260
Min. Negotiated Rate	$7.30
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$687.34
Rate for Payer: Aetna Medicare Advantage	$818.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$916.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$252.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$916.67
Rate for Payer: Cigna Commercial	$506.53
Rate for Payer: Cigna Medicare Advantage	$252.70
Rate for Payer: Clover Medicare Advantage	$240.06
Rate for Payer: EmblemHealth Commercial	$758.10
Rate for Payer: Humana Medicare Advantage	$260.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$252.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.82
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.55
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$8.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$7.30

INJECTION FOR CHOLANGIOGRAM

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	2011600
Hospital Revenue Code	361
Min. Negotiated Rate	$2,147.05
Max. Negotiated Rate	$2,147.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05

INJECTION FOR CHOLANGIOGRAM

Facility

$11,644.64

Service Code	HCPCS 47531
Hospital Charge Code	16000982
Hospital Revenue Code	360
Min. Negotiated Rate	$330.71
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,027.61
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.70
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$367.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$330.71

INJECTION FOR CHOLANGIOGRAM

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	7412075
Hospital Revenue Code	361
Min. Negotiated Rate	$2,147.05
Max. Negotiated Rate	$2,147.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05

INJECTION FOR CHOLANGIOGRAM

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	7412075
Hospital Revenue Code	361
Min. Negotiated Rate	$406.51
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,721.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$452.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$406.51

INJECTION FOR CHOLANGIOGRAM

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	366847531
Hospital Revenue Code	361
Min. Negotiated Rate	$2,147.05
Max. Negotiated Rate	$2,147.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05

INJECTION FOR CHOLANGIOGRAM

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	366847531
Hospital Revenue Code	361
Min. Negotiated Rate	$406.51
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,721.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$452.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$406.51

INJECTION FOR CHOLANGIOGRAM

Facility

$14,313.70

Service Code	HCPCS 47531
Hospital Charge Code	2011600
Hospital Revenue Code	361
Min. Negotiated Rate	$406.51
Max. Negotiated Rate	$15,429.97
Rate for Payer: Aetna Commercial	$11,569.82
Rate for Payer: Aetna Medicare Advantage	$13,781.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,429.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,253.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,429.97
Rate for Payer: Cigna Commercial	$8,526.35
Rate for Payer: Cigna Medicare Advantage	$4,253.61
Rate for Payer: Clover Medicare Advantage	$4,040.93
Rate for Payer: EmblemHealth Commercial	$12,760.83
Rate for Payer: Humana Medicare Advantage	$4,381.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,253.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,721.56
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,147.05
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$452.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,253.61
Rate for Payer: Wellcare Medicare Advantage	$4,253.61
Rate for Payer: Wellpoint Medicaid Managed Care	$406.51

INJECTION FOR CHOLANGIOGRAM

Facility

$11,644.64

Service Code	HCPCS 47531
Hospital Charge Code	16000982
Hospital Revenue Code	360
Min. Negotiated Rate	$1,746.70
Max. Negotiated Rate	$1,746.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,746.70

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	2301091
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	74308250
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$345.05

Service Code	HCPCS 96372
Hospital Charge Code	83652387
Hospital Revenue Code	510
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$310.30
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.71
Rate for Payer: Qualcare PPO/HMO/WC	$51.76
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4501031
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	74308250
Hospital Revenue Code	260
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$232.67
Rate for Payer: Aetna Medicare Advantage	$277.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$310.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$85.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$310.30
Rate for Payer: Cigna Commercial	$171.47
Rate for Payer: Cigna Medicare Advantage	$85.54
Rate for Payer: Clover Medicare Advantage	$81.26
Rate for Payer: EmblemHealth Commercial	$256.62
Rate for Payer: Humana Medicare Advantage	$88.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$85.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.00
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$88.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.54
Rate for Payer: Wellcare Medicare Advantage	$85.54
Rate for Payer: Wellpoint Medicaid Managed Care	$79.52

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	4511524
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	100111
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

INJECTION IM/SUBQ

Facility

$2,800.00

Service Code	HCPCS 96372
Hospital Charge Code	8200511
Hospital Revenue Code	260
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$420.00
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

Know your out-of-pocket cost for care.

All Charges