Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INVEGA SUSTENNA 156 MG INJ

Facility

$10,366.91

Service Code	HCPCS J2426
Hospital Charge Code	606350946
Hospital Revenue Code	636
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$2,508.79
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.70
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,508.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,555.04
Rate for Payer: UnitedHealthcare Community & State	$327.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$294.42

INVEGA SUSTENNA 234MG

Facility

$15,550.10

Service Code	HCPCS J2426
Hospital Charge Code	6063943348
Hospital Revenue Code	636
Min. Negotiated Rate	$2,332.51
Max. Negotiated Rate	$3,763.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.51

INVEGA SUSTENNA 234MG

Facility

$15,550.10

Service Code	HCPCS J2426
Hospital Charge Code	6063943348
Hospital Revenue Code	636
Min. Negotiated Rate	$14.33
Max. Negotiated Rate	$3,763.12
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.70
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,763.12
Rate for Payer: Qualcare PPO/HMO/WC	$2,332.51
Rate for Payer: UnitedHealthcare Community & State	$491.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$441.62

INVIA CONNECTOR DBL LUM

Facility

$67.90

Hospital Charge Code	270687289
Hospital Revenue Code	271
Min. Negotiated Rate	$10.19
Max. Negotiated Rate	$10.19
Rate for Payer: Qualcare PPO/HMO/WC	$10.19

INVIA CONNECTOR DBL LUM

Facility

$67.90

Hospital Charge Code	270687289
Hospital Revenue Code	271
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$33.95
Rate for Payer: Aetna Commercial	$25.80
Rate for Payer: Aetna Medicare Advantage	$20.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.31
Rate for Payer: Cigna Commercial	$33.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.65
Rate for Payer: Oxford Commercial	$13.58
Rate for Payer: Qualcare PPO/HMO/WC	$10.19
Rate for Payer: UnitedHealthcare Commercial	$13.58
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.93

INVIA FITPAD WHITE

Facility

$52.50

Hospital Charge Code	270687295
Hospital Revenue Code	271
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$19.95
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.39
Rate for Payer: Cigna Commercial	$26.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.65
Rate for Payer: Oxford Commercial	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$7.88
Rate for Payer: UnitedHealthcare Commercial	$10.50
Rate for Payer: UnitedHealthcare Community & State	$1.66
Rate for Payer: Wellpoint Medicaid Managed Care	$1.49

INVIA FITPAD WHITE

Facility

$52.50

Hospital Charge Code	270687295
Hospital Revenue Code	271
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$7.88

INVIA FOAM DRESSING KIT FITPAD

Facility

$175.00

Hospital Charge Code	270687290
Hospital Revenue Code	271
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

INVIA FOAM DRESSING KIT FITPAD

Facility

$175.00

Hospital Charge Code	270687290
Hospital Revenue Code	271
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$87.50
Rate for Payer: Aetna Commercial	$66.50
Rate for Payer: Aetna Medicare Advantage	$52.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.62
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$35.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$35.00
Rate for Payer: UnitedHealthcare Community & State	$5.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

INVIA WHITE FOAM SMALL NPWT

Facility

$49.00

Hospital Charge Code	270687292
Hospital Revenue Code	271
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.35

INVIA WHITE FOAM SMALL NPWT

Facility

$49.00

Hospital Charge Code	270687292
Hospital Revenue Code	271
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$24.50
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna Medicare Advantage	$14.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.49
Rate for Payer: Cigna Commercial	$24.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.74
Rate for Payer: Oxford Commercial	$9.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.35
Rate for Payer: UnitedHealthcare Commercial	$9.80
Rate for Payer: UnitedHealthcare Community & State	$1.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.39

INVICTUS MIS TI ROD 5.5X60MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703544
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

INVICTUS MIS TI ROD 5.5X60MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703544
Hospital Revenue Code	278
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$37.13
Rate for Payer: Wellpoint Medicaid Managed Care	$33.37

INVICTUS MIS TI ROD 5.5X65MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703543
Hospital Revenue Code	278
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$284.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

INVICTUS MIS TI ROD 5.5X65MM

Facility

$1,175.00

Service Code	HCPCS C1713
Hospital Charge Code	270703543
Hospital Revenue Code	278
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.35
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Community & State	$37.13
Rate for Payer: Wellpoint Medicaid Managed Care	$33.37

INVICTUS REDUCTION SCREW 7.5X5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704967
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

INVICTUS REDUCTION SCREW 7.5X5

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270704967
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

INVIRASE TABLET 500MG

Facility

$70.35

Service Code	NDC 4024451
Hospital Charge Code	60635532
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$35.17
Rate for Payer: Aetna Commercial	$26.73
Rate for Payer: Aetna Medicare Advantage	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.94
Rate for Payer: Cigna Commercial	$35.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.29
Rate for Payer: Oxford Commercial	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.55
Rate for Payer: UnitedHealthcare Commercial	$14.07
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

INVIRASE TABLET 500MG

Facility

$70.35

Service Code	NDC 4024451
Hospital Charge Code	60635532
Hospital Revenue Code	250
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$10.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.55

IOBP KIT

Facility

$9,500.00

Hospital Charge Code	270686675
Hospital Revenue Code	272
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

IOBP KIT

Facility

$9,500.00

Hospital Charge Code	270686675
Hospital Revenue Code	272
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$1,900.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$1,900.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

IODINE 0.9 % GEL

Facility

$918.30

Service Code	NDC 40565012256
Hospital Charge Code	60629897
Hospital Revenue Code	250
Min. Negotiated Rate	$26.08
Max. Negotiated Rate	$459.15
Rate for Payer: Aetna Commercial	$348.95
Rate for Payer: Aetna Medicare Advantage	$275.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.17
Rate for Payer: Cigna Commercial	$459.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.76
Rate for Payer: Oxford Commercial	$183.66
Rate for Payer: Qualcare PPO/HMO/WC	$137.75
Rate for Payer: UnitedHealthcare Commercial	$183.66
Rate for Payer: UnitedHealthcare Community & State	$29.02
Rate for Payer: Wellpoint Medicaid Managed Care	$26.08

IODINE 0.9 % GEL

Facility

$918.30

Service Code	NDC 40565012256
Hospital Charge Code	60629897
Hospital Revenue Code	250
Min. Negotiated Rate	$137.75
Max. Negotiated Rate	$137.75
Rate for Payer: Qualcare PPO/HMO/WC	$137.75

IODIXANOL(VISIP)320/ML 150ML

Facility

$512.55

Service Code	HCPCS Q9967
Hospital Charge Code	60630205
Hospital Revenue Code	636
Min. Negotiated Rate	$76.88
Max. Negotiated Rate	$124.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.04
Rate for Payer: Qualcare PPO/HMO/WC	$76.88

IODIXANOL(VISIP)320/ML 150ML

Facility

$512.55

Service Code	HCPCS Q9967
Hospital Charge Code	60630205
Hospital Revenue Code	636
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$256.27
Rate for Payer: Aetna Commercial	$194.77
Rate for Payer: Aetna Medicare Advantage	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.70
Rate for Payer: Cigna Commercial	$256.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.04
Rate for Payer: Qualcare PPO/HMO/WC	$76.88
Rate for Payer: UnitedHealthcare Community & State	$16.20
Rate for Payer: Wellpoint Medicaid Managed Care	$14.56

Know your out-of-pocket cost for care.

All Charges