Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

I SNARE SYSTEM 25G 5MM

Facility

$425.00

Hospital Charge Code	270680913
Hospital Revenue Code	272
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$63.75
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

ISOFLURANE INHALATION 100ML

Facility

$176.88

Service Code	NDC 10019036040
Hospital Charge Code	60632349
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$88.44
Rate for Payer: Aetna Commercial	$67.21
Rate for Payer: Aetna Medicare Advantage	$53.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.10
Rate for Payer: Cigna Commercial	$88.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.99
Rate for Payer: Oxford Commercial	$35.38
Rate for Payer: Qualcare PPO/HMO/WC	$26.53
Rate for Payer: UnitedHealthcare Commercial	$35.38
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.02

ISOFLURANE INHALATION 100ML

Facility

$176.88

Service Code	NDC 10019036040
Hospital Charge Code	60632349
Hospital Revenue Code	250
Min. Negotiated Rate	$26.53
Max. Negotiated Rate	$26.53
Rate for Payer: Qualcare PPO/HMO/WC	$26.53

ISOLATION/EXTRACTION-NUCL ACID

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479451
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

ISOLATION/EXTRACTION-NUCL ACID

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479451
Hospital Revenue Code	301
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

ISOLATION/EXTRACTION OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38472802
Hospital Revenue Code	301
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

ISOLATION/EXTRACTION OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38472802
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

ISOLATION/EXTRACT OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479422
Hospital Revenue Code	301
Min. Negotiated Rate	$2.81
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.62
Rate for Payer: Aetna Medicare Advantage	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.25
Rate for Payer: Cigna Commercial	$49.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.13
Rate for Payer: Wellpoint Medicaid Managed Care	$2.81

ISOLATION/EXTRACT OF NUC AC

Facility

$99.00

Service Code	HCPCS 83891
Hospital Charge Code	38479422
Hospital Revenue Code	301
Min. Negotiated Rate	$14.85
Max. Negotiated Rate	$14.85
Rate for Payer: Qualcare PPO/HMO/WC	$14.85

ISOLYSER LTS MULTI-DOSE 22oz

Facility

$37.52

Hospital Charge Code	270650134
Hospital Revenue Code	270
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$18.76
Rate for Payer: Aetna Commercial	$14.26
Rate for Payer: Aetna Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.57
Rate for Payer: Cigna Commercial	$18.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.76
Rate for Payer: Oxford Commercial	$7.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.63
Rate for Payer: UnitedHealthcare Commercial	$7.50
Rate for Payer: UnitedHealthcare Community & State	$1.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

ISOLYSER LTS MULTI-DOSE 22oz

Facility

$37.52

Hospital Charge Code	270650134
Hospital Revenue Code	270
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$5.63

ISONIAZID

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	3009823
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ISONIAZID

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	3009823
Hospital Revenue Code	301
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$195.00
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	$195.00
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	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
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	$11.08

ISONIAZID 300 MG TAB

Facility

$8.64

Service Code	NDC 51079008320
Hospital Charge Code	60628629
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna Commercial	$3.28
Rate for Payer: Aetna Medicare Advantage	$2.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: Oxford Commercial	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$1.73
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

ISONIAZID 300 MG TAB

Facility

$8.64

Service Code	NDC 51079008320
Hospital Charge Code	60628629
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$1.30

ISONIAZIDE SYRUP/16OZ

Facility

$33.30

Service Code	NDC 46287000901
Hospital Charge Code	60634575
Hospital Revenue Code	250
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.00

ISONIAZIDE SYRUP/16OZ

Facility

$33.30

Service Code	NDC 46287000901
Hospital Charge Code	60634575
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$16.65
Rate for Payer: Aetna Commercial	$12.65
Rate for Payer: Aetna Medicare Advantage	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.49
Rate for Payer: Cigna Commercial	$16.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.66
Rate for Payer: Oxford Commercial	$6.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.00
Rate for Payer: UnitedHealthcare Commercial	$6.66
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

ISONIAZID TAB 100MG

Facility

$4.00

Service Code	NDC 555006602
Hospital Charge Code	60628628
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ISONIAZID TAB 100MG

Facility

$4.00

Service Code	NDC 555006602
Hospital Charge Code	60628628
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

ISONIAZIO INJ 100MG/1ML 10ML

Facility

$2,358.80

Service Code	NDC 781305670
Hospital Charge Code	60628844
Hospital Revenue Code	250
Min. Negotiated Rate	$353.82
Max. Negotiated Rate	$353.82
Rate for Payer: Qualcare PPO/HMO/WC	$353.82

ISONIAZIO INJ 100MG/1ML 10ML

Facility

$2,358.80

Service Code	NDC 781305670
Hospital Charge Code	60628844
Hospital Revenue Code	250
Min. Negotiated Rate	$66.99
Max. Negotiated Rate	$1,179.40
Rate for Payer: Aetna Commercial	$896.34
Rate for Payer: Aetna Medicare Advantage	$707.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$601.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$601.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$601.49
Rate for Payer: Cigna Commercial	$1,179.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$613.29
Rate for Payer: Oxford Commercial	$471.76
Rate for Payer: Qualcare PPO/HMO/WC	$353.82
Rate for Payer: UnitedHealthcare Commercial	$471.76
Rate for Payer: UnitedHealthcare Community & State	$74.54
Rate for Payer: Wellpoint Medicaid Managed Care	$66.99

ISOPROPANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3037072
Hospital Revenue Code	306
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ISOPROPANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3037072
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ISOPROPYL ALCOHOL 70%

Facility

$7.64

Service Code	NDC 869081043
Hospital Charge Code	6063943120
Hospital Revenue Code	270
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$2.90
Rate for Payer: Aetna Medicare Advantage	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.95
Rate for Payer: Cigna Commercial	$3.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.99
Rate for Payer: Oxford Commercial	$1.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.15
Rate for Payer: UnitedHealthcare Commercial	$1.53
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

ISOPROPYL ALCOHOL 70%

Facility

$7.64

Service Code	NDC 869081043
Hospital Charge Code	6063943120
Hospital Revenue Code	270
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.15

Know your out-of-pocket cost for care.

All Charges