Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IV CATHETER ACCUVANCE 16GX2

Facility

$18.05

Hospital Charge Code	270650281
Hospital Revenue Code	270
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$9.03
Rate for Payer: Aetna Commercial	$6.86
Rate for Payer: Aetna Medicare Advantage	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.60
Rate for Payer: Cigna Commercial	$9.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.69
Rate for Payer: Oxford Commercial	$3.61
Rate for Payer: Qualcare PPO/HMO/WC	$2.71
Rate for Payer: UnitedHealthcare Commercial	$3.61
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

IV CATHETER ACCUVANCE 16GX2

Facility

$18.05

Hospital Charge Code	270650281
Hospital Revenue Code	270
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$2.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.71

IVC FILTER SENTRY

Facility

$6,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270684923
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

IVC FILTER SENTRY

Facility

$6,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270684923
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	2692090
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	2692090
Hospital Revenue Code	921
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$7,555.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.00
Rate for Payer: Oxford Commercial	$6,888.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$7,555.00
Rate for Payer: UnitedHealthcare Community & State	$543.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$488.48

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	74115053
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	74116053
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	74116053
Hospital Revenue Code	921
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$7,555.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.00
Rate for Payer: Oxford Commercial	$6,888.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$7,555.00
Rate for Payer: UnitedHealthcare Community & State	$543.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$488.48

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	74117053
Hospital Revenue Code	921
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$7,555.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.00
Rate for Payer: Oxford Commercial	$6,888.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$7,555.00
Rate for Payer: UnitedHealthcare Community & State	$543.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$488.48

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	74115053
Hospital Revenue Code	921
Min. Negotiated Rate	$269.30
Max. Negotiated Rate	$7,555.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.00
Rate for Payer: Oxford Commercial	$6,888.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Commercial	$7,555.00
Rate for Payer: UnitedHealthcare Community & State	$543.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$488.48

IVC & ILIAC VEINS DUPLEX

Facility

$17,200.00

Service Code	HCPCS 93978
Hospital Charge Code	74117053
Hospital Revenue Code	921
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$2,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

IV D5W 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650209
Hospital Revenue Code	258
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

IV D5W 100ML SINGLE

Facility

$7.70

Hospital Charge Code	270650209
Hospital Revenue Code	258
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.96
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

IV D5W 50ML SINGLE

Facility

$7.95

Hospital Charge Code	270650210
Hospital Revenue Code	258
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare Advantage	$2.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.07
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.19
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

IV D5W 50ML SINGLE

Facility

$7.95

Hospital Charge Code	270650210
Hospital Revenue Code	258
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

IVERMECTIN 3 MG TAB

Facility

$37.39

Service Code	NDC 6003220
Hospital Charge Code	60630088
Hospital Revenue Code	250
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$5.61
Rate for Payer: Qualcare PPO/HMO/WC	$5.61

IVERMECTIN 3 MG TAB

Facility

$37.39

Service Code	NDC 6003220
Hospital Charge Code	60630088
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$18.70
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare Advantage	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.53
Rate for Payer: Cigna Commercial	$18.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.72
Rate for Payer: Oxford Commercial	$7.48
Rate for Payer: Qualcare PPO/HMO/WC	$5.61
Rate for Payer: UnitedHealthcare Commercial	$7.48
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

IV HYDRA 16-90MIN-INITIAL

Facility

$402.60

Service Code	HCPCS 96360
Hospital Charge Code	93500005
Hospital Revenue Code	260
Min. Negotiated Rate	$60.39
Max. Negotiated Rate	$60.39
Rate for Payer: Qualcare PPO/HMO/WC	$60.39

IV HYDRA 16-90MIN-INITIAL

Facility

$402.60

Service Code	HCPCS 96360
Hospital Charge Code	93500005
Hospital Revenue Code	260
Min. Negotiated Rate	$11.43
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	$155.10
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	$104.68
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.39
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$12.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.70
Rate for Payer: Wellcare Medicare Advantage	$252.70
Rate for Payer: Wellpoint Medicaid Managed Care	$11.43

IV INF MED EA ADDTL HR

Facility

$145.60

Service Code	HCPCS 96366
Hospital Charge Code	93500037
Hospital Revenue Code	260
Min. Negotiated Rate	$21.84
Max. Negotiated Rate	$21.84
Rate for Payer: Qualcare PPO/HMO/WC	$21.84

IV INF MED EA ADDTL HR

Facility

$145.60

Service Code	HCPCS 96366
Hospital Charge Code	93500037
Hospital Revenue Code	260
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$1,235.00
Rate for Payer: Aetna Commercial	$151.31
Rate for Payer: Aetna Medicare Advantage	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.80
Rate for Payer: Cigna Commercial	$111.50
Rate for Payer: Cigna Medicare Advantage	$55.63
Rate for Payer: Clover Medicare Advantage	$52.85
Rate for Payer: EmblemHealth Commercial	$166.89
Rate for Payer: Humana Medicare Advantage	$57.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.86
Rate for Payer: Oxford Commercial	$1,092.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.84
Rate for Payer: UnitedHealthcare Commercial	$1,235.00
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.63
Rate for Payer: Wellcare Medicare Advantage	$55.63
Rate for Payer: Wellpoint Medicaid Managed Care	$4.14

IV INF TOCILIZUM COVID19 DOSE1

Facility

$2,250.00

Service Code	HCPCS M0249
Hospital Charge Code	3037M0249
Hospital Revenue Code	771
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$337.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

IV INF TOCILIZUM COVID19 DOSE1

Facility

$2,250.00

Service Code	HCPCS M0249
Hospital Charge Code	3230M0249
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,900.30
Rate for Payer: Aetna Commercial	$1,424.90
Rate for Payer: Aetna Medicare Advantage	$1,697.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,900.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,900.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$523.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,900.30
Rate for Payer: Cigna Medicare Advantage	$523.86
Rate for Payer: Clover Medicare Advantage	$497.67
Rate for Payer: EmblemHealth Commercial	$1,571.58
Rate for Payer: Humana Medicare Advantage	$539.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$523.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$523.86
Rate for Payer: Wellcare Medicare Advantage	$523.86
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

IV INF TOCILIZUM COVID19 DOSE1

Facility

$2,250.00

Service Code	HCPCS M0249
Hospital Charge Code	3248M0249
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,900.30
Rate for Payer: Aetna Commercial	$1,424.90
Rate for Payer: Aetna Medicare Advantage	$1,697.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,900.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,900.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$523.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,900.30
Rate for Payer: Cigna Medicare Advantage	$523.86
Rate for Payer: Clover Medicare Advantage	$497.67
Rate for Payer: EmblemHealth Commercial	$1,571.58
Rate for Payer: Humana Medicare Advantage	$539.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$523.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$523.86
Rate for Payer: Wellcare Medicare Advantage	$523.86
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

Know your out-of-pocket cost for care.

All Charges