Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

LOOP ELECTRODE HF RESECT 24

Facility

$502.92

Hospital Charge Code	270658615
Hospital Revenue Code	272
Min. Negotiated Rate	$14.28
Max. Negotiated Rate	$251.46
Rate for Payer: Aetna Commercial	$191.11
Rate for Payer: Aetna Medicare Advantage	$150.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.24
Rate for Payer: Cigna Commercial	$251.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.76
Rate for Payer: Oxford Commercial	$100.58
Rate for Payer: Qualcare PPO/HMO/WC	$75.44
Rate for Payer: UnitedHealthcare Commercial	$100.58
Rate for Payer: UnitedHealthcare Community & State	$15.89
Rate for Payer: Wellpoint Medicaid Managed Care	$14.28

LOOP ELECTRODE HF RESECT 24

Facility

$502.92

Hospital Charge Code	270658615
Hospital Revenue Code	272
Min. Negotiated Rate	$75.44
Max. Negotiated Rate	$75.44
Rate for Payer: Qualcare PPO/HMO/WC	$75.44

LOOP ELECTRODE HF RESECT 26FR

Facility

$7,777.00

Hospital Charge Code	270665953
Hospital Revenue Code	270
Min. Negotiated Rate	$220.87
Max. Negotiated Rate	$3,888.50
Rate for Payer: Aetna Commercial	$2,955.26
Rate for Payer: Aetna Medicare Advantage	$2,333.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,983.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,983.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,983.13
Rate for Payer: Cigna Commercial	$3,888.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,022.02
Rate for Payer: Oxford Commercial	$1,555.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,166.55
Rate for Payer: UnitedHealthcare Commercial	$1,555.40
Rate for Payer: UnitedHealthcare Community & State	$245.75
Rate for Payer: Wellpoint Medicaid Managed Care	$220.87

LOOP ELECTRODE HF RESECT 26FR

Facility

$7,777.00

Hospital Charge Code	270665953
Hospital Revenue Code	270
Min. Negotiated Rate	$1,166.55
Max. Negotiated Rate	$1,166.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,166.55

LOOP MONOPOLAR ANG .35MM YELLO

Facility

$3,370.50

Hospital Charge Code	270682726
Hospital Revenue Code	272
Min. Negotiated Rate	$95.72
Max. Negotiated Rate	$1,685.25
Rate for Payer: Aetna Commercial	$1,280.79
Rate for Payer: Aetna Medicare Advantage	$1,011.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$859.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$859.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$859.48
Rate for Payer: Cigna Commercial	$1,685.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$876.33
Rate for Payer: Oxford Commercial	$674.10
Rate for Payer: Qualcare PPO/HMO/WC	$505.57
Rate for Payer: UnitedHealthcare Commercial	$674.10
Rate for Payer: UnitedHealthcare Community & State	$106.51
Rate for Payer: Wellpoint Medicaid Managed Care	$95.72

LOOP MONOPOLAR ANG .35MM YELLO

Facility

$3,370.50

Hospital Charge Code	270682726
Hospital Revenue Code	272
Min. Negotiated Rate	$505.57
Max. Negotiated Rate	$505.57
Rate for Payer: Qualcare PPO/HMO/WC	$505.57

LOOP RECORDER IMPLANTABLE

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270696573
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

LOOP RECORDER IMPLANTABLE

Facility

$21,500.00

Service Code	HCPCS C1764
Hospital Charge Code	270696573
Hospital Revenue Code	278
Min. Negotiated Rate	$610.60
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$679.40
Rate for Payer: Wellpoint Medicaid Managed Care	$610.60

LOOP VASCULAR MINI BLUE

Facility

$46.00

Hospital Charge Code	270666271
Hospital Revenue Code	272
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$23.00
Rate for Payer: Aetna Commercial	$17.48
Rate for Payer: Aetna Medicare Advantage	$13.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.73
Rate for Payer: Cigna Commercial	$23.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.96
Rate for Payer: Oxford Commercial	$9.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.90
Rate for Payer: UnitedHealthcare Commercial	$9.20
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.31

LOOP VASCULAR MINI BLUE

Facility

$46.00

Hospital Charge Code	270666271
Hospital Revenue Code	272
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$6.90
Rate for Payer: Qualcare PPO/HMO/WC	$6.90

LOOP VESSEL BLUE MAXI 30-723

Facility

$5.70

Hospital Charge Code	270644692
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

LOOP VESSEL BLUE MAXI 30-723

Facility

$5.70

Hospital Charge Code	270644692
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Commercial	$2.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.48
Rate for Payer: Oxford Commercial	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.14
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

LOOP VESSEL RED MAXI

Facility

$12.56

Hospital Charge Code	270651003
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$4.77
Rate for Payer: Aetna Medicare Advantage	$3.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.20
Rate for Payer: Cigna Commercial	$6.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.27
Rate for Payer: Oxford Commercial	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.51
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

LOOP VESSEL RED MAXI

Facility

$12.56

Hospital Charge Code	270651003
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

LOOP VESSEL RED MINI

Facility

$5.70

Hospital Charge Code	270647510
Hospital Revenue Code	270
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare Advantage	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.45
Rate for Payer: Cigna Commercial	$2.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.48
Rate for Payer: Oxford Commercial	$1.14
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.14
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

LOOP VESSEL RED MINI

Facility

$5.70

Hospital Charge Code	270647510
Hospital Revenue Code	270
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

LOOP YELLOW MINI VESSAL VL203

Facility

$7.00

Hospital Charge Code	270630138
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

LOOP YELLOW MINI VESSAL VL203

Facility

$7.00

Hospital Charge Code	270630138
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$2.66
Rate for Payer: Aetna Medicare Advantage	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.78
Rate for Payer: Cigna Commercial	$3.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.82
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

LOPERAMIDE 2MG LIQ

Facility

$4.00

Service Code	NDC 46122011126
Hospital Charge Code	60635815
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

LOPERAMIDE 2MG LIQ

Facility

$4.00

Service Code	NDC 46122011126
Hospital Charge Code	60635815
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

LOPERAMIDE CAP 2MG

Facility

$5.83

Service Code	NDC 51079069020
Hospital Charge Code	60628118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.92
Rate for Payer: Aetna Commercial	$2.22
Rate for Payer: Aetna Medicare Advantage	$1.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.52
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

LOPERAMIDE CAP 2MG

Facility

$5.83

Service Code	NDC 51079069020
Hospital Charge Code	60628118
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

LOPINAVIR/RITONAVIR 1 CAP

Facility

$75.11

Service Code	NDC 54569575200
Hospital Charge Code	60629152
Hospital Revenue Code	250
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$11.27
Rate for Payer: Qualcare PPO/HMO/WC	$11.27

LOPINAVIR/RITONAVIR 1 CAP

Facility

$75.11

Service Code	NDC 54569575200
Hospital Charge Code	60629152
Hospital Revenue Code	250
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.55
Rate for Payer: Aetna Commercial	$28.54
Rate for Payer: Aetna Medicare Advantage	$22.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.15
Rate for Payer: Cigna Commercial	$37.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.53
Rate for Payer: Oxford Commercial	$15.02
Rate for Payer: Qualcare PPO/HMO/WC	$11.27
Rate for Payer: UnitedHealthcare Commercial	$15.02
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

LOPINAVIR/RITONAVIR 400-100/5M

Facility

$102.31

Service Code	NDC 74395646
Hospital Charge Code	60632263
Hospital Revenue Code	250
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$15.35
Rate for Payer: Qualcare PPO/HMO/WC	$15.35

Know your out-of-pocket cost for care.

All Charges