Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MEFLOQUINE TAB 250MG

Facility

$90.79

Service Code	NDC 54002511
Hospital Charge Code	60627340
Hospital Revenue Code	250
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$13.62

MEFLOQUINE TAB 250MG

Facility

$90.79

Service Code	NDC 54002511
Hospital Charge Code	60627340
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$45.40
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.15
Rate for Payer: Cigna Commercial	$45.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$13.62
Rate for Payer: UnitedHealthcare Commercial	$18.16
Rate for Payer: UnitedHealthcare Community & State	$2.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

MEFOXIN 1GM

Facility

$75.24

Service Code	HCPCS J0694
Hospital Charge Code	6063943287
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$37.62
Rate for Payer: Aetna Commercial	$28.59
Rate for Payer: Aetna Medicare Advantage	$22.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.19
Rate for Payer: Cigna Commercial	$37.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.29
Rate for Payer: UnitedHealthcare Community & State	$2.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

MEFOXIN 1GM

Facility

$75.24

Service Code	HCPCS J0694
Hospital Charge Code	6063943287
Hospital Revenue Code	636
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$18.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.21
Rate for Payer: Qualcare PPO/HMO/WC	$11.29

MEGESTROL 20MG TAB

Facility

$4.42

Service Code	NDC 51079043420
Hospital Charge Code	606361026
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

MEGESTROL 20MG TAB

Facility

$4.42

Service Code	NDC 51079043420
Hospital Charge Code	606361026
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.15
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

MEGESTROL 400 MG UD CUPS

Facility

$40.20

Service Code	NDC 60432012608
Hospital Charge Code	60630225
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.03

MEGESTROL 400 MG UD CUPS

Facility

$40.20

Service Code	NDC 60432012608
Hospital Charge Code	60630225
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.10
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna Medicare Advantage	$12.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.25
Rate for Payer: Cigna Commercial	$20.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.45
Rate for Payer: Oxford Commercial	$8.04
Rate for Payer: Qualcare PPO/HMO/WC	$6.03
Rate for Payer: UnitedHealthcare Commercial	$8.04
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

MEGESTROL ACETATE 40 MG TAB

Facility

$8.58

Service Code	NDC 54860425
Hospital Charge Code	6027007
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.72
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

MEGESTROL ACETATE 40 MG TAB

Facility

$8.58

Service Code	NDC 54860425
Hospital Charge Code	6027007
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

MELATONIN 3MG TABLET

Facility

$4.00

Service Code	NDC 77333051610
Hospital Charge Code	606390254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MELATONIN 3MG TABLET

Facility

$4.00

Service Code	NDC 77333051610
Hospital Charge Code	606390254
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

MELATONIN SERUM PLASMA

Facility

$215.00

Service Code	HCPCS C1713
Hospital Charge Code	399900538
Hospital Revenue Code	302
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

MELATONIN SERUM PLASMA

Facility

$215.00

Service Code	HCPCS C1713
Hospital Charge Code	399900538
Hospital Revenue Code	302
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.90
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$6.11

MELPHALAN TAB 2MG

Facility

$81.81

Service Code	HCPCS J8600
Hospital Charge Code	60627394
Hospital Revenue Code	636
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$40.91
Rate for Payer: Aetna Commercial	$31.09
Rate for Payer: Aetna Medicare Advantage	$24.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.86
Rate for Payer: Cigna Commercial	$40.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.32

MELPHALAN TAB 2MG

Facility

$81.81

Service Code	HCPCS J8600
Hospital Charge Code	60627394
Hospital Revenue Code	636
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$19.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Qualcare PPO/HMO/WC	$12.27

MEMANTINE 10MG

Facility

$41.88

Service Code	NDC 456321063
Hospital Charge Code	60629833
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$20.94
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.68
Rate for Payer: Cigna Commercial	$20.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Oxford Commercial	$8.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.28
Rate for Payer: UnitedHealthcare Commercial	$8.38
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

MEMANTINE 10MG

Facility

$41.88

Service Code	NDC 456321063
Hospital Charge Code	60629833
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.28

MEMANTINE 5MG TAB UD

Facility

$41.88

Service Code	NDC 456320563
Hospital Charge Code	60629854
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$6.28
Rate for Payer: Qualcare PPO/HMO/WC	$6.28

MEMANTINE 5MG TAB UD

Facility

$41.88

Service Code	NDC 456320563
Hospital Charge Code	60629854
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$20.94
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna Medicare Advantage	$12.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.68
Rate for Payer: Cigna Commercial	$20.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Oxford Commercial	$8.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.28
Rate for Payer: UnitedHealthcare Commercial	$8.38
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

MEMBRANE PALIN GEN FLOW 1ML

Facility

$13,875.00

Hospital Charge Code	270676393
Hospital Revenue Code	272
Min. Negotiated Rate	$394.05
Max. Negotiated Rate	$6,937.50
Rate for Payer: Aetna Commercial	$5,272.50
Rate for Payer: Aetna Medicare Advantage	$4,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,538.12
Rate for Payer: Cigna Commercial	$6,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,607.50
Rate for Payer: Oxford Commercial	$2,775.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25
Rate for Payer: UnitedHealthcare Commercial	$2,775.00
Rate for Payer: UnitedHealthcare Community & State	$438.45
Rate for Payer: Wellpoint Medicaid Managed Care	$394.05

MEMBRANE PALIN GEN FLOW 1ML

Facility

$13,875.00

Hospital Charge Code	270676393
Hospital Revenue Code	272
Min. Negotiated Rate	$2,081.25
Max. Negotiated Rate	$2,081.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25

MEMBRANE PALINGEN FLOW .25ML

Facility

$4,750.00

Service Code	HCPCS Q4139
Hospital Charge Code	270678044
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

MEMBRANE PALINGEN FLOW .25ML

Facility

$4,750.00

Service Code	HCPCS Q4139
Hospital Charge Code	270678044
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

MEMBRANE PALIN GEN FLOW .5ML

Facility

$9,500.00

Hospital Charge Code	270677473
Hospital Revenue Code	636
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,299.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

Know your out-of-pocket cost for care.

All Charges