Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MEROPENEM 1G/50 ML NS DUPLEX

Facility

$298.82

Service Code	HCPCS J2185
Hospital Charge Code	6063943368
Hospital Revenue Code	636
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$149.41
Rate for Payer: Aetna Commercial	$113.55
Rate for Payer: Aetna Medicare Advantage	$89.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.20
Rate for Payer: Cigna Commercial	$149.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.31
Rate for Payer: Qualcare PPO/HMO/WC	$44.82
Rate for Payer: UnitedHealthcare Community & State	$9.44
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

MEROPENEM 1G/NS 100ML

Facility

$139.04

Service Code	HCPCS J2185
Hospital Charge Code	606390082
Hospital Revenue Code	636
Min. Negotiated Rate	$20.86
Max. Negotiated Rate	$33.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.65
Rate for Payer: Qualcare PPO/HMO/WC	$20.86

MEROPENEM 1G/NS 100ML

Facility

$139.04

Service Code	HCPCS J2185
Hospital Charge Code	606390082
Hospital Revenue Code	636
Min. Negotiated Rate	$3.95
Max. Negotiated Rate	$69.52
Rate for Payer: Aetna Commercial	$52.84
Rate for Payer: Aetna Medicare Advantage	$41.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.46
Rate for Payer: Cigna Commercial	$69.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.65
Rate for Payer: Qualcare PPO/HMO/WC	$20.86
Rate for Payer: UnitedHealthcare Community & State	$4.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.95

MEROPENEM 500MG/50ML 0.9%NACL

Facility

$130.92

Service Code	HCPCS J2185
Hospital Charge Code	606360464
Hospital Revenue Code	636
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$65.46
Rate for Payer: Aetna Commercial	$49.75
Rate for Payer: Aetna Medicare Advantage	$39.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.38
Rate for Payer: Cigna Commercial	$65.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.68
Rate for Payer: Qualcare PPO/HMO/WC	$19.64
Rate for Payer: UnitedHealthcare Community & State	$4.14
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

MEROPENEM 500MG/50ML 0.9%NACL

Facility

$130.92

Service Code	HCPCS J2185
Hospital Charge Code	606360464
Hospital Revenue Code	636
Min. Negotiated Rate	$19.64
Max. Negotiated Rate	$31.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.68
Rate for Payer: Qualcare PPO/HMO/WC	$19.64

MEROPENEM 500 MG PDS

Facility

$149.41

Service Code	HCPCS J2185
Hospital Charge Code	60630095
Hospital Revenue Code	636
Min. Negotiated Rate	$22.41
Max. Negotiated Rate	$36.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$22.41

MEROPENEM 500 MG PDS

Facility

$149.41

Service Code	HCPCS J2185
Hospital Charge Code	60630095
Hospital Revenue Code	636
Min. Negotiated Rate	$4.24
Max. Negotiated Rate	$74.70
Rate for Payer: Aetna Commercial	$56.78
Rate for Payer: Aetna Medicare Advantage	$44.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.10
Rate for Payer: Cigna Commercial	$74.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.16
Rate for Payer: Qualcare PPO/HMO/WC	$22.41
Rate for Payer: UnitedHealthcare Community & State	$4.72
Rate for Payer: Wellpoint Medicaid Managed Care	$4.24

MESALAMINE 1000 MG SUPP

Facility

$190.08

Service Code	NDC 58914050142
Hospital Charge Code	60629964
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$95.04
Rate for Payer: Aetna Commercial	$72.23
Rate for Payer: Aetna Medicare Advantage	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.47
Rate for Payer: Cigna Commercial	$95.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.42
Rate for Payer: Oxford Commercial	$38.02
Rate for Payer: Qualcare PPO/HMO/WC	$28.51
Rate for Payer: UnitedHealthcare Commercial	$38.02
Rate for Payer: UnitedHealthcare Community & State	$6.01
Rate for Payer: Wellpoint Medicaid Managed Care	$5.40

MESALAMINE 1000 MG SUPP

Facility

$190.08

Service Code	NDC 58914050142
Hospital Charge Code	60629964
Hospital Revenue Code	250
Min. Negotiated Rate	$28.51
Max. Negotiated Rate	$28.51
Rate for Payer: Qualcare PPO/HMO/WC	$28.51

MESALAMINE 1 BOTTLE NMA

Facility

$162.74

Service Code	NDC 45802009851
Hospital Charge Code	60628163
Hospital Revenue Code	250
Min. Negotiated Rate	$24.41
Max. Negotiated Rate	$24.41
Rate for Payer: Qualcare PPO/HMO/WC	$24.41

MESALAMINE 1 BOTTLE NMA

Facility

$162.74

Service Code	NDC 45802009851
Hospital Charge Code	60628163
Hospital Revenue Code	250
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$81.37
Rate for Payer: Aetna Commercial	$61.84
Rate for Payer: Aetna Medicare Advantage	$48.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.50
Rate for Payer: Cigna Commercial	$81.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.31
Rate for Payer: Oxford Commercial	$32.55
Rate for Payer: Qualcare PPO/HMO/WC	$24.41
Rate for Payer: UnitedHealthcare Commercial	$32.55
Rate for Payer: UnitedHealthcare Community & State	$5.14
Rate for Payer: Wellpoint Medicaid Managed Care	$4.62

MESALAMINE 400 MG ECT

Facility

$7.37

Service Code	NDC 430075327
Hospital Charge Code	60628161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.69
Rate for Payer: Aetna Commercial	$2.80
Rate for Payer: Aetna Medicare Advantage	$2.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.88
Rate for Payer: Cigna Commercial	$3.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.92
Rate for Payer: Oxford Commercial	$1.47
Rate for Payer: Qualcare PPO/HMO/WC	$1.11
Rate for Payer: UnitedHealthcare Commercial	$1.47
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

MESALAMINE 400 MG ECT

Facility

$7.37

Service Code	NDC 430075327
Hospital Charge Code	60628161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$1.11

MESH 10CM X10CM

Facility

$16,362.00

Service Code	HCPCS C1781
Hospital Charge Code	270700308
Hospital Revenue Code	278
Min. Negotiated Rate	$464.68
Max. Negotiated Rate	$8,181.00
Rate for Payer: Aetna Commercial	$6,217.56
Rate for Payer: Aetna Medicare Advantage	$4,908.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,172.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,172.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,272.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,172.31
Rate for Payer: Cigna Commercial	$8,181.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,959.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,454.30
Rate for Payer: UnitedHealthcare Community & State	$517.04
Rate for Payer: Wellpoint Medicaid Managed Care	$464.68

MESH 10CM X10CM

Facility

$16,362.00

Service Code	HCPCS C1781
Hospital Charge Code	270700308
Hospital Revenue Code	278
Min. Negotiated Rate	$2,454.30
Max. Negotiated Rate	$3,959.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,272.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,959.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,454.30

MESH 3.0 SMALL CIRCLE 0010213

Facility

$1,944.75

Service Code	HCPCS C1781
Hospital Charge Code	270647198
Hospital Revenue Code	278
Min. Negotiated Rate	$55.23
Max. Negotiated Rate	$972.38
Rate for Payer: Aetna Commercial	$739.00
Rate for Payer: Aetna Medicare Advantage	$583.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$495.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$495.91
Rate for Payer: Cigna Commercial	$972.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.63
Rate for Payer: Qualcare PPO/HMO/WC	$291.71
Rate for Payer: UnitedHealthcare Community & State	$61.45
Rate for Payer: Wellpoint Medicaid Managed Care	$55.23

MESH 3.0 SMALL CIRCLE 0010213

Facility

$1,944.75

Service Code	HCPCS C1781
Hospital Charge Code	270647198
Hospital Revenue Code	278
Min. Negotiated Rate	$291.71
Max. Negotiated Rate	$470.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$388.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.63
Rate for Payer: Qualcare PPO/HMO/WC	$291.71

MESH 3DMAX LIGHT LG

Facility

$1,875.00

Hospital Charge Code	270693172
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$59.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.25

MESH 3DMAX LIGHT LG

Facility

$1,875.00

Hospital Charge Code	270693172
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

MESH 3DMAX LIGHT XL 4.8X6.7 LT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689456
Hospital Revenue Code	278
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$992.25
Rate for Payer: Aetna Commercial	$754.11
Rate for Payer: Aetna Medicare Advantage	$595.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.05
Rate for Payer: Cigna Commercial	$992.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68
Rate for Payer: UnitedHealthcare Community & State	$62.71
Rate for Payer: Wellpoint Medicaid Managed Care	$56.36

MESH 3DMAX LIGHT XL 4.8X6.7 LT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689456
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$480.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX LIGHT XL 4.8X6.7 RT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689459
Hospital Revenue Code	278
Min. Negotiated Rate	$297.68
Max. Negotiated Rate	$480.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68

MESH 3DMAX LIGHT XL 4.8X6.7 RT

Facility

$1,984.50

Service Code	HCPCS C1781
Hospital Charge Code	270689459
Hospital Revenue Code	278
Min. Negotiated Rate	$56.36
Max. Negotiated Rate	$992.25
Rate for Payer: Aetna Commercial	$754.11
Rate for Payer: Aetna Medicare Advantage	$595.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$506.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$506.05
Rate for Payer: Cigna Commercial	$992.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$480.25
Rate for Payer: Qualcare PPO/HMO/WC	$297.68
Rate for Payer: UnitedHealthcare Community & State	$62.71
Rate for Payer: Wellpoint Medicaid Managed Care	$56.36

MESH 3DMAX MID LG LT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693768
Hospital Revenue Code	278
Min. Negotiated Rate	$309.67
Max. Negotiated Rate	$499.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: Qualcare PPO/HMO/WC	$309.67

MESH 3DMAX MID LG LT 10X16CM

Facility

$2,064.45

Service Code	HCPCS C1781
Hospital Charge Code	270693768
Hospital Revenue Code	278
Min. Negotiated Rate	$58.63
Max. Negotiated Rate	$1,032.22
Rate for Payer: Aetna Commercial	$784.49
Rate for Payer: Aetna Medicare Advantage	$619.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$526.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$526.43
Rate for Payer: Cigna Commercial	$1,032.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$499.60
Rate for Payer: Qualcare PPO/HMO/WC	$309.67
Rate for Payer: UnitedHealthcare Community & State	$65.24
Rate for Payer: Wellpoint Medicaid Managed Care	$58.63

Know your out-of-pocket cost for care.

All Charges