Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MEXILETINE CAP 200MG

Facility

$20.30

Service Code	NDC 93874001
Hospital Charge Code	60627583
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$3.04

MG-ALUM/SIMETH SUSP 30ML(MYLAN

Facility

$2.00

Hospital Charge Code	83652577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

MG-ALUM/SIMETH SUSP 30ML(MYLAN

Facility

$2.00

Hospital Charge Code	83652577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

M.GENITALIUM AMP PROBE URINE V

Facility

$173.23

Service Code	HCPCS 87563
Hospital Charge Code	401387563
Hospital Revenue Code	306
Min. Negotiated Rate	$25.98
Max. Negotiated Rate	$25.98
Rate for Payer: Qualcare PPO/HMO/WC	$25.98

M.GENITALIUM AMP PROBE URINE V

Facility

$173.23

Service Code	HCPCS 87563
Hospital Charge Code	401387563
Hospital Revenue Code	306
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$86.61
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.04
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.98
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.92

M.HOMINIS/UREAPLASMA CULT

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900268
Hospital Revenue Code	309
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$15.86
Rate for Payer: Qualcare PPO/HMO/WC	$15.86

M.HOMINIS/UREAPLASMA CULT

Facility

$390.00

Service Code	HCPCS 87109
Hospital Charge Code	39900490
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

M.HOMINIS/UREAPLASMA CULT

Facility

$105.75

Service Code	HCPCS 87109
Hospital Charge Code	39900268
Hospital Revenue Code	309
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.83
Rate for Payer: Cigna Commercial	$52.88
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.86
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.00

M.HOMINIS/UREAPLASMA CULT

Facility

$390.00

Service Code	HCPCS 87109
Hospital Charge Code	39900490
Hospital Revenue Code	309
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$41.86
Rate for Payer: Aetna Medicare Advantage	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$23.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.39
Rate for Payer: Clover Medicare Advantage	$14.62
Rate for Payer: EmblemHealth Commercial	$46.17
Rate for Payer: Humana Medicare Advantage	$15.85
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.39
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	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.39
Rate for Payer: Wellcare Medicare Advantage	$15.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MIC

Facility

$160.00

Service Code	HCPCS 87186
Hospital Charge Code	38475074
Hospital Revenue Code	309
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare Advantage	$28.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.38
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: Cigna Medicare Advantage	$8.65
Rate for Payer: Clover Medicare Advantage	$8.22
Rate for Payer: EmblemHealth Commercial	$25.95
Rate for Payer: Humana Medicare Advantage	$8.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.65
Rate for Payer: Wellcare Medicare Advantage	$8.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

MIC

Facility

$160.00

Service Code	HCPCS 87186
Hospital Charge Code	38475074
Hospital Revenue Code	309
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

MICA DEPTH GAUGE 150 STER MICA

Facility

$558.00

Service Code	HCPCS C1713
Hospital Charge Code	270702606
Hospital Revenue Code	278
Min. Negotiated Rate	$83.70
Max. Negotiated Rate	$135.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$111.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.04
Rate for Payer: Qualcare PPO/HMO/WC	$83.70

MICA DEPTH GAUGE 150 STER MICA

Facility

$558.00

Service Code	HCPCS C1713
Hospital Charge Code	270702606
Hospital Revenue Code	278
Min. Negotiated Rate	$15.85
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna Commercial	$212.04
Rate for Payer: Aetna Medicare Advantage	$167.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$111.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.29
Rate for Payer: Cigna Commercial	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.04
Rate for Payer: Qualcare PPO/HMO/WC	$83.70
Rate for Payer: UnitedHealthcare Community & State	$17.63
Rate for Payer: Wellpoint Medicaid Managed Care	$15.85

MICA FIRST MET TRANSL STER MIC

Facility

$567.00

Service Code	HCPCS C1713
Hospital Charge Code	270702610
Hospital Revenue Code	278
Min. Negotiated Rate	$85.05
Max. Negotiated Rate	$137.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.21
Rate for Payer: Qualcare PPO/HMO/WC	$85.05

MICA FIRST MET TRANSL STER MIC

Facility

$567.00

Service Code	HCPCS C1713
Hospital Charge Code	270702610
Hospital Revenue Code	278
Min. Negotiated Rate	$16.10
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna Commercial	$215.46
Rate for Payer: Aetna Medicare Advantage	$170.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$113.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.59
Rate for Payer: Cigna Commercial	$283.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.21
Rate for Payer: Qualcare PPO/HMO/WC	$85.05
Rate for Payer: UnitedHealthcare Community & State	$17.92
Rate for Payer: Wellpoint Medicaid Managed Care	$16.10

MICAFUNGIN 100 MG IV

Facility

$1,503.48

Service Code	HCPCS J2248
Hospital Charge Code	60629929
Hospital Revenue Code	636
Min. Negotiated Rate	$42.70
Max. Negotiated Rate	$751.74
Rate for Payer: Aetna Commercial	$571.32
Rate for Payer: Aetna Medicare Advantage	$451.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.39
Rate for Payer: Cigna Commercial	$751.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.84
Rate for Payer: Qualcare PPO/HMO/WC	$225.52
Rate for Payer: UnitedHealthcare Community & State	$47.51
Rate for Payer: Wellpoint Medicaid Managed Care	$42.70

MICAFUNGIN 100 MG IV

Facility

$1,503.48

Service Code	HCPCS J2248
Hospital Charge Code	60629929
Hospital Revenue Code	636
Min. Negotiated Rate	$225.52
Max. Negotiated Rate	$363.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.84
Rate for Payer: Qualcare PPO/HMO/WC	$225.52

MICAFUNGIN SODIUM 50 MG VIAL

Facility

$751.74

Service Code	HCPCS J2248
Hospital Charge Code	60629930
Hospital Revenue Code	636
Min. Negotiated Rate	$112.76
Max. Negotiated Rate	$181.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.92
Rate for Payer: Qualcare PPO/HMO/WC	$112.76

MICAFUNGIN SODIUM 50 MG VIAL

Facility

$751.74

Service Code	HCPCS J2248
Hospital Charge Code	60629930
Hospital Revenue Code	636
Min. Negotiated Rate	$21.35
Max. Negotiated Rate	$375.87
Rate for Payer: Aetna Commercial	$285.66
Rate for Payer: Aetna Medicare Advantage	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.69
Rate for Payer: Cigna Commercial	$375.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.92
Rate for Payer: Qualcare PPO/HMO/WC	$112.76
Rate for Payer: UnitedHealthcare Community & State	$23.75
Rate for Payer: Wellpoint Medicaid Managed Care	$21.35

MICA PROSTEP SOLO GUIDE

Facility

$9,656.25

Hospital Charge Code	270703201
Hospital Revenue Code	270
Min. Negotiated Rate	$274.24
Max. Negotiated Rate	$4,828.12
Rate for Payer: Aetna Commercial	$3,669.38
Rate for Payer: Aetna Medicare Advantage	$2,896.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,462.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,462.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,462.34
Rate for Payer: Cigna Commercial	$4,828.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,510.62
Rate for Payer: Oxford Commercial	$1,931.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,448.44
Rate for Payer: UnitedHealthcare Commercial	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$305.14
Rate for Payer: Wellpoint Medicaid Managed Care	$274.24

MICA PROSTEP SOLO GUIDE

Facility

$9,656.25

Hospital Charge Code	270703201
Hospital Revenue Code	270
Min. Negotiated Rate	$1,448.44
Max. Negotiated Rate	$1,448.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,448.44

MICA SCREW

Facility

$2,860.00

Hospital Charge Code	270703200
Hospital Revenue Code	278
Min. Negotiated Rate	$81.22
Max. Negotiated Rate	$1,430.00
Rate for Payer: Aetna Commercial	$1,086.80
Rate for Payer: Aetna Medicare Advantage	$858.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$729.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$729.30
Rate for Payer: Cigna Commercial	$1,430.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: Qualcare PPO/HMO/WC	$429.00
Rate for Payer: UnitedHealthcare Community & State	$90.38
Rate for Payer: Wellpoint Medicaid Managed Care	$81.22

MICA SCREW

Facility

$2,860.00

Hospital Charge Code	270703200
Hospital Revenue Code	278
Min. Negotiated Rate	$429.00
Max. Negotiated Rate	$692.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$572.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$692.12
Rate for Payer: Qualcare PPO/HMO/WC	$429.00

MICA SCREW 4X60MM

Facility

$2,845.25

Hospital Charge Code	270702620
Hospital Revenue Code	278
Min. Negotiated Rate	$80.81
Max. Negotiated Rate	$1,422.62
Rate for Payer: Aetna Commercial	$1,081.19
Rate for Payer: Aetna Medicare Advantage	$853.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$725.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$725.54
Rate for Payer: Cigna Commercial	$1,422.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79
Rate for Payer: UnitedHealthcare Community & State	$89.91
Rate for Payer: Wellpoint Medicaid Managed Care	$80.81

MICA SCREW 4X60MM

Facility

$2,845.25

Hospital Charge Code	270702620
Hospital Revenue Code	278
Min. Negotiated Rate	$426.79
Max. Negotiated Rate	$688.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$569.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$688.55
Rate for Payer: Qualcare PPO/HMO/WC	$426.79

Know your out-of-pocket cost for care.

All Charges