Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MICONAZOLE NITRATE 100 MG SUP

Facility

$6.23

Service Code	NDC 713019757
Hospital Charge Code	60628340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.12
Rate for Payer: Aetna Commercial	$2.37
Rate for Payer: Aetna Medicare Advantage	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.59
Rate for Payer: Cigna Commercial	$3.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.93
Rate for Payer: UnitedHealthcare Commercial	$1.25
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

MICONAZOLE NITRATE 100 MG SUP

Facility

$6.23

Service Code	NDC 713019757
Hospital Charge Code	60628340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.93

MICONAZOLE NITRATE 2% CREAM

Facility

$49.18

Service Code	NDC 603780550
Hospital Charge Code	60628341
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$24.59
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$14.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.54
Rate for Payer: Cigna Commercial	$24.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.79
Rate for Payer: Oxford Commercial	$9.84
Rate for Payer: Qualcare PPO/HMO/WC	$7.38
Rate for Payer: UnitedHealthcare Commercial	$9.84
Rate for Payer: UnitedHealthcare Community & State	$1.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

MICONAZOLE NITRATE 2% CREAM

Facility

$49.18

Service Code	NDC 603780550
Hospital Charge Code	60628341
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.38

MICONAZOLE NITRATE 45 GM CRE

Facility

$78.99

Service Code	NDC 904773445
Hospital Charge Code	6009179
Hospital Revenue Code	251
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$39.49
Rate for Payer: Aetna Commercial	$30.02
Rate for Payer: Aetna Medicare Advantage	$23.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.14
Rate for Payer: Cigna Commercial	$39.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.54
Rate for Payer: Oxford Commercial	$15.80
Rate for Payer: Qualcare PPO/HMO/WC	$11.85
Rate for Payer: UnitedHealthcare Commercial	$15.80
Rate for Payer: UnitedHealthcare Community & State	$2.50
Rate for Payer: Wellpoint Medicaid Managed Care	$2.24

MICONAZOLE NITRATE 45 GM CRE

Facility

$78.99

Service Code	NDC 904773445
Hospital Charge Code	6009179
Hospital Revenue Code	251
Min. Negotiated Rate	$11.85
Max. Negotiated Rate	$11.85
Rate for Payer: Qualcare PPO/HMO/WC	$11.85

MICROALBUMIN,24HU(W/O CR)

Facility

$390.00

Service Code	HCPCS 82043
Hospital Charge Code	39900034
Hospital Revenue Code	307
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
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	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MICROALBUMIN,24HU(W/O CR)

Facility

$390.00

Service Code	HCPCS 82043
Hospital Charge Code	39900034
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MICROALBUMIN CREATININE RATIO

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39880002B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MICROALBUMIN CREATININE RATIO

Facility

$390.00

Service Code	HCPCS 82043
Hospital Charge Code	39880002A
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MICROALBUMIN CREATININE RATIO

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39880002B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MICROALBUMIN CREATININE RATIO

Facility

$390.00

Service Code	HCPCS 82043
Hospital Charge Code	39880002A
Hospital Revenue Code	307
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
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	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MICROALBUMIN URINE QUANT

Facility

$511.00

Service Code	HCPCS 82043
Hospital Charge Code	38472927
Hospital Revenue Code	307
Min. Negotiated Rate	$76.65
Max. Negotiated Rate	$76.65
Rate for Payer: Qualcare PPO/HMO/WC	$76.65

MICROALBUMIN URINE QUANT

Facility

$511.00

Service Code	HCPCS 82043
Hospital Charge Code	38472927
Hospital Revenue Code	307
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$255.50
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$255.50
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$14.51

MICROALBUMIN WITH CREATININE I

Facility

$390.00

Service Code	HCPCS 82043
Hospital Charge Code	39990139A
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MICROALBUMIN WITH CREATININE I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39990139B
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MICROALBUMIN WITH CREATININE I

Facility

$390.00

Service Code	HCPCS 82043
Hospital Charge Code	39990139A
Hospital Revenue Code	307
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
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	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

MICROALBUMIN WITH CREATININE I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39990139B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

MICROALBUMI QUANT.UR

Facility

$511.00

Service Code	HCPCS 82043
Hospital Charge Code	38479116
Hospital Revenue Code	307
Min. Negotiated Rate	$4.62
Max. Negotiated Rate	$255.50
Rate for Payer: Aetna Commercial	$15.72
Rate for Payer: Aetna Medicare Advantage	$18.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.97
Rate for Payer: Cigna Commercial	$255.50
Rate for Payer: Cigna Medicare Advantage	$5.78
Rate for Payer: Clover Medicare Advantage	$5.49
Rate for Payer: EmblemHealth Commercial	$17.34
Rate for Payer: Humana Medicare Advantage	$5.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$76.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.78
Rate for Payer: Wellcare Medicare Advantage	$5.78
Rate for Payer: Wellpoint Medicaid Managed Care	$14.51

MICROALBUMI QUANT.UR

Facility

$511.00

Service Code	HCPCS 82043
Hospital Charge Code	38479116
Hospital Revenue Code	307
Min. Negotiated Rate	$76.65
Max. Negotiated Rate	$76.65
Rate for Payer: Qualcare PPO/HMO/WC	$76.65

MICRO AMNI MEMB ALLOGRFT100MG

Facility

$9,170.00

Service Code	HCPCS Q4145
Hospital Charge Code	270680996
Hospital Revenue Code	278
Min. Negotiated Rate	$260.43
Max. Negotiated Rate	$4,585.00
Rate for Payer: Aetna Commercial	$3,484.60
Rate for Payer: Aetna Medicare Advantage	$2,751.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,338.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,338.35
Rate for Payer: Cigna Commercial	$4,585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: Wellpoint Medicaid Managed Care	$260.43

MICRO AMNI MEMB ALLOGRFT100MG

Facility

$9,170.00

Service Code	HCPCS Q4145
Hospital Charge Code	270680996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

MICRO ANCHOR WITH # 3 ETHOLAN

Facility

$2,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270680313
Hospital Revenue Code	278
Min. Negotiated Rate	$68.02
Max. Negotiated Rate	$1,197.50
Rate for Payer: Aetna Commercial	$910.10
Rate for Payer: Aetna Medicare Advantage	$718.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$610.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$610.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$610.73
Rate for Payer: Cigna Commercial	$1,197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.59
Rate for Payer: Qualcare PPO/HMO/WC	$359.25
Rate for Payer: UnitedHealthcare Community & State	$75.68
Rate for Payer: Wellpoint Medicaid Managed Care	$68.02

MICRO ANCHOR WITH # 3 ETHOLAN

Facility

$2,395.00

Service Code	HCPCS C1713
Hospital Charge Code	270680313
Hospital Revenue Code	278
Min. Negotiated Rate	$359.25
Max. Negotiated Rate	$579.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$479.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$579.59
Rate for Payer: Qualcare PPO/HMO/WC	$359.25

MICRO ANIS 17 MM/3MM

Facility

$980.00

Hospital Charge Code	270703199
Hospital Revenue Code	278
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$237.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$237.16
Rate for Payer: Qualcare PPO/HMO/WC	$147.00

Know your out-of-pocket cost for care.

All Charges