Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MYOMECTOMY,EXC FIBROIDS-UTER

Facility

$9,489.90

Service Code	HCPCS 58140
Hospital Charge Code	73190009
Hospital Revenue Code	361
Min. Negotiated Rate	$1,423.48
Max. Negotiated Rate	$1,423.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,423.48

MYOPLASMA PNEUMONIAE ANTIBODIE

Facility

$272.00

Service Code	HCPCS 86738
Hospital Charge Code	38476138
Hospital Revenue Code	302
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare Advantage	$42.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.03
Rate for Payer: Cigna Commercial	$136.00
Rate for Payer: Cigna Medicare Advantage	$13.24
Rate for Payer: Clover Medicare Advantage	$12.58
Rate for Payer: EmblemHealth Commercial	$39.72
Rate for Payer: Humana Medicare Advantage	$13.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.80
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.24
Rate for Payer: Wellcare Medicare Advantage	$13.24
Rate for Payer: Wellpoint Medicaid Managed Care	$7.72

MYOPLASMA PNEUMONIAE ANTIBODIE

Facility

$272.00

Service Code	HCPCS 86738
Hospital Charge Code	38476138
Hospital Revenue Code	302
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$40.80
Rate for Payer: Qualcare PPO/HMO/WC	$40.80

MYOREGEN PRP KIT

Facility

$1,400.00

Hospital Charge Code	270703613
Hospital Revenue Code	272
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

MYOREGEN PRP KIT

Facility

$1,400.00

Hospital Charge Code	270703613
Hospital Revenue Code	272
Min. Negotiated Rate	$39.76
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$532.00
Rate for Payer: Aetna Medicare Advantage	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$357.00
Rate for Payer: Cigna Commercial	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$280.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00
Rate for Payer: UnitedHealthcare Commercial	$280.00
Rate for Payer: UnitedHealthcare Community & State	$44.24
Rate for Payer: Wellpoint Medicaid Managed Care	$39.76

MYOSURE FIBROID REMOVAL XL

Facility

$7,271.67

Hospital Charge Code	270662593
Hospital Revenue Code	272
Min. Negotiated Rate	$1,090.75
Max. Negotiated Rate	$1,090.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.75

MYOSURE FIBROID REMOVAL XL

Facility

$7,271.67

Hospital Charge Code	270662593
Hospital Revenue Code	272
Min. Negotiated Rate	$206.52
Max. Negotiated Rate	$3,635.84
Rate for Payer: Aetna Commercial	$2,763.23
Rate for Payer: Aetna Medicare Advantage	$2,181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,854.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,854.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,854.28
Rate for Payer: Cigna Commercial	$3,635.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,890.63
Rate for Payer: Oxford Commercial	$1,454.33
Rate for Payer: Qualcare PPO/HMO/WC	$1,090.75
Rate for Payer: UnitedHealthcare Commercial	$1,454.33
Rate for Payer: UnitedHealthcare Community & State	$229.78
Rate for Payer: Wellpoint Medicaid Managed Care	$206.52

MYOSURE TISSUE REMOVAL DEVICE

Facility

$7,790.00

Hospital Charge Code	270660314
Hospital Revenue Code	272
Min. Negotiated Rate	$221.24
Max. Negotiated Rate	$3,895.00
Rate for Payer: Aetna Commercial	$2,960.20
Rate for Payer: Aetna Medicare Advantage	$2,337.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,986.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,986.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,986.45
Rate for Payer: Cigna Commercial	$3,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,025.40
Rate for Payer: Oxford Commercial	$1,558.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,168.50
Rate for Payer: UnitedHealthcare Commercial	$1,558.00
Rate for Payer: UnitedHealthcare Community & State	$246.16
Rate for Payer: Wellpoint Medicaid Managed Care	$221.24

MYOSURE TISSUE REMOVAL DEVICE

Facility

$7,790.00

Hospital Charge Code	270660314
Hospital Revenue Code	272
Min. Negotiated Rate	$1,168.50
Max. Negotiated Rate	$1,168.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,168.50

MYRIAD ECM MATRIX 10X10 SR3

Facility

$4,593.75

Hospital Charge Code	270692092
Hospital Revenue Code	272
Min. Negotiated Rate	$689.06
Max. Negotiated Rate	$689.06
Rate for Payer: Qualcare PPO/HMO/WC	$689.06

MYRIAD ECM MATRIX 10X10 SR3

Facility

$4,593.75

Hospital Charge Code	270692092
Hospital Revenue Code	272
Min. Negotiated Rate	$130.46
Max. Negotiated Rate	$2,296.88
Rate for Payer: Aetna Commercial	$1,745.62
Rate for Payer: Aetna Medicare Advantage	$1,378.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,171.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,171.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,171.41
Rate for Payer: Cigna Commercial	$2,296.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.38
Rate for Payer: Oxford Commercial	$918.75
Rate for Payer: Qualcare PPO/HMO/WC	$689.06
Rate for Payer: UnitedHealthcare Commercial	$918.75
Rate for Payer: UnitedHealthcare Community & State	$145.16
Rate for Payer: Wellpoint Medicaid Managed Care	$130.46

MYRIAD ECM MATRIX 10X10 SR5

Facility

$6,354.65

Hospital Charge Code	270692101
Hospital Revenue Code	272
Min. Negotiated Rate	$180.47
Max. Negotiated Rate	$3,177.32
Rate for Payer: Aetna Commercial	$2,414.77
Rate for Payer: Aetna Medicare Advantage	$1,906.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,620.44
Rate for Payer: Cigna Commercial	$3,177.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,652.21
Rate for Payer: Oxford Commercial	$1,270.93
Rate for Payer: Qualcare PPO/HMO/WC	$953.20
Rate for Payer: UnitedHealthcare Commercial	$1,270.93
Rate for Payer: UnitedHealthcare Community & State	$200.81
Rate for Payer: Wellpoint Medicaid Managed Care	$180.47

MYRIAD ECM MATRIX 10X10 SR5

Facility

$6,354.65

Hospital Charge Code	270692101
Hospital Revenue Code	272
Min. Negotiated Rate	$953.20
Max. Negotiated Rate	$953.20
Rate for Payer: Qualcare PPO/HMO/WC	$953.20

MYRINGOTOMY BLADE

Facility

$75.00

Hospital Charge Code	270335209
Hospital Revenue Code	272
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

MYRINGOTOMY BLADE

Facility

$75.00

Hospital Charge Code	270335209
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

MYXREDLIN INSULIN HUMAN 100UM/

Facility

$210.00

Hospital Charge Code	606390575
Hospital Revenue Code	250
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

MYXREDLIN INSULIN HUMAN 100UM/

Facility

$210.00

Hospital Charge Code	606390575
Hospital Revenue Code	250
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$42.00
Rate for Payer: UnitedHealthcare Community & State	$6.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

N300 LEAD ANCHOR KIT

Facility

$125.00

Hospital Charge Code	270703935
Hospital Revenue Code	279
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Qualcare PPO/HMO/WC	$18.75

N300 LEAD ANCHOR KIT

Facility

$125.00

Hospital Charge Code	270703935
Hospital Revenue Code	279
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$62.50
Rate for Payer: Aetna Commercial	$47.50
Rate for Payer: Aetna Medicare Advantage	$37.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.88
Rate for Payer: Cigna Commercial	$62.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.50
Rate for Payer: Oxford Commercial	$25.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.75
Rate for Payer: UnitedHealthcare Commercial	$25.00
Rate for Payer: UnitedHealthcare Community & State	$3.95
Rate for Payer: Wellpoint Medicaid Managed Care	$3.55

NABUMETONE 500MG TAB

Facility

$8.71

Service Code	NDC 115165701
Hospital Charge Code	6063943141
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.31

NABUMETONE 500MG TAB

Facility

$8.71

Service Code	NDC 115165701
Hospital Charge Code	6063943141
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.26
Rate for Payer: Oxford Commercial	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$1.74
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

NABUMETONE 750MG TAB

Facility

$10.25

Service Code	NDC 115165801
Hospital Charge Code	6063943142
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

NABUMETONE 750MG TAB

Facility

$10.25

Service Code	NDC 115165801
Hospital Charge Code	6063943142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.12
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.61
Rate for Payer: Cigna Commercial	$5.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.67
Rate for Payer: Oxford Commercial	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$2.05
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

NACL 0.45% 1000ML

Facility

$9.65

Hospital Charge Code	270040210
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

NACL 0.45% 1000ML

Facility

$9.65

Hospital Charge Code	270040210
Hospital Revenue Code	258
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

Know your out-of-pocket cost for care.

All Charges