Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NC TREK NEO RX 5.50 X 15

Facility

$500.00

Hospital Charge Code	270704334
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 5.50 X 15

Facility

$500.00

Hospital Charge Code	270704334
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

NC TREK NEO RX 5.50 X 20

Facility

$500.00

Hospital Charge Code	270704335
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

NC TREK NEO RX 5.50 X 20

Facility

$500.00

Hospital Charge Code	270704335
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 12

Facility

$500.00

Hospital Charge Code	270704336
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 12

Facility

$500.00

Hospital Charge Code	270704336
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

NC TREK NEO RX 6.00 X 15

Facility

$500.00

Hospital Charge Code	270704337
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NC TREK NEO RX 6.00 X 15

Facility

$500.00

Hospital Charge Code	270704337
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

NC TREK NEO RX 6.00 X 20

Facility

$500.00

Hospital Charge Code	270704338
Hospital Revenue Code	272
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

NC TREK NEO RX 6.00 X 20

Facility

$500.00

Hospital Charge Code	270704338
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

NDLBXHAWKINSIIIFLEXSTR20G10CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270663360R
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDLBXHAWKINSIIIFLEXSTR20G10CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270663360R
Hospital Revenue Code	278
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$66.69
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Community & State	$5.55
Rate for Payer: Wellpoint Medicaid Managed Care	$4.98

NDL LOC 20G5CM FLX HAWKINS III

Facility

$135.00

Service Code	HCPCS A4648
Hospital Charge Code	270660542
Hospital Revenue Code	278
Min. Negotiated Rate	$20.25
Max. Negotiated Rate	$32.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25

NDL LOC 20G5CM FLX HAWKINS III

Facility

$135.00

Service Code	HCPCS A4648
Hospital Charge Code	270660542
Hospital Revenue Code	278
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$51.30
Rate for Payer: Aetna Medicare Advantage	$40.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.42
Rate for Payer: Cigna Commercial	$67.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.67
Rate for Payer: Qualcare PPO/HMO/WC	$20.25
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.83

NDL LOC 20G5CM HD HAWKINS III

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645788
Hospital Revenue Code	278
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$66.69
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Community & State	$5.55
Rate for Payer: Wellpoint Medicaid Managed Care	$4.98

NDL LOC 20G5CM HD HAWKINS III

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645788
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787
Hospital Revenue Code	278
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$4.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787R
Hospital Revenue Code	278
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.40
Rate for Payer: Aetna Medicare Advantage	$39.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.15
Rate for Payer: Cigna Commercial	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50
Rate for Payer: UnitedHealthcare Community & State	$4.11
Rate for Payer: Wellpoint Medicaid Managed Care	$3.69

NDL LOC BX HAWKINS III 20G3CM

Facility

$130.00

Service Code	HCPCS A4648
Hospital Charge Code	270645787R
Hospital Revenue Code	278
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$31.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.46
Rate for Payer: Qualcare PPO/HMO/WC	$19.50

NDLLOCHAWKINSIIIHDW20G7.5CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645789
Hospital Revenue Code	278
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$42.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

NDLLOCHAWKINSIIIHDW20G7.5CM

Facility

$175.50

Service Code	HCPCS A4648
Hospital Charge Code	270645789
Hospital Revenue Code	278
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$66.69
Rate for Payer: Aetna Medicare Advantage	$52.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$35.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.75
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.47
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Community & State	$5.55
Rate for Payer: Wellpoint Medicaid Managed Care	$4.98

NEBCIN/40MG/1ML

Facility

$7.97

Service Code	NDC 67457047322
Hospital Charge Code	60633513
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

NEBCIN/40MG/1ML

Facility

$7.97

Service Code	NDC 67457047322
Hospital Charge Code	60633513
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.07
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

NEBIVOLOL 10 MG TAB

Facility

$24.86

Service Code	NDC 456141030
Hospital Charge Code	606351003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$12.43
Rate for Payer: Aetna Commercial	$9.45
Rate for Payer: Aetna Medicare Advantage	$7.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.34
Rate for Payer: Cigna Commercial	$12.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.46
Rate for Payer: Oxford Commercial	$4.97
Rate for Payer: Qualcare PPO/HMO/WC	$3.73
Rate for Payer: UnitedHealthcare Commercial	$4.97
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

Know your out-of-pocket cost for care.

All Charges