Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NORMODYNE/300MG

Facility

$7.71

Service Code	NDC 172436660
Hospital Charge Code	60634821
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

NORMODYNE/300MG

Facility

$7.71

Service Code	NDC 172436660
Hospital Charge Code	60634821
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.85
Rate for Payer: Aetna Commercial	$2.93
Rate for Payer: Aetna Medicare Advantage	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.97
Rate for Payer: Cigna Commercial	$3.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.54
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

Normosol R 500ml

Facility

$31.52

Hospital Charge Code	606361029
Hospital Revenue Code	258
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$15.76
Rate for Payer: Aetna Commercial	$11.98
Rate for Payer: Aetna Medicare Advantage	$9.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.04
Rate for Payer: Cigna Commercial	$15.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.20
Rate for Payer: Oxford Commercial	$6.30
Rate for Payer: Qualcare PPO/HMO/WC	$4.73
Rate for Payer: UnitedHealthcare Commercial	$6.30
Rate for Payer: UnitedHealthcare Community & State	$1.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.90

Normosol R 500ml

Facility

$31.52

Hospital Charge Code	606361029
Hospital Revenue Code	258
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$4.73
Rate for Payer: Qualcare PPO/HMO/WC	$4.73

NOROVIRUS

Facility

$390.00

Service Code	HCPCS 87449
Hospital Charge Code	39900393
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

NOROVIRUS

Facility

$390.00

Service Code	HCPCS 87449
Hospital Charge Code	39900393
Hospital Revenue Code	306
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
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	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

NOROVIRUS,EIA,STOOL

Facility

$75.65

Service Code	HCPCS 87449
Hospital Charge Code	39900394
Hospital Revenue Code	306
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.59
Rate for Payer: Aetna Medicare Advantage	$38.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.46
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: Cigna Medicare Advantage	$11.98
Rate for Payer: Clover Medicare Advantage	$11.38
Rate for Payer: EmblemHealth Commercial	$35.94
Rate for Payer: Humana Medicare Advantage	$12.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.67
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.98
Rate for Payer: Wellcare Medicare Advantage	$11.98
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

NOROVIRUS,EIA,STOOL

Facility

$75.65

Service Code	HCPCS 87449
Hospital Charge Code	39900394
Hospital Revenue Code	306
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

NORTRIPTYLINE

Facility

$390.00

Service Code	HCPCS 80335
Hospital Charge Code	39900444
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

NORTRIPTYLINE

Facility

$390.00

Service Code	HCPCS 80335
Hospital Charge Code	39900444
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

NORTRIPTYLINE 10 MG CAP

Facility

$4.00

Service Code	NDC 68084003101
Hospital Charge Code	60627771
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

NORTRIPTYLINE 10 MG CAP

Facility

$4.00

Service Code	NDC 68084003101
Hospital Charge Code	60627771
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

NORTRIPTYLINE 25 MG CAP

Facility

$5.90

Service Code	NDC 68084003201
Hospital Charge Code	60627772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.95
Rate for Payer: Aetna Commercial	$2.24
Rate for Payer: Aetna Medicare Advantage	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.50
Rate for Payer: Cigna Commercial	$2.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.53
Rate for Payer: Oxford Commercial	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.18
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

NORTRIPTYLINE 25 MG CAP

Facility

$5.90

Service Code	NDC 68084003201
Hospital Charge Code	60627772
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

NORTRIPTYLINE 50 MG CAP

Facility

$18.56

Service Code	NDC 51862001701
Hospital Charge Code	60627773
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.28
Rate for Payer: Aetna Commercial	$7.05
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.73
Rate for Payer: Cigna Commercial	$9.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.83
Rate for Payer: Oxford Commercial	$3.71
Rate for Payer: Qualcare PPO/HMO/WC	$2.78
Rate for Payer: UnitedHealthcare Commercial	$3.71
Rate for Payer: UnitedHealthcare Community & State	$0.59
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

NORTRIPTYLINE 50 MG CAP

Facility

$18.56

Service Code	NDC 51862001701
Hospital Charge Code	60627773
Hospital Revenue Code	250
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.78

NORTRIPTYLINE (AVENTYL)

Facility

$151.00

Service Code	HCPCS 80335
Hospital Charge Code	38472740
Hospital Revenue Code	301
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$57.38
Rate for Payer: Aetna Medicare Advantage	$45.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.51
Rate for Payer: Cigna Commercial	$75.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.26
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.29

NORTRIPTYLINE (AVENTYL)

Facility

$151.00

Service Code	HCPCS 80335
Hospital Charge Code	38472740
Hospital Revenue Code	301
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$22.65
Rate for Payer: Qualcare PPO/HMO/WC	$22.65

NORVERAPAMIL

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472018
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

NORVERAPAMIL

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472018
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

NORVIR ORAL SOLUTION

Facility

$48.24

Service Code	NDC 74194063
Hospital Charge Code	60635150
Hospital Revenue Code	250
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$24.12
Rate for Payer: Aetna Commercial	$18.33
Rate for Payer: Aetna Medicare Advantage	$14.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.30
Rate for Payer: Cigna Commercial	$24.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.54
Rate for Payer: Oxford Commercial	$9.65
Rate for Payer: Qualcare PPO/HMO/WC	$7.24
Rate for Payer: UnitedHealthcare Commercial	$9.65
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.37

NORVIR ORAL SOLUTION

Facility

$48.24

Service Code	NDC 74194063
Hospital Charge Code	60635150
Hospital Revenue Code	250
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$7.24

NOVASURE ADVANCE

Facility

$5,690.00

Hospital Charge Code	270679291
Hospital Revenue Code	272
Min. Negotiated Rate	$161.60
Max. Negotiated Rate	$2,845.00
Rate for Payer: Aetna Commercial	$2,162.20
Rate for Payer: Aetna Medicare Advantage	$1,707.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,450.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,450.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,450.95
Rate for Payer: Cigna Commercial	$2,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,479.40
Rate for Payer: Oxford Commercial	$1,138.00
Rate for Payer: Qualcare PPO/HMO/WC	$853.50
Rate for Payer: UnitedHealthcare Commercial	$1,138.00
Rate for Payer: UnitedHealthcare Community & State	$179.80
Rate for Payer: Wellpoint Medicaid Managed Care	$161.60

NOVASURE ADVANCE

Facility

$5,690.00

Hospital Charge Code	270679291
Hospital Revenue Code	272
Min. Negotiated Rate	$853.50
Max. Negotiated Rate	$853.50
Rate for Payer: Qualcare PPO/HMO/WC	$853.50

NOVASURE W/SURESOUND DEVICE

Facility

$5,750.00

Hospital Charge Code	270641829
Hospital Revenue Code	272
Min. Negotiated Rate	$163.30
Max. Negotiated Rate	$2,875.00
Rate for Payer: Aetna Commercial	$2,185.00
Rate for Payer: Aetna Medicare Advantage	$1,725.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,466.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,466.25
Rate for Payer: Cigna Commercial	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,495.00
Rate for Payer: Oxford Commercial	$1,150.00
Rate for Payer: Qualcare PPO/HMO/WC	$862.50
Rate for Payer: UnitedHealthcare Commercial	$1,150.00
Rate for Payer: UnitedHealthcare Community & State	$181.70
Rate for Payer: Wellpoint Medicaid Managed Care	$163.30

Know your out-of-pocket cost for care.

All Charges