Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NYSTATIN TRIAMCIN CRM 30GM

Facility

$147.07

Service Code	NDC 75907006044
Hospital Charge Code	6007223
Hospital Revenue Code	251
Min. Negotiated Rate	$22.06
Max. Negotiated Rate	$22.06
Rate for Payer: Qualcare PPO/HMO/WC	$22.06

NYSTATIN/TRIAMCINOLONE OINTMNT

Facility

$750.00

Service Code	NDC 168008115
Hospital Charge Code	60632330
Hospital Revenue Code	250
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

NYSTATIN/TRIAMCINOLONE OINTMNT

Facility

$750.00

Service Code	NDC 168008115
Hospital Charge Code	60632330
Hospital Revenue Code	250
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

NYSTATIN W/TRIAMCINOLONE

Facility

$750.00

Service Code	NDC 51672127201
Hospital Charge Code	60633566
Hospital Revenue Code	250
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Oxford Commercial	$150.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$150.00
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

NYSTATIN W/TRIAMCINOLONE

Facility

$750.00

Service Code	NDC 51672127201
Hospital Charge Code	60633566
Hospital Revenue Code	250
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

O2 THERAPY INITIAL

Facility

$93.05

Hospital Charge Code	9509902
Hospital Revenue Code	270
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$46.52
Rate for Payer: Aetna Commercial	$35.36
Rate for Payer: Aetna Medicare Advantage	$27.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.73
Rate for Payer: Cigna Commercial	$46.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.19
Rate for Payer: Oxford Commercial	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$13.96
Rate for Payer: UnitedHealthcare Commercial	$18.61
Rate for Payer: UnitedHealthcare Community & State	$2.94
Rate for Payer: Wellpoint Medicaid Managed Care	$2.64

O2 THERAPY INITIAL

Facility

$93.05

Hospital Charge Code	9509902
Hospital Revenue Code	270
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$13.96
Rate for Payer: Qualcare PPO/HMO/WC	$13.96

OAT SET. 10MM

Facility

$2,600.00

Hospital Charge Code	270671283
Hospital Revenue Code	272
Min. Negotiated Rate	$390.00
Max. Negotiated Rate	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$390.00

OAT SET. 10MM

Facility

$2,600.00

Hospital Charge Code	270671283
Hospital Revenue Code	272
Min. Negotiated Rate	$73.84
Max. Negotiated Rate	$1,300.00
Rate for Payer: Aetna Commercial	$988.00
Rate for Payer: Aetna Medicare Advantage	$780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$663.00
Rate for Payer: Cigna Commercial	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$676.00
Rate for Payer: Oxford Commercial	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$390.00
Rate for Payer: UnitedHealthcare Commercial	$520.00
Rate for Payer: UnitedHealthcare Community & State	$82.16
Rate for Payer: Wellpoint Medicaid Managed Care	$73.84

OAT SET. 6MM

Facility

$3,715.00

Hospital Charge Code	270671281
Hospital Revenue Code	272
Min. Negotiated Rate	$557.25
Max. Negotiated Rate	$557.25
Rate for Payer: Qualcare PPO/HMO/WC	$557.25

OAT SET. 6MM

Facility

$3,715.00

Hospital Charge Code	270671281
Hospital Revenue Code	272
Min. Negotiated Rate	$105.51
Max. Negotiated Rate	$1,857.50
Rate for Payer: Aetna Commercial	$1,411.70
Rate for Payer: Aetna Medicare Advantage	$1,114.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$947.33
Rate for Payer: Cigna Commercial	$1,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$965.90
Rate for Payer: Oxford Commercial	$743.00
Rate for Payer: Qualcare PPO/HMO/WC	$557.25
Rate for Payer: UnitedHealthcare Commercial	$743.00
Rate for Payer: UnitedHealthcare Community & State	$117.39
Rate for Payer: Wellpoint Medicaid Managed Care	$105.51

OAT SET. 8MM

Facility

$3,715.00

Hospital Charge Code	270671282
Hospital Revenue Code	272
Min. Negotiated Rate	$557.25
Max. Negotiated Rate	$557.25
Rate for Payer: Qualcare PPO/HMO/WC	$557.25

OAT SET. 8MM

Facility

$3,715.00

Hospital Charge Code	270671282
Hospital Revenue Code	272
Min. Negotiated Rate	$105.51
Max. Negotiated Rate	$1,857.50
Rate for Payer: Aetna Commercial	$1,411.70
Rate for Payer: Aetna Medicare Advantage	$1,114.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$947.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$947.33
Rate for Payer: Cigna Commercial	$1,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$965.90
Rate for Payer: Oxford Commercial	$743.00
Rate for Payer: Qualcare PPO/HMO/WC	$557.25
Rate for Payer: UnitedHealthcare Commercial	$743.00
Rate for Payer: UnitedHealthcare Community & State	$117.39
Rate for Payer: Wellpoint Medicaid Managed Care	$105.51

OATS KIT 8MM

Facility

$3,250.00

Hospital Charge Code	270704124
Hospital Revenue Code	272
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$487.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

OATS KIT 8MM

Facility

$3,250.00

Hospital Charge Code	270704124
Hospital Revenue Code	272
Min. Negotiated Rate	$92.30
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.00
Rate for Payer: Oxford Commercial	$650.00
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Commercial	$650.00
Rate for Payer: UnitedHealthcare Community & State	$102.70
Rate for Payer: Wellpoint Medicaid Managed Care	$92.30

OBSERVATION DIRECT ADMIT

Facility

$1,303.50

Service Code	HCPCS G0379
Hospital Charge Code	100510
Hospital Revenue Code	762
Min. Negotiated Rate	$195.53
Max. Negotiated Rate	$195.53
Rate for Payer: Qualcare PPO/HMO/WC	$195.53

OBSERVATION DIRECT ADMIT

Facility

$1,303.50

Service Code	HCPCS G0379
Hospital Charge Code	100510
Hospital Revenue Code	762
Min. Negotiated Rate	$41.19
Max. Negotiated Rate	$10,618.00
Rate for Payer: Aetna Commercial	$1,924.43
Rate for Payer: Aetna Medicare Advantage	$2,292.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,566.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,566.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$707.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,566.49
Rate for Payer: Cigna Commercial	$1,418.20
Rate for Payer: Cigna Medicare Advantage	$707.51
Rate for Payer: Clover Medicare Advantage	$672.13
Rate for Payer: EmblemHealth Commercial	$2,122.53
Rate for Payer: Humana Medicare Advantage	$728.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$707.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$338.91
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$195.53
Rate for Payer: UnitedHealthcare Commercial	$10,618.00
Rate for Payer: UnitedHealthcare Community & State	$41.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$707.51
Rate for Payer: Wellcare Medicare Advantage	$707.51
Rate for Payer: Wellpoint Medicaid Managed Care	$50.00

OBSERVATION PER HOUR

Facility

$3,582.00

Service Code	HCPCS G0378
Hospital Charge Code	100110
Hospital Revenue Code	762
Min. Negotiated Rate	$537.30
Max. Negotiated Rate	$537.30
Rate for Payer: Qualcare PPO/HMO/WC	$537.30

OBSERVATION PER HOUR

Facility

$3,582.00

Service Code	HCPCS G0378
Hospital Charge Code	100110
Hospital Revenue Code	762
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$10,618.00
Rate for Payer: Aetna Commercial	$1,361.16
Rate for Payer: Aetna Medicare Advantage	$1,074.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$913.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$913.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$913.41
Rate for Payer: Cigna Commercial	$1,791.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$931.32
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$537.30
Rate for Payer: UnitedHealthcare Commercial	$10,618.00
Rate for Payer: UnitedHealthcare Community & State	$113.19
Rate for Payer: Wellpoint Medicaid Managed Care	$50.00

OBSTETRICAL CARE

Facility

$12,676.20

Service Code	HCPCS 59409
Hospital Charge Code	16001012
Hospital Revenue Code	360
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$13,950.60
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,950.60
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,295.81
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.43
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$400.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$360.00

OBSTETRICAL CARE

Facility

$12,676.20

Service Code	HCPCS 59409
Hospital Charge Code	16001012
Hospital Revenue Code	360
Min. Negotiated Rate	$1,901.43
Max. Negotiated Rate	$1,901.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,901.43

OBSTETRIC PANEL

Facility

$105.00

Service Code	HCPCS 80055
Hospital Charge Code	38476799
Hospital Revenue Code	301
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

OBSTETRIC PANEL

Facility

$105.00

Service Code	HCPCS 80055
Hospital Charge Code	38476799
Hospital Revenue Code	301
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$173.43
Rate for Payer: Aetna Commercial	$130.04
Rate for Payer: Aetna Medicare Advantage	$154.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.43
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: Cigna Medicare Advantage	$47.81
Rate for Payer: Clover Medicare Advantage	$45.42
Rate for Payer: EmblemHealth Commercial	$143.43
Rate for Payer: Humana Medicare Advantage	$49.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$38.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.81
Rate for Payer: Wellcare Medicare Advantage	$47.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

OB TRANSAB AMNIOINFUSION,US IN

Facility

$669.00

Service Code	HCPCS 59070
Hospital Charge Code	73190023
Hospital Revenue Code	361
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$984.72
Rate for Payer: Aetna Medicare Advantage	$1,172.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,313.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$362.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,313.26
Rate for Payer: Cigna Commercial	$725.69
Rate for Payer: Cigna Medicare Advantage	$362.03
Rate for Payer: Clover Medicare Advantage	$343.93
Rate for Payer: EmblemHealth Commercial	$1,086.09
Rate for Payer: Humana Medicare Advantage	$372.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$362.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.94
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.35
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$21.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.03
Rate for Payer: Wellcare Medicare Advantage	$362.03
Rate for Payer: Wellpoint Medicaid Managed Care	$19.00

OB TRANSAB AMNIOINFUSION,US IN

Facility

$669.00

Service Code	HCPCS 59070
Hospital Charge Code	73190023
Hospital Revenue Code	361
Min. Negotiated Rate	$100.35
Max. Negotiated Rate	$100.35
Rate for Payer: Qualcare PPO/HMO/WC	$100.35

Know your out-of-pocket cost for care.

All Charges