Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

OCTAGAM 10% 20GM/200ML

Facility

$10,004.78

Service Code	HCPCS J1568
Hospital Charge Code	606390174
Hospital Revenue Code	636
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$2,421.16
Rate for Payer: Aetna Commercial	$127.95
Rate for Payer: Aetna Medicare Advantage	$152.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.64
Rate for Payer: Cigna Medicare Advantage	$47.04
Rate for Payer: Clover Medicare Advantage	$44.69
Rate for Payer: EmblemHealth Commercial	$141.12
Rate for Payer: Humana Medicare Advantage	$48.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,421.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.72
Rate for Payer: UnitedHealthcare Community & State	$316.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.04
Rate for Payer: Wellcare Medicare Advantage	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$284.14

OCTAGAM 10% 20GM/200ML

Facility

$10,004.78

Service Code	HCPCS J1568
Hospital Charge Code	606390174
Hospital Revenue Code	636
Min. Negotiated Rate	$1,500.72
Max. Negotiated Rate	$2,421.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,421.16
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.72

OCTAGAM 2.5GM 5%/50ML

Facility

$3,471.27

Service Code	HCPCS J1568JW
Hospital Charge Code	606390486
Hospital Revenue Code	636
Min. Negotiated Rate	$98.58
Max. Negotiated Rate	$1,735.63
Rate for Payer: Aetna Commercial	$1,319.08
Rate for Payer: Aetna Medicare Advantage	$1,041.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$885.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$885.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$885.17
Rate for Payer: Cigna Commercial	$1,735.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.05
Rate for Payer: Qualcare PPO/HMO/WC	$520.69
Rate for Payer: UnitedHealthcare Community & State	$109.69
Rate for Payer: Wellpoint Medicaid Managed Care	$98.58

OCTAGAM 2.5GM 5%/50ML

Facility

$3,471.27

Service Code	HCPCS J1568JW
Hospital Charge Code	606390486
Hospital Revenue Code	636
Min. Negotiated Rate	$520.69
Max. Negotiated Rate	$840.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$840.05
Rate for Payer: Qualcare PPO/HMO/WC	$520.69

OCTAGAM 5% 5GM/100ML

Facility

$4,755.66

Service Code	HCPCS J1568
Hospital Charge Code	60628294
Hospital Revenue Code	636
Min. Negotiated Rate	$713.35
Max. Negotiated Rate	$1,150.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,150.87
Rate for Payer: Qualcare PPO/HMO/WC	$713.35

OCTAGAM 5% 5GM/100ML

Facility

$4,755.66

Service Code	HCPCS J1568
Hospital Charge Code	60628294
Hospital Revenue Code	636
Min. Negotiated Rate	$44.69
Max. Negotiated Rate	$1,150.87
Rate for Payer: Aetna Commercial	$127.95
Rate for Payer: Aetna Medicare Advantage	$152.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$47.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.64
Rate for Payer: Cigna Medicare Advantage	$47.04
Rate for Payer: Clover Medicare Advantage	$44.69
Rate for Payer: EmblemHealth Commercial	$141.12
Rate for Payer: Humana Medicare Advantage	$48.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$47.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,150.87
Rate for Payer: Qualcare PPO/HMO/WC	$713.35
Rate for Payer: UnitedHealthcare Community & State	$150.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.04
Rate for Payer: Wellcare Medicare Advantage	$47.04
Rate for Payer: Wellpoint Medicaid Managed Care	$135.06

OC TAP

Facility

$2,700.00

Hospital Charge Code	270683739
Hospital Revenue Code	272
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$405.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

OC TAP

Facility

$2,700.00

Hospital Charge Code	270683739
Hospital Revenue Code	272
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$702.00
Rate for Payer: Oxford Commercial	$540.00
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Commercial	$540.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

OCTREOTIDE 100 MCG/ML INJ

Facility

$205.56

Service Code	HCPCS J2354
Hospital Charge Code	60628540
Hospital Revenue Code	636
Min. Negotiated Rate	$30.83
Max. Negotiated Rate	$49.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.75
Rate for Payer: Qualcare PPO/HMO/WC	$30.83

OCTREOTIDE 100 MCG/ML INJ

Facility

$205.56

Service Code	HCPCS J2354
Hospital Charge Code	60628540
Hospital Revenue Code	636
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$102.78
Rate for Payer: Aetna Commercial	$78.11
Rate for Payer: Aetna Medicare Advantage	$61.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.42
Rate for Payer: Cigna Commercial	$102.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.75
Rate for Payer: Qualcare PPO/HMO/WC	$30.83
Rate for Payer: UnitedHealthcare Community & State	$6.50
Rate for Payer: Wellpoint Medicaid Managed Care	$5.84

OCTREOTIDE 30 MG LAR INJ

Facility

$36,803.90

Service Code	HCPCS J2353
Hospital Charge Code	60629867
Hospital Revenue Code	636
Min. Negotiated Rate	$178.93
Max. Negotiated Rate	$8,906.54
Rate for Payer: Aetna Commercial	$512.31
Rate for Payer: Aetna Medicare Advantage	$610.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$683.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$683.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$188.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$683.24
Rate for Payer: Cigna Medicare Advantage	$188.35
Rate for Payer: Clover Medicare Advantage	$178.93
Rate for Payer: EmblemHealth Commercial	$565.05
Rate for Payer: Humana Medicare Advantage	$194.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$188.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,906.54
Rate for Payer: Qualcare PPO/HMO/WC	$5,520.59
Rate for Payer: UnitedHealthcare Community & State	$1,163.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$188.35
Rate for Payer: Wellcare Medicare Advantage	$188.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1,045.23

OCTREOTIDE 30 MG LAR INJ

Facility

$36,803.90

Service Code	HCPCS J2353
Hospital Charge Code	60629867
Hospital Revenue Code	636
Min. Negotiated Rate	$5,520.59
Max. Negotiated Rate	$8,906.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,906.54
Rate for Payer: Qualcare PPO/HMO/WC	$5,520.59

OCTREOTIDE 500 MCG/ML INJ

Facility

$991.40

Service Code	HCPCS J2354
Hospital Charge Code	60628854
Hospital Revenue Code	636
Min. Negotiated Rate	$148.71
Max. Negotiated Rate	$239.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.92
Rate for Payer: Qualcare PPO/HMO/WC	$148.71

OCTREOTIDE 500 MCG/ML INJ

Facility

$991.40

Service Code	HCPCS J2354
Hospital Charge Code	60628854
Hospital Revenue Code	636
Min. Negotiated Rate	$28.16
Max. Negotiated Rate	$495.70
Rate for Payer: Aetna Commercial	$376.73
Rate for Payer: Aetna Medicare Advantage	$297.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$252.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$252.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$252.81
Rate for Payer: Cigna Commercial	$495.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.92
Rate for Payer: Qualcare PPO/HMO/WC	$148.71
Rate for Payer: UnitedHealthcare Community & State	$31.33
Rate for Payer: Wellpoint Medicaid Managed Care	$28.16

OCTREOTIDE 50 MCG/ML INJ

Facility

$105.99

Service Code	HCPCS J2354
Hospital Charge Code	6010367
Hospital Revenue Code	636
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$52.99
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$52.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

OCTREOTIDE 50 MCG/ML INJ

Facility

$105.99

Service Code	HCPCS J2354
Hospital Charge Code	6010367
Hospital Revenue Code	636
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$25.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

OCULAR OCCLUDER

Facility

$47.00

Hospital Charge Code	270335238
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

OCULAR OCCLUDER

Facility

$47.00

Hospital Charge Code	270335238
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.22
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

OCULAR OCCLUDER 36/BX

Facility

$16.05

Hospital Charge Code	270652844
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$8.03
Rate for Payer: Aetna Commercial	$6.10
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.09
Rate for Payer: Cigna Commercial	$8.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.17
Rate for Payer: Oxford Commercial	$3.21
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

OCULAR OCCLUDER 36/BX

Facility

$16.05

Hospital Charge Code	270652844
Hospital Revenue Code	270
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.41

OF,ANKLE FRACTURE

Facility

$48,992.10

Service Code	HCPCS 27766
Hospital Charge Code	16000399
Hospital Revenue Code	360
Min. Negotiated Rate	$1,391.38
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,737.95
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,548.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,391.38

OF,ANKLE FRACTURE

Facility

$48,992.10

Service Code	HCPCS 27766
Hospital Charge Code	16000399
Hospital Revenue Code	360
Min. Negotiated Rate	$7,348.81
Max. Negotiated Rate	$7,348.81
Rate for Payer: Qualcare PPO/HMO/WC	$7,348.81

OF CLAVICLE FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23515
Hospital Charge Code	16000390
Hospital Revenue Code	360
Min. Negotiated Rate	$9,591.54
Max. Negotiated Rate	$9,591.54
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54

OF CLAVICLE FRACTURE

Facility

$63,943.60

Service Code	HCPCS 23515
Hospital Charge Code	16000390
Hospital Revenue Code	360
Min. Negotiated Rate	$1,816.00
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,625.34
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,591.54
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$2,020.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,816.00

OFFICE CONSULT COMPREHENSIVE

Facility

$1,160.60

Service Code	HCPCS 99244
Hospital Charge Code	83653210
Hospital Revenue Code	514
Min. Negotiated Rate	$32.96
Max. Negotiated Rate	$580.30
Rate for Payer: Aetna Commercial	$441.03
Rate for Payer: Aetna Medicare Advantage	$348.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$295.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$295.95
Rate for Payer: Cigna Commercial	$580.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.76
Rate for Payer: Qualcare PPO/HMO/WC	$174.09
Rate for Payer: UnitedHealthcare Community & State	$36.67
Rate for Payer: Wellpoint Medicaid Managed Care	$32.96

Know your out-of-pocket cost for care.

All Charges