Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

AXLE RS OSS

Facility

$3,600.00

Service Code	HCPCS C1776
Hospital Charge Code	270667949
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$871.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067S
Hospital Revenue Code	272
Min. Negotiated Rate	$325.89
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,983.50
Rate for Payer: Oxford Commercial	$2,295.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$2,295.00
Rate for Payer: UnitedHealthcare Community & State	$362.61
Rate for Payer: Wellpoint Medicaid Managed Care	$325.89

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067S
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

AXS Cat 6

Facility

$11,475.00

Hospital Charge Code	270685067N
Hospital Revenue Code	272
Min. Negotiated Rate	$325.89
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,983.50
Rate for Payer: Oxford Commercial	$2,295.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$2,295.00
Rate for Payer: UnitedHealthcare Community & State	$362.61
Rate for Payer: Wellpoint Medicaid Managed Care	$325.89

AXUMIN FLUCICLOVINE F-18 1MCI

Facility

$1,834.00

Service Code	HCPCS A9588
Hospital Charge Code	80000052
Hospital Revenue Code	343
Min. Negotiated Rate	$52.09
Max. Negotiated Rate	$1,169.03
Rate for Payer: Aetna Commercial	$876.57
Rate for Payer: Aetna Medicare Advantage	$1,044.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,169.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,169.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$322.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$177.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,169.03
Rate for Payer: Cigna Medicare Advantage	$225.59
Rate for Payer: Clover Medicare Advantage	$306.16
Rate for Payer: EmblemHealth Commercial	$966.81
Rate for Payer: Humana Medicare Advantage	$331.94
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$322.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$476.84
Rate for Payer: Qualcare PPO/HMO/WC	$275.10
Rate for Payer: UnitedHealthcare Community & State	$57.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$322.27
Rate for Payer: Wellcare Medicare Advantage	$322.27
Rate for Payer: Wellpoint Medicaid Managed Care	$52.09

AXUMIN FLUCICLOVINE F-18 1MCI

Facility

$1,834.00

Service Code	HCPCS A9588
Hospital Charge Code	80000052
Hospital Revenue Code	343
Min. Negotiated Rate	$275.10
Max. Negotiated Rate	$275.10
Rate for Payer: Qualcare PPO/HMO/WC	$275.10

AYR BABY SAKINE .65% DROPS

Facility

$16.01

Service Code	NDC 225055050
Hospital Charge Code	606350990
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$8.01
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

AYR BABY SAKINE .65% DROPS

Facility

$16.01

Service Code	NDC 225055050
Hospital Charge Code	606350990
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

AZACITIDINE 100 MG REC

Facility

$4,705.34

Service Code	HCPCS J9025
Hospital Charge Code	60629945
Hospital Revenue Code	636
Min. Negotiated Rate	$133.63
Max. Negotiated Rate	$2,352.67
Rate for Payer: Aetna Commercial	$1,788.03
Rate for Payer: Aetna Medicare Advantage	$1,411.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,199.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,199.86
Rate for Payer: Cigna Commercial	$2,352.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.69
Rate for Payer: Qualcare PPO/HMO/WC	$705.80
Rate for Payer: UnitedHealthcare Community & State	$148.69
Rate for Payer: Wellpoint Medicaid Managed Care	$133.63

AZACITIDINE 100 MG REC

Facility

$4,705.34

Service Code	HCPCS J9025
Hospital Charge Code	60629945
Hospital Revenue Code	636
Min. Negotiated Rate	$705.80
Max. Negotiated Rate	$1,138.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,138.69
Rate for Payer: Qualcare PPO/HMO/WC	$705.80

AZACITIDINE 1 MG J9025

Facility

$32.38

Hospital Charge Code	60639251T
Hospital Revenue Code	636
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$7.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.86

AZACITIDINE 1 MG J9025

Facility

$32.38

Hospital Charge Code	60639251T
Hospital Revenue Code	636
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$16.19
Rate for Payer: Aetna Commercial	$12.30
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.26
Rate for Payer: Cigna Commercial	$16.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.86
Rate for Payer: UnitedHealthcare Community & State	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

AZATHIOPRINE 50 MG TAB

Facility

$9.65

Service Code	HCPCS J7500
Hospital Charge Code	60627364
Hospital Revenue Code	636
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

AZATHIOPRINE 50 MG TAB

Facility

$9.65

Service Code	HCPCS J7500
Hospital Charge Code	60627364
Hospital Revenue Code	636
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	$2.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

AZITHROMYCIN 100 MG/5 ML SUSP

Facility

$42.34

Service Code	NDC 69311019
Hospital Charge Code	60629272
Hospital Revenue Code	250
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$6.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.35

AZITHROMYCIN 100 MG/5 ML SUSP

Facility

$42.34

Service Code	NDC 69311019
Hospital Charge Code	60629272
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$21.17
Rate for Payer: Aetna Commercial	$16.09
Rate for Payer: Aetna Medicare Advantage	$12.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.80
Rate for Payer: Cigna Commercial	$21.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.01
Rate for Payer: Oxford Commercial	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$6.35
Rate for Payer: UnitedHealthcare Commercial	$8.47
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

AZITHROMYCIN 200 MG/5 ML SUSP

Facility

$28.21

Service Code	NDC 69313019
Hospital Charge Code	60627272
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.23

AZITHROMYCIN 200 MG/5 ML SUSP

Facility

$28.21

Service Code	NDC 69313019
Hospital Charge Code	60627272
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.11
Rate for Payer: Aetna Commercial	$10.72
Rate for Payer: Aetna Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.19
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.33
Rate for Payer: Oxford Commercial	$5.64
Rate for Payer: Qualcare PPO/HMO/WC	$4.23
Rate for Payer: UnitedHealthcare Commercial	$5.64
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

AZITHROMYCIN 250 MG TAB UD

Facility

$52.06

Service Code	NDC 69406189
Hospital Charge Code	60628569
Hospital Revenue Code	250
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$7.81
Rate for Payer: Qualcare PPO/HMO/WC	$7.81

AZITHROMYCIN 250 MG TAB UD

Facility

$52.06

Service Code	NDC 69406189
Hospital Charge Code	60628569
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$26.03
Rate for Payer: Aetna Commercial	$19.78
Rate for Payer: Aetna Medicare Advantage	$15.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.28
Rate for Payer: Cigna Commercial	$26.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.54
Rate for Payer: Oxford Commercial	$10.41
Rate for Payer: Qualcare PPO/HMO/WC	$7.81
Rate for Payer: UnitedHealthcare Commercial	$10.41
Rate for Payer: UnitedHealthcare Community & State	$1.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

AZITHROMYCIN 500MG/NS 250ML

Facility

$104.19

Service Code	HCPCS J0456
Hospital Charge Code	60628965
Hospital Revenue Code	636
Min. Negotiated Rate	$15.63
Max. Negotiated Rate	$25.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$15.63

AZITHROMYCIN 500MG/NS 250ML

Facility

$104.19

Service Code	HCPCS J0456
Hospital Charge Code	60628965
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$52.09
Rate for Payer: Aetna Commercial	$39.59
Rate for Payer: Aetna Medicare Advantage	$31.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.57
Rate for Payer: Cigna Commercial	$52.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.21
Rate for Payer: Qualcare PPO/HMO/WC	$15.63
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

AZITHROMYCIN 600MG TABLET

Facility

$359.66

Service Code	NDC 69308030
Hospital Charge Code	60632286
Hospital Revenue Code	250
Min. Negotiated Rate	$53.95
Max. Negotiated Rate	$53.95
Rate for Payer: Qualcare PPO/HMO/WC	$53.95

AZITHROMYCIN 600MG TABLET

Facility

$359.66

Service Code	NDC 69308030
Hospital Charge Code	60632286
Hospital Revenue Code	250
Min. Negotiated Rate	$10.21
Max. Negotiated Rate	$179.83
Rate for Payer: Aetna Commercial	$136.67
Rate for Payer: Aetna Medicare Advantage	$107.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.71
Rate for Payer: Cigna Commercial	$179.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.51
Rate for Payer: Oxford Commercial	$71.93
Rate for Payer: Qualcare PPO/HMO/WC	$53.95
Rate for Payer: UnitedHealthcare Commercial	$71.93
Rate for Payer: UnitedHealthcare Community & State	$11.37
Rate for Payer: Wellpoint Medicaid Managed Care	$10.21

Know your out-of-pocket cost for care.

All Charges