Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BABESIA MICROTI (IGG,IGM) I

Facility

$390.00

Service Code	HCPCS 8675391
Hospital Charge Code	39990104A
Hospital Revenue Code	302
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BABESIA MICROTI (IGG,IGM) II

Facility

$390.00

Service Code	HCPCS 8675391
Hospital Charge Code	39990104B
Hospital Revenue Code	302
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BABESIA MICROTI (IGG,IGM) II

Facility

$390.00

Service Code	HCPCS 8675391
Hospital Charge Code	39990104B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BABESIAQ

Facility

$241.20

Service Code	HCPCS 87798
Hospital Charge Code	39900400
Hospital Revenue Code	306
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$120.60
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.18
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

BABESIAQ

Facility

$241.20

Service Code	HCPCS 87798
Hospital Charge Code	39900400
Hospital Revenue Code	306
Min. Negotiated Rate	$36.18
Max. Negotiated Rate	$36.18
Rate for Payer: Qualcare PPO/HMO/WC	$36.18

BABESIOSIS AB (IGG,M) I

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048A
Hospital Revenue Code	302
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$12.77
Rate for Payer: Qualcare PPO/HMO/WC	$12.77

BABESIOSIS AB (IGG,M) I

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048A
Hospital Revenue Code	302
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.36
Rate for Payer: Aetna Medicare Advantage	$25.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.71
Rate for Payer: Cigna Commercial	$42.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.77
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

BABESIOSIS AB (IGG,M) II

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048B
Hospital Revenue Code	302
Min. Negotiated Rate	$12.77
Max. Negotiated Rate	$12.77
Rate for Payer: Qualcare PPO/HMO/WC	$12.77

BABESIOSIS AB (IGG,M) II

Facility

$85.15

Service Code	HCPCS 8675391
Hospital Charge Code	39990048B
Hospital Revenue Code	302
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.36
Rate for Payer: Aetna Medicare Advantage	$25.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.71
Rate for Payer: Cigna Commercial	$42.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.77
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.69
Rate for Payer: Wellpoint Medicaid Managed Care	$2.42

BABY PIN BALLS REFILL RACK DB

Facility

$28.33

Hospital Charge Code	270667645
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.25

BABY PIN BALLS REFILL RACK DB

Facility

$28.33

Hospital Charge Code	270667645
Hospital Revenue Code	272
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.16
Rate for Payer: Aetna Commercial	$10.77
Rate for Payer: Aetna Medicare Advantage	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.22
Rate for Payer: Cigna Commercial	$14.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.37
Rate for Payer: Oxford Commercial	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$4.25
Rate for Payer: UnitedHealthcare Commercial	$5.67
Rate for Payer: UnitedHealthcare Community & State	$0.90
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

BACG LOW LEVEL

Facility

$886.20

Service Code	HCPCS 84702
Hospital Charge Code	38479483
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$443.10
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$443.10
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.41
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.93
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$25.17

BACG LOW LEVEL

Facility

$886.20

Service Code	HCPCS 84702
Hospital Charge Code	38479483
Hospital Revenue Code	301
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$132.93
Rate for Payer: Qualcare PPO/HMO/WC	$132.93

BACITRACIN 50000 UNITS INJ

Facility

$89.18

Service Code	NDC 9023301
Hospital Charge Code	60627320
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$44.59
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare Advantage	$26.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.74
Rate for Payer: Cigna Commercial	$44.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.19
Rate for Payer: Oxford Commercial	$17.84
Rate for Payer: Qualcare PPO/HMO/WC	$13.38
Rate for Payer: UnitedHealthcare Commercial	$17.84
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

BACITRACIN 50000 UNITS INJ

Facility

$89.18

Service Code	NDC 9023301
Hospital Charge Code	60627320
Hospital Revenue Code	250
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$13.38
Rate for Payer: Qualcare PPO/HMO/WC	$13.38

BACITRACIN OINTMENT 15 GM

Facility

$4.00

Service Code	NDC 45802006001
Hospital Charge Code	60635665
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

BACITRACIN OINTMENT 15 GM

Facility

$4.00

Service Code	NDC 45802006001
Hospital Charge Code	60635665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACITRACIN OINT PKT

Facility

$4.00

Service Code	NDC 168011109
Hospital Charge Code	60628321
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

BACITRACIN OINT PKT

Facility

$5.00

Hospital Charge Code	60628321W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BACITRACIN OINT PKT

Facility

$4.00

Service Code	NDC 168011109
Hospital Charge Code	60628321
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

BACITRACIN OINT PKT

Facility

$5.00

Hospital Charge Code	60628321W
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

BACITRACIN OPHTH OINT 3.5GM

Facility

$248.24

Service Code	NDC 574402235
Hospital Charge Code	60628009
Hospital Revenue Code	250
Min. Negotiated Rate	$37.24
Max. Negotiated Rate	$37.24
Rate for Payer: Qualcare PPO/HMO/WC	$37.24

BACITRACIN OPHTH OINT 3.5GM

Facility

$248.24

Service Code	NDC 574402235
Hospital Charge Code	60628009
Hospital Revenue Code	250
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$124.12
Rate for Payer: Aetna Commercial	$94.33
Rate for Payer: Aetna Medicare Advantage	$74.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.30
Rate for Payer: Cigna Commercial	$124.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.54
Rate for Payer: Oxford Commercial	$49.65
Rate for Payer: Qualcare PPO/HMO/WC	$37.24
Rate for Payer: UnitedHealthcare Commercial	$49.65
Rate for Payer: UnitedHealthcare Community & State	$7.84
Rate for Payer: Wellpoint Medicaid Managed Care	$7.05

BACITRACIN/POLYMXIN B OPHTAL

Facility

$172.19

Service Code	NDC 17478023835
Hospital Charge Code	6063943284
Hospital Revenue Code	250
Min. Negotiated Rate	$25.83
Max. Negotiated Rate	$25.83
Rate for Payer: Qualcare PPO/HMO/WC	$25.83

BACITRACIN/POLYMXIN B OPHTAL

Facility

$172.19

Service Code	NDC 17478023835
Hospital Charge Code	6063943284
Hospital Revenue Code	250
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$86.09
Rate for Payer: Aetna Commercial	$65.43
Rate for Payer: Aetna Medicare Advantage	$51.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.91
Rate for Payer: Cigna Commercial	$86.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Oxford Commercial	$34.44
Rate for Payer: Qualcare PPO/HMO/WC	$25.83
Rate for Payer: UnitedHealthcare Commercial	$34.44
Rate for Payer: UnitedHealthcare Community & State	$5.44
Rate for Payer: Wellpoint Medicaid Managed Care	$4.89

Know your out-of-pocket cost for care.

All Charges