Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BACITRACIN POLY POWD

Facility

$2,237.80

Service Code	NDC 38779001501
Hospital Charge Code	60628324
Hospital Revenue Code	250
Min. Negotiated Rate	$335.67
Max. Negotiated Rate	$335.67
Rate for Payer: Qualcare PPO/HMO/WC	$335.67

BACITRACIN POLY POWD

Facility

$2,237.80

Service Code	NDC 38779001501
Hospital Charge Code	60628324
Hospital Revenue Code	250
Min. Negotiated Rate	$63.55
Max. Negotiated Rate	$1,118.90
Rate for Payer: Aetna Commercial	$850.36
Rate for Payer: Aetna Medicare Advantage	$671.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$570.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$570.64
Rate for Payer: Cigna Commercial	$1,118.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$581.83
Rate for Payer: Oxford Commercial	$447.56
Rate for Payer: Qualcare PPO/HMO/WC	$335.67
Rate for Payer: UnitedHealthcare Commercial	$447.56
Rate for Payer: UnitedHealthcare Community & State	$70.71
Rate for Payer: Wellpoint Medicaid Managed Care	$63.55

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$82,658.07

Service Code	MSDRG 519
Min. Negotiated Rate	$25,168.32
Max. Negotiated Rate	$82,658.07
Rate for Payer: Aetna Commercial	$60,728.55
Rate for Payer: Aetna Medicare Advantage	$82,658.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54,578.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54,578.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,492.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54,578.85
Rate for Payer: Cigna Commercial	$44,590.46
Rate for Payer: Cigna Medicare Advantage	$26,492.97
Rate for Payer: Clover Medicare Advantage	$25,168.32
Rate for Payer: EmblemHealth Commercial	$79,478.91
Rate for Payer: Humana Medicare Advantage	$27,287.76
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,492.97
Rate for Payer: Oxford Commercial	$35,243.52
Rate for Payer: UnitedHealthcare Commercial	$47,174.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,492.97
Rate for Payer: Wellcare Medicare Advantage	$26,492.97

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$137,539.30

Service Code	MSDRG 518
Min. Negotiated Rate	$41,878.95
Max. Negotiated Rate	$137,539.30
Rate for Payer: Aetna Commercial	$99,815.59
Rate for Payer: Aetna Medicare Advantage	$137,539.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$101,123.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$101,123.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44,083.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$101,123.25
Rate for Payer: Cigna Commercial	$83,315.63
Rate for Payer: Cigna Medicare Advantage	$44,083.11
Rate for Payer: Clover Medicare Advantage	$41,878.95
Rate for Payer: EmblemHealth Commercial	$132,249.33
Rate for Payer: Humana Medicare Advantage	$45,405.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44,083.11
Rate for Payer: Oxford Commercial	$65,851.23
Rate for Payer: UnitedHealthcare Commercial	$88,144.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$44,083.11
Rate for Payer: Wellcare Medicare Advantage	$44,083.11

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$66,662.29

Service Code	MSDRG 520
Min. Negotiated Rate	$20,297.81
Max. Negotiated Rate	$66,662.29
Rate for Payer: Aetna Commercial	$49,336.18
Rate for Payer: Aetna Medicare Advantage	$66,662.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39,618.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39,618.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,366.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39,618.15
Rate for Payer: Cigna Commercial	$33,303.51
Rate for Payer: Cigna Medicare Advantage	$21,366.12
Rate for Payer: Clover Medicare Advantage	$20,297.81
Rate for Payer: EmblemHealth Commercial	$64,098.36
Rate for Payer: Humana Medicare Advantage	$22,007.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,366.12
Rate for Payer: Oxford Commercial	$26,322.52
Rate for Payer: UnitedHealthcare Commercial	$35,233.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,366.12
Rate for Payer: Wellcare Medicare Advantage	$21,366.12

BACLOFEN 10 MG TAB

Facility

$16.55

Service Code	NDC 172409660
Hospital Charge Code	60627477
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.28
Rate for Payer: Aetna Commercial	$6.29
Rate for Payer: Aetna Medicare Advantage	$4.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.22
Rate for Payer: Cigna Commercial	$8.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.30
Rate for Payer: Oxford Commercial	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.48
Rate for Payer: UnitedHealthcare Commercial	$3.31
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

BACLOFEN 10 MG TAB

Facility

$16.55

Service Code	NDC 172409660
Hospital Charge Code	60627477
Hospital Revenue Code	250
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$2.48

BACLOFEN 20 MG TAB

Facility

$8.71

Service Code	NDC 63739048010
Hospital Charge Code	60627478
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.36
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare Advantage	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.22
Rate for Payer: Cigna Commercial	$4.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.26
Rate for Payer: Oxford Commercial	$1.74
Rate for Payer: Qualcare PPO/HMO/WC	$1.31
Rate for Payer: UnitedHealthcare Commercial	$1.74
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

BACLOFEN 20 MG TAB

Facility

$8.71

Service Code	NDC 63739048010
Hospital Charge Code	60627478
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.31

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$46,365.62

Service Code	APR-DRG 0494
Min. Negotiated Rate	$45,456.49
Max. Negotiated Rate	$46,365.62
Rate for Payer: UnitedHealthcare Community & State	$45,456.49
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$46,365.62
Rate for Payer: Wellpoint Medicaid Managed Care	$45,456.49

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$25,417.90

Service Code	APR-DRG 0492
Min. Negotiated Rate	$24,919.51
Max. Negotiated Rate	$25,417.90
Rate for Payer: UnitedHealthcare Community & State	$24,919.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,417.90
Rate for Payer: Wellpoint Medicaid Managed Care	$24,919.51

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$28,194.34

Service Code	APR-DRG 0493
Min. Negotiated Rate	$27,641.51
Max. Negotiated Rate	$28,194.34
Rate for Payer: UnitedHealthcare Community & State	$27,641.51
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$28,194.34
Rate for Payer: Wellpoint Medicaid Managed Care	$27,641.51

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$11,933.02

Service Code	APR-DRG 0491
Min. Negotiated Rate	$11,699.04
Max. Negotiated Rate	$11,933.02
Rate for Payer: UnitedHealthcare Community & State	$11,699.04
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,933.02
Rate for Payer: Wellpoint Medicaid Managed Care	$11,699.04

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$100,950.78

Service Code	MSDRG 095
Min. Negotiated Rate	$30,738.22
Max. Negotiated Rate	$100,950.78
Rate for Payer: Aetna Medicare Advantage	$100,950.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65,937.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65,937.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$32,356.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65,937.90
Rate for Payer: Cigna Commercial	$57,498.11
Rate for Payer: Cigna Medicare Advantage	$32,356.02
Rate for Payer: Clover Medicare Advantage	$30,738.22
Rate for Payer: EmblemHealth Commercial	$97,068.06
Rate for Payer: Humana Medicare Advantage	$33,326.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$32,356.02
Rate for Payer: Oxford Commercial	$45,445.50
Rate for Payer: UnitedHealthcare Commercial	$60,830.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$32,356.02
Rate for Payer: Wellcare Medicare Advantage	$32,356.02

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$130,655.02

Service Code	MSDRG 094
Min. Negotiated Rate	$39,782.78
Max. Negotiated Rate	$130,655.02
Rate for Payer: Aetna Medicare Advantage	$130,655.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100,292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100,292.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41,876.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100,292.10
Rate for Payer: Cigna Commercial	$78,457.98
Rate for Payer: Cigna Medicare Advantage	$41,876.61
Rate for Payer: Clover Medicare Advantage	$39,782.78
Rate for Payer: EmblemHealth Commercial	$125,629.83
Rate for Payer: Humana Medicare Advantage	$43,132.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$41,876.61
Rate for Payer: Oxford Commercial	$62,011.83
Rate for Payer: UnitedHealthcare Commercial	$83,005.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$41,876.61
Rate for Payer: Wellcare Medicare Advantage	$41,876.61

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$100,950.78

Service Code	MSDRG 096
Min. Negotiated Rate	$30,738.22
Max. Negotiated Rate	$100,950.78
Rate for Payer: Aetna Medicare Advantage	$100,950.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60,396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60,396.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$32,356.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60,396.90
Rate for Payer: Cigna Commercial	$57,498.11
Rate for Payer: Cigna Medicare Advantage	$32,356.02
Rate for Payer: Clover Medicare Advantage	$30,738.22
Rate for Payer: EmblemHealth Commercial	$97,068.06
Rate for Payer: Humana Medicare Advantage	$33,326.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$32,356.02
Rate for Payer: Oxford Commercial	$45,445.50
Rate for Payer: UnitedHealthcare Commercial	$60,830.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$32,356.02
Rate for Payer: Wellcare Medicare Advantage	$32,356.02

BACTERIAL ANTIGEN I

Facility

$390.00

Service Code	HCPCS 87802
Hospital Charge Code	39990134A
Hospital Revenue Code	306
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$34.63
Rate for Payer: Aetna Medicare Advantage	$41.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.73
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	$46.18
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$12.73
Rate for Payer: Clover Medicare Advantage	$12.09
Rate for Payer: EmblemHealth Commercial	$38.19
Rate for Payer: Humana Medicare Advantage	$13.11
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.73
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	$10.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.73
Rate for Payer: Wellcare Medicare Advantage	$12.73
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BACTERIAL ANTIGEN I

Facility

$390.00

Service Code	HCPCS 87802
Hospital Charge Code	39990134A
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN II

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134B
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN II

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134B
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
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	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BACTERIAL ANTIGEN III

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134C
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGEN III

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134C
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
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	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BACTERIAL ANTIGEN IV

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134D
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$43.71
Rate for Payer: Aetna Medicare Advantage	$52.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.07
Rate for Payer: Clover Medicare Advantage	$15.27
Rate for Payer: EmblemHealth Commercial	$48.21
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.07
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	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.07
Rate for Payer: Wellcare Medicare Advantage	$16.07
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BACTERIAL ANTIGEN IV

Facility

$390.00

Service Code	HCPCS 87899
Hospital Charge Code	39990134D
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BACTERIAL ANTIGENS

Facility

$247.00

Service Code	HCPCS 87899
Hospital Charge Code	38475032
Hospital Revenue Code	306
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Qualcare PPO/HMO/WC	$37.05

Know your out-of-pocket cost for care.

All Charges