Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PYRIDOSTIGMINE 180 MG ER TAB

Facility

$152.36

Service Code	NDC 187301330
Hospital Charge Code	60629837
Hospital Revenue Code	250
Min. Negotiated Rate	$22.85
Max. Negotiated Rate	$22.85
Rate for Payer: Qualcare PPO/HMO/WC	$22.85

PYRIDOSTIGMINE 180 MG ER TAB

Facility

$152.36

Service Code	NDC 187301330
Hospital Charge Code	60629837
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$76.18
Rate for Payer: Aetna Commercial	$57.90
Rate for Payer: Aetna Medicare Advantage	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.85
Rate for Payer: Cigna Commercial	$76.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.61
Rate for Payer: Oxford Commercial	$30.47
Rate for Payer: Qualcare PPO/HMO/WC	$22.85
Rate for Payer: UnitedHealthcare Commercial	$30.47
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.33

PYRIDOSTIGMINE 60 MG TAB

Facility

$80.33

Service Code	NDC 187301030
Hospital Charge Code	60627416
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$12.05
Rate for Payer: Qualcare PPO/HMO/WC	$12.05

PYRIDOSTIGMINE 60 MG TAB

Facility

$80.33

Service Code	NDC 187301030
Hospital Charge Code	60627416
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$40.16
Rate for Payer: Aetna Commercial	$30.53
Rate for Payer: Aetna Medicare Advantage	$24.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.48
Rate for Payer: Cigna Commercial	$40.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.89
Rate for Payer: Oxford Commercial	$16.07
Rate for Payer: Qualcare PPO/HMO/WC	$12.05
Rate for Payer: UnitedHealthcare Commercial	$16.07
Rate for Payer: UnitedHealthcare Community & State	$2.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

PYRIDOXINE/100MG/1ML/VIAL

Facility

$75.31

Service Code	HCPCS J3415
Hospital Charge Code	60634979
Hospital Revenue Code	636
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.30

PYRIDOXINE/100MG/1ML/VIAL

Facility

$75.31

Service Code	HCPCS J3415
Hospital Charge Code	60634979
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$37.66
Rate for Payer: Aetna Commercial	$28.62
Rate for Payer: Aetna Medicare Advantage	$22.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.20
Rate for Payer: Cigna Commercial	$37.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.23
Rate for Payer: Qualcare PPO/HMO/WC	$11.30
Rate for Payer: UnitedHealthcare Community & State	$2.38
Rate for Payer: Wellpoint Medicaid Managed Care	$2.14

PYRIDOXINE/100MG/TAB

Facility

$4.00

Service Code	NDC 904051860
Hospital Charge Code	60633793
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

PYRIDOXINE/100MG/TAB

Facility

$4.00

Service Code	NDC 904051860
Hospital Charge Code	60633793
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDOXINE 25MG TABLET

Facility

$4.00

Service Code	NDC 61748009201
Hospital Charge Code	60632254
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

PYRIDOXINE 25MG TABLET

Facility

$4.00

Service Code	NDC 61748009201
Hospital Charge Code	60632254
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYRIDOXINE 50 MG TAB

Facility

$4.00

Service Code	NDC 904052060
Hospital Charge Code	60628486
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

PYRIDOXINE 50 MG TAB

Facility

$4.00

Service Code	NDC 904052060
Hospital Charge Code	60628486
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

PYROVATE

Facility

$303.00

Service Code	HCPCS 84210
Hospital Charge Code	38472930
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$39.39
Rate for Payer: Aetna Medicare Advantage	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.53
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: Cigna Medicare Advantage	$14.48
Rate for Payer: Clover Medicare Advantage	$13.76
Rate for Payer: EmblemHealth Commercial	$43.44
Rate for Payer: Humana Medicare Advantage	$14.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.48
Rate for Payer: Wellcare Medicare Advantage	$14.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

PYROVATE

Facility

$303.00

Service Code	HCPCS 84210
Hospital Charge Code	38472930
Hospital Revenue Code	301
Min. Negotiated Rate	$45.45
Max. Negotiated Rate	$45.45
Rate for Payer: Qualcare PPO/HMO/WC	$45.45

PYRUVATE,BLOOD

Facility

$74.60

Service Code	HCPCS 84210
Hospital Charge Code	39900127
Hospital Revenue Code	301
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$39.39
Rate for Payer: Aetna Medicare Advantage	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.53
Rate for Payer: Cigna Commercial	$37.30
Rate for Payer: Cigna Medicare Advantage	$14.48
Rate for Payer: Clover Medicare Advantage	$13.76
Rate for Payer: EmblemHealth Commercial	$43.44
Rate for Payer: Humana Medicare Advantage	$14.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.19
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.48
Rate for Payer: Wellcare Medicare Advantage	$14.48
Rate for Payer: Wellpoint Medicaid Managed Care	$2.12

PYRUVATE,BLOOD

Facility

$74.60

Service Code	HCPCS 84210
Hospital Charge Code	39900127
Hospital Revenue Code	301
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$11.19
Rate for Payer: Qualcare PPO/HMO/WC	$11.19

PYRUVATE, CSF

Facility

$360.00

Service Code	HCPCS 84210
Hospital Charge Code	38472929
Hospital Revenue Code	301
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

PYRUVATE, CSF

Facility

$360.00

Service Code	HCPCS 84210
Hospital Charge Code	38472929
Hospital Revenue Code	301
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$39.39
Rate for Payer: Aetna Medicare Advantage	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.53
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: Cigna Medicare Advantage	$14.48
Rate for Payer: Clover Medicare Advantage	$13.76
Rate for Payer: EmblemHealth Commercial	$43.44
Rate for Payer: Humana Medicare Advantage	$14.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.48
Rate for Payer: Wellcare Medicare Advantage	$14.48
Rate for Payer: Wellpoint Medicaid Managed Care	$10.22

QC DRILL BIT 2.5MM DIA X 110MM

Facility

$269.60

Hospital Charge Code	270663182
Hospital Revenue Code	272
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$134.80
Rate for Payer: Aetna Commercial	$102.45
Rate for Payer: Aetna Medicare Advantage	$80.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.75
Rate for Payer: Cigna Commercial	$134.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.10
Rate for Payer: Oxford Commercial	$53.92
Rate for Payer: Qualcare PPO/HMO/WC	$40.44
Rate for Payer: UnitedHealthcare Commercial	$53.92
Rate for Payer: UnitedHealthcare Community & State	$8.52
Rate for Payer: Wellpoint Medicaid Managed Care	$7.66

QC DRILL BIT 2.5MM DIA X 110MM

Facility

$269.60

Hospital Charge Code	270663182
Hospital Revenue Code	272
Min. Negotiated Rate	$40.44
Max. Negotiated Rate	$40.44
Rate for Payer: Qualcare PPO/HMO/WC	$40.44

QCKFIX SCREW4.0X46

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	270686388
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$199.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

QCKFIX SCREW4.0X46

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	270686388
Hospital Revenue Code	278
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Community & State	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$23.43

QCKFIX SCREW 4.0X54

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	270686389
Hospital Revenue Code	278
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Community & State	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$23.43

QCKFIX SCREW 4.0X54

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	270686389
Hospital Revenue Code	278
Min. Negotiated Rate	$123.75
Max. Negotiated Rate	$199.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.75

QCKFIX SCREW TI CANN ST 4.0x22

Facility

$825.00

Service Code	HCPCS C1713
Hospital Charge Code	270688390
Hospital Revenue Code	278
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$412.50
Rate for Payer: Aetna Commercial	$313.50
Rate for Payer: Aetna Medicare Advantage	$247.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$210.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$210.38
Rate for Payer: Cigna Commercial	$412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$199.65
Rate for Payer: Qualcare PPO/HMO/WC	$123.75
Rate for Payer: UnitedHealthcare Community & State	$26.07
Rate for Payer: Wellpoint Medicaid Managed Care	$23.43

Know your out-of-pocket cost for care.

All Charges