Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RESUSCITATOR ADULT MANUAL

Facility

$193.00

Hospital Charge Code	270331414
Hospital Revenue Code	272
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$28.95
Rate for Payer: Qualcare PPO/HMO/WC	$28.95

RETACRIT ALFAEPBX 20000U/2MLVL

Facility

$1,239.50

Service Code	NDC 69131810
Hospital Charge Code	606390491
Hospital Revenue Code	635
Min. Negotiated Rate	$185.93
Max. Negotiated Rate	$185.93
Rate for Payer: Qualcare PPO/HMO/WC	$185.93

RETACRIT ALFAEPBX 20000U/2MLVL

Facility

$1,239.50

Service Code	NDC 69131810
Hospital Charge Code	606390491
Hospital Revenue Code	635
Min. Negotiated Rate	$35.20
Max. Negotiated Rate	$619.75
Rate for Payer: Aetna Commercial	$471.01
Rate for Payer: Aetna Medicare Advantage	$371.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$316.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$316.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$316.07
Rate for Payer: Cigna Commercial	$619.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.27
Rate for Payer: Oxford Commercial	$247.90
Rate for Payer: Qualcare PPO/HMO/WC	$185.93
Rate for Payer: UnitedHealthcare Commercial	$247.90
Rate for Payer: UnitedHealthcare Community & State	$39.17
Rate for Payer: Wellpoint Medicaid Managed Care	$35.20

RETACRIT ALFA-EPBX 2000IU/ML

Facility

$176.95

Service Code	NDC 69130510
Hospital Charge Code	606390489
Hospital Revenue Code	634
Min. Negotiated Rate	$26.54
Max. Negotiated Rate	$26.54
Rate for Payer: Qualcare PPO/HMO/WC	$26.54

RETACRIT ALFA-EPBX 2000IU/ML

Facility

$176.95

Service Code	NDC 69130510
Hospital Charge Code	606390489
Hospital Revenue Code	634
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$88.47
Rate for Payer: Aetna Commercial	$67.24
Rate for Payer: Aetna Medicare Advantage	$53.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.12
Rate for Payer: Cigna Commercial	$88.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.01
Rate for Payer: Oxford Commercial	$35.39
Rate for Payer: Qualcare PPO/HMO/WC	$26.54
Rate for Payer: UnitedHealthcare Commercial	$35.39
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.03

RETACRIT ALFA-EPBX 3000IU/ML

Facility

$265.99

Service Code	NDC 69130610
Hospital Charge Code	606390490
Hospital Revenue Code	634
Min. Negotiated Rate	$7.55
Max. Negotiated Rate	$133.00
Rate for Payer: Aetna Commercial	$101.08
Rate for Payer: Aetna Medicare Advantage	$79.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.83
Rate for Payer: Cigna Commercial	$133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.16
Rate for Payer: Oxford Commercial	$53.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.90
Rate for Payer: UnitedHealthcare Commercial	$53.20
Rate for Payer: UnitedHealthcare Community & State	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.55

RETACRIT ALFA-EPBX 3000IU/ML

Facility

$265.99

Service Code	NDC 69130610
Hospital Charge Code	606390490
Hospital Revenue Code	634
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$39.90

RETACRIT SAL SOL 10,000U/ML

Facility

$884.40

Service Code	NDC 69130810
Hospital Charge Code	606390459
Hospital Revenue Code	635
Min. Negotiated Rate	$25.12
Max. Negotiated Rate	$442.20
Rate for Payer: Aetna Commercial	$336.07
Rate for Payer: Aetna Medicare Advantage	$265.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$225.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$225.52
Rate for Payer: Cigna Commercial	$442.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.94
Rate for Payer: Oxford Commercial	$176.88
Rate for Payer: Qualcare PPO/HMO/WC	$132.66
Rate for Payer: UnitedHealthcare Commercial	$176.88
Rate for Payer: UnitedHealthcare Community & State	$27.95
Rate for Payer: Wellpoint Medicaid Managed Care	$25.12

RETACRIT SAL SOL 10,000U/ML

Facility

$884.40

Service Code	NDC 69130810
Hospital Charge Code	606390459
Hospital Revenue Code	635
Min. Negotiated Rate	$132.66
Max. Negotiated Rate	$132.66
Rate for Payer: Qualcare PPO/HMO/WC	$132.66

RETACRIT SAL SOL 4000U/ML

Facility

$348.40

Service Code	NDC 69130710
Hospital Charge Code	606390458
Hospital Revenue Code	634
Min. Negotiated Rate	$52.26
Max. Negotiated Rate	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$52.26

RETACRIT SAL SOL 4000U/ML

Facility

$348.40

Service Code	NDC 69130710
Hospital Charge Code	606390458
Hospital Revenue Code	634
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$174.20
Rate for Payer: Aetna Commercial	$132.39
Rate for Payer: Aetna Medicare Advantage	$104.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.84
Rate for Payer: Cigna Commercial	$174.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.58
Rate for Payer: Oxford Commercial	$69.68
Rate for Payer: Qualcare PPO/HMO/WC	$52.26
Rate for Payer: UnitedHealthcare Commercial	$69.68
Rate for Payer: UnitedHealthcare Community & State	$11.01
Rate for Payer: Wellpoint Medicaid Managed Care	$9.89

RETAINER NUT

Facility

$276.00

Hospital Charge Code	270692632
Hospital Revenue Code	272
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$41.40

RETAINER NUT

Facility

$276.00

Hospital Charge Code	270692632
Hospital Revenue Code	272
Min. Negotiated Rate	$7.84
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Commercial	$104.88
Rate for Payer: Aetna Medicare Advantage	$82.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.38
Rate for Payer: Cigna Commercial	$138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.76
Rate for Payer: Oxford Commercial	$55.20
Rate for Payer: Qualcare PPO/HMO/WC	$41.40
Rate for Payer: UnitedHealthcare Commercial	$55.20
Rate for Payer: UnitedHealthcare Community & State	$8.72
Rate for Payer: Wellpoint Medicaid Managed Care	$7.84

RETAINER VISCERA

Facility

$131.50

Hospital Charge Code	270600379
Hospital Revenue Code	272
Min. Negotiated Rate	$3.73
Max. Negotiated Rate	$65.75
Rate for Payer: Aetna Commercial	$49.97
Rate for Payer: Aetna Medicare Advantage	$39.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.53
Rate for Payer: Cigna Commercial	$65.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.19
Rate for Payer: Oxford Commercial	$26.30
Rate for Payer: Qualcare PPO/HMO/WC	$19.73
Rate for Payer: UnitedHealthcare Commercial	$26.30
Rate for Payer: UnitedHealthcare Community & State	$4.16
Rate for Payer: Wellpoint Medicaid Managed Care	$3.73

RETAINER VISCERA

Facility

$131.50

Hospital Charge Code	270600379
Hospital Revenue Code	272
Min. Negotiated Rate	$19.73
Max. Negotiated Rate	$19.73
Rate for Payer: Qualcare PPO/HMO/WC	$19.73

RETAINING FEMORAL CRUCIATE

Facility

$8,512.20

Service Code	HCPCS C1713
Hospital Charge Code	270704016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.83
Max. Negotiated Rate	$2,059.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,702.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,059.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,276.83

RETAINING FEMORAL CRUCIATE

Facility

$8,512.20

Service Code	HCPCS C1713
Hospital Charge Code	270704016
Hospital Revenue Code	278
Min. Negotiated Rate	$241.75
Max. Negotiated Rate	$4,256.10
Rate for Payer: Aetna Commercial	$3,234.64
Rate for Payer: Aetna Medicare Advantage	$2,553.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,170.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,170.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,702.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,170.61
Rate for Payer: Cigna Commercial	$4,256.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,059.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,276.83
Rate for Payer: UnitedHealthcare Community & State	$268.99
Rate for Payer: Wellpoint Medicaid Managed Care	$241.75

RETENTIVE POLY LINER +6

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688884
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETENTIVE POLY LINER +6

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688884
Hospital Revenue Code	278
Min. Negotiated Rate	$180.63
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$200.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.63

RETENTIVE POLY LINER +9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688780
Hospital Revenue Code	278
Min. Negotiated Rate	$954.04
Max. Negotiated Rate	$1,539.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04

RETENTIVE POLY LINER +9

Facility

$6,360.25

Service Code	HCPCS C1776
Hospital Charge Code	270688780
Hospital Revenue Code	278
Min. Negotiated Rate	$180.63
Max. Negotiated Rate	$3,180.12
Rate for Payer: Aetna Commercial	$2,416.89
Rate for Payer: Aetna Medicare Advantage	$1,908.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,621.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,621.86
Rate for Payer: Cigna Commercial	$3,180.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,539.18
Rate for Payer: Qualcare PPO/HMO/WC	$954.04
Rate for Payer: UnitedHealthcare Community & State	$200.98
Rate for Payer: Wellpoint Medicaid Managed Care	$180.63

RETICOLOCYTE COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38473012
Hospital Revenue Code	301
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

RETICOLOCYTE COUNT

Facility

$57.00

Service Code	HCPCS 85044
Hospital Charge Code	38473012
Hospital Revenue Code	301
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$11.72
Rate for Payer: Aetna Medicare Advantage	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.63
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: Cigna Medicare Advantage	$4.31
Rate for Payer: Clover Medicare Advantage	$4.09
Rate for Payer: EmblemHealth Commercial	$12.93
Rate for Payer: Humana Medicare Advantage	$4.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.31
Rate for Payer: Wellcare Medicare Advantage	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

RETICULINE IGG SCREEN W REFLEX

Facility

$60.25

Service Code	HCPCS 86255
Hospital Charge Code	401186255
Hospital Revenue Code	306
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.04

RETICULINE IGG SCREEN W REFLEX

Facility

$60.25

Service Code	HCPCS 86255
Hospital Charge Code	401186255
Hospital Revenue Code	306
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$30.12
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.04
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$1.71

Know your out-of-pocket cost for care.

All Charges