Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

RICKETTSIA AB PNL W/REFL IV

Facility

$390.00

Service Code	HCPCS 8675791
Hospital Charge Code	39990106D
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

RICKETTS(RMSF)IGG,M,W/RFL I

Facility

$390.00

Service Code	HCPCS 8675791
Hospital Charge Code	39990105A
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

RICKETTS(RMSF)IGG,M,W/RFL I

Facility

$390.00

Service Code	HCPCS 8675791
Hospital Charge Code	39990105A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RICKETTS(RMSF)IGG,M,W/RFL II

Facility

$390.00

Service Code	HCPCS 8675791
Hospital Charge Code	39990105B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

RICKETTS(RMSF)IGG,M,W/RFL II

Facility

$390.00

Service Code	HCPCS 8675791
Hospital Charge Code	39990105B
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

RIFABUTIN 150MG CAP

Facility

$150.48

Service Code	NDC 13530117
Hospital Charge Code	60635380
Hospital Revenue Code	250
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$75.24
Rate for Payer: Aetna Commercial	$57.18
Rate for Payer: Aetna Medicare Advantage	$45.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.37
Rate for Payer: Cigna Commercial	$75.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.12
Rate for Payer: Oxford Commercial	$30.10
Rate for Payer: Qualcare PPO/HMO/WC	$22.57
Rate for Payer: UnitedHealthcare Commercial	$30.10
Rate for Payer: UnitedHealthcare Community & State	$4.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.27

RIFABUTIN 150MG CAP

Facility

$150.48

Service Code	NDC 13530117
Hospital Charge Code	60635380
Hospital Revenue Code	250
Min. Negotiated Rate	$22.57
Max. Negotiated Rate	$22.57
Rate for Payer: Qualcare PPO/HMO/WC	$22.57

RIFAMPIN 15MG CAP

Facility

$13.33

Service Code	NDC 68084035721
Hospital Charge Code	6063943170
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$5.07
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.47
Rate for Payer: Oxford Commercial	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

RIFAMPIN 15MG CAP

Facility

$13.33

Service Code	NDC 68084035721
Hospital Charge Code	6063943170
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

RIFAMPIN 300 MG CAP

Facility

$20.37

Service Code	NDC 51079089020
Hospital Charge Code	6027114
Hospital Revenue Code	251
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.06

RIFAMPIN 300 MG CAP

Facility

$20.37

Service Code	NDC 51079089020
Hospital Charge Code	6027114
Hospital Revenue Code	251
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$10.19
Rate for Payer: Aetna Commercial	$7.74
Rate for Payer: Aetna Medicare Advantage	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.19
Rate for Payer: Cigna Commercial	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.30
Rate for Payer: Oxford Commercial	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.06
Rate for Payer: UnitedHealthcare Commercial	$4.07
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

RIFAXIMIM 550MG TAB

Facility

$206.63

Service Code	NDC 65649030303
Hospital Charge Code	60632220
Hospital Revenue Code	250
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$103.31
Rate for Payer: Aetna Commercial	$78.52
Rate for Payer: Aetna Medicare Advantage	$61.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.69
Rate for Payer: Cigna Commercial	$103.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.72
Rate for Payer: Oxford Commercial	$41.33
Rate for Payer: Qualcare PPO/HMO/WC	$30.99
Rate for Payer: UnitedHealthcare Commercial	$41.33
Rate for Payer: UnitedHealthcare Community & State	$6.53
Rate for Payer: Wellpoint Medicaid Managed Care	$5.87

RIFAXIMIM 550MG TAB

Facility

$206.63

Service Code	NDC 65649030303
Hospital Charge Code	60632220
Hospital Revenue Code	250
Min. Negotiated Rate	$30.99
Max. Negotiated Rate	$30.99
Rate for Payer: Qualcare PPO/HMO/WC	$30.99

RIFAZIMIN 200MG TAB

Facility

$118.19

Service Code	NDC 65649030103
Hospital Charge Code	60630014
Hospital Revenue Code	250
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$59.09
Rate for Payer: Aetna Commercial	$44.91
Rate for Payer: Aetna Medicare Advantage	$35.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.14
Rate for Payer: Cigna Commercial	$59.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.73
Rate for Payer: Oxford Commercial	$23.64
Rate for Payer: Qualcare PPO/HMO/WC	$17.73
Rate for Payer: UnitedHealthcare Commercial	$23.64
Rate for Payer: UnitedHealthcare Community & State	$3.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.36

RIFAZIMIN 200MG TAB

Facility

$118.19

Service Code	NDC 65649030103
Hospital Charge Code	60630014
Hospital Revenue Code	250
Min. Negotiated Rate	$17.73
Max. Negotiated Rate	$17.73
Rate for Payer: Qualcare PPO/HMO/WC	$17.73

RIGHT HEART CATH

Facility

$11,541.00

Service Code	HCPCS 93451
Hospital Charge Code	366893451
Hospital Revenue Code	481
Min. Negotiated Rate	$1,731.15
Max. Negotiated Rate	$1,731.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.15

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	5100045
Hospital Revenue Code	481
Min. Negotiated Rate	$459.80
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,209.40
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$511.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$459.80

RIGHT HEART CATH

Facility

$16,190.00

Service Code	HCPCS 93451
Hospital Charge Code	5100045
Hospital Revenue Code	481
Min. Negotiated Rate	$2,428.50
Max. Negotiated Rate	$2,428.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,428.50

RIGHT HEART CATH

Facility

$11,541.00

Service Code	HCPCS 93451
Hospital Charge Code	366893451
Hospital Revenue Code	481
Min. Negotiated Rate	$327.76
Max. Negotiated Rate	$13,971.32
Rate for Payer: Aetna Commercial	$10,476.08
Rate for Payer: Aetna Medicare Advantage	$12,478.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,971.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,851.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,213.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13,971.32
Rate for Payer: Cigna Commercial	$7,720.31
Rate for Payer: Cigna Medicare Advantage	$3,851.50
Rate for Payer: Clover Medicare Advantage	$3,658.93
Rate for Payer: EmblemHealth Commercial	$11,554.50
Rate for Payer: Humana Medicare Advantage	$3,967.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,851.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,000.66
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,731.15
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$364.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,851.50
Rate for Payer: Wellcare Medicare Advantage	$3,851.50
Rate for Payer: Wellpoint Medicaid Managed Care	$327.76

RIGIDLOOP ADJ DISP SYSTEM

Facility

$2,625.00

Hospital Charge Code	270673365
Hospital Revenue Code	272
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

RIGIDLOOP ADJ DISP SYSTEM

Facility

$2,625.00

Hospital Charge Code	270673365
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

RIGIDLOOP CORTRICAL FIXATION I

Facility

$1,000.00

Hospital Charge Code	270668384
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

RIGIDLOOP CORTRICAL FIXATION I

Facility

$1,000.00

Hospital Charge Code	270668384
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

RIGIDLOOP KIT

Facility

$2,600.00

Hospital Charge Code	270666241
Hospital Revenue Code	272
Min. Negotiated Rate	$73.84
Max. Negotiated Rate	$1,300.00
Rate for Payer: Aetna Commercial	$988.00
Rate for Payer: Aetna Medicare Advantage	$780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$663.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$663.00
Rate for Payer: Cigna Commercial	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$676.00
Rate for Payer: Oxford Commercial	$520.00
Rate for Payer: Qualcare PPO/HMO/WC	$390.00
Rate for Payer: UnitedHealthcare Commercial	$520.00
Rate for Payer: UnitedHealthcare Community & State	$82.16
Rate for Payer: Wellpoint Medicaid Managed Care	$73.84

RIGIDLOOP KIT

Facility

$2,600.00

Hospital Charge Code	270666241
Hospital Revenue Code	272
Min. Negotiated Rate	$390.00
Max. Negotiated Rate	$390.00
Rate for Payer: Qualcare PPO/HMO/WC	$390.00

Know your out-of-pocket cost for care.

All Charges