Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TELETHX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77306
Hospital Charge Code	85000891
Hospital Revenue Code	333
Min. Negotiated Rate	$19.08
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,613.62
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.67
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.77
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$21.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$19.08

TELETHX ISODOSE PLAN SIMPLE

Facility

$671.79

Service Code	HCPCS 77306
Hospital Charge Code	85000891
Hospital Revenue Code	333
Min. Negotiated Rate	$100.77
Max. Negotiated Rate	$100.77
Rate for Payer: Qualcare PPO/HMO/WC	$100.77

TELETX ISODOSE PLAN SIMPLE-GL

Facility

$953.00

Service Code	HCPCS 77305
Hospital Charge Code	85000475
Hospital Revenue Code	333
Min. Negotiated Rate	$142.95
Max. Negotiated Rate	$142.95
Rate for Payer: Qualcare PPO/HMO/WC	$142.95

TELETX ISODOSE PLAN SIMPLE-GL

Facility

$953.00

Service Code	HCPCS 77305
Hospital Charge Code	85000475
Hospital Revenue Code	333
Min. Negotiated Rate	$27.07
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$362.14
Rate for Payer: Aetna Medicare Advantage	$285.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.01
Rate for Payer: Cigna Commercial	$476.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.78
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$142.95
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$30.11
Rate for Payer: Wellpoint Medicaid Managed Care	$27.07

TELFA 3X4 EA

Facility

$5.00

Hospital Charge Code	270350045
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

TELFA 3X4 EA

Facility

$5.00

Hospital Charge Code	270350045
Hospital Revenue Code	272
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

TEMAZEPAM 15 MG CAP

Facility

$4.76

Service Code	NDC 51079041821
Hospital Charge Code	60627851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.38
Rate for Payer: Aetna Commercial	$1.81
Rate for Payer: Aetna Medicare Advantage	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.21
Rate for Payer: Cigna Commercial	$2.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.24
Rate for Payer: Oxford Commercial	$0.95
Rate for Payer: Qualcare PPO/HMO/WC	$0.71
Rate for Payer: UnitedHealthcare Commercial	$0.95
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

TEMAZEPAM 15 MG CAP

Facility

$4.76

Service Code	NDC 51079041821
Hospital Charge Code	60627851
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.71

TEMAZEPAM/30MG/CAP

Facility

$5.56

Service Code	NDC 51079041920
Hospital Charge Code	60633978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Qualcare PPO/HMO/WC	$0.83

TEMAZEPAM/30MG/CAP

Facility

$5.56

Service Code	NDC 51079041920
Hospital Charge Code	60633978
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.78
Rate for Payer: Aetna Commercial	$2.11
Rate for Payer: Aetna Medicare Advantage	$1.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.42
Rate for Payer: Cigna Commercial	$2.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.45
Rate for Payer: Oxford Commercial	$1.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.83
Rate for Payer: UnitedHealthcare Commercial	$1.11
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TEMAZEPAM (RESTORIL)

Facility

$324.00

Service Code	HCPCS 80346
Hospital Charge Code	38472751
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$123.12
Rate for Payer: Aetna Medicare Advantage	$97.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

TEMAZEPAM (RESTORIL)

Facility

$324.00

Service Code	HCPCS 80346
Hospital Charge Code	38472751
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

TEMNO COAXIAL BIO NDLE22GX15CM

Facility

$241.13

Hospital Charge Code	270657364R
Hospital Revenue Code	272
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$120.56
Rate for Payer: Aetna Commercial	$91.63
Rate for Payer: Aetna Medicare Advantage	$72.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.49
Rate for Payer: Cigna Commercial	$120.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.69
Rate for Payer: Oxford Commercial	$48.23
Rate for Payer: Qualcare PPO/HMO/WC	$36.17
Rate for Payer: UnitedHealthcare Commercial	$48.23
Rate for Payer: UnitedHealthcare Community & State	$7.62
Rate for Payer: Wellpoint Medicaid Managed Care	$6.85

TEMNO COAXIAL BIO NDLE22GX15CM

Facility

$241.13

Hospital Charge Code	270657364R
Hospital Revenue Code	272
Min. Negotiated Rate	$36.17
Max. Negotiated Rate	$36.17
Rate for Payer: Qualcare PPO/HMO/WC	$36.17

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044
Hospital Revenue Code	272
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$23.22
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.07
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044R
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044R
Hospital Revenue Code	272
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$23.22
Rate for Payer: Aetna Commercial	$17.65
Rate for Payer: Aetna Medicare Advantage	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.84
Rate for Payer: Cigna Commercial	$23.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.07
Rate for Payer: Oxford Commercial	$9.29
Rate for Payer: Qualcare PPO/HMO/WC	$6.97
Rate for Payer: UnitedHealthcare Commercial	$9.29
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

TEMNO COXIAL BIO NDLE 22GX11CM

Facility

$46.44

Hospital Charge Code	270655044
Hospital Revenue Code	272
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$6.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.97

TEMPERATURE SKIN SENSOR

Facility

$66.00

Hospital Charge Code	270331375
Hospital Revenue Code	272
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.16
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.87

TEMPERATURE SKIN SENSOR

Facility

$66.00

Hospital Charge Code	270331375
Hospital Revenue Code	272
Min. Negotiated Rate	$9.90
Max. Negotiated Rate	$9.90
Rate for Payer: Qualcare PPO/HMO/WC	$9.90

TEMPLATE BENDNG 12HL 4.5DCP PL

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651503
Hospital Revenue Code	272
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$53.43
Rate for Payer: Aetna Medicare Advantage	$42.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.85
Rate for Payer: Cigna Commercial	$70.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.56
Rate for Payer: Oxford Commercial	$28.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.09
Rate for Payer: UnitedHealthcare Commercial	$28.12
Rate for Payer: UnitedHealthcare Community & State	$4.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

TEMPLATE BENDNG 12HL 4.5DCP PL

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651503
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$21.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.09

TEMPLATE BENDNG 9 HL 4.5 DCP

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651509
Hospital Revenue Code	272
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$21.09
Rate for Payer: Qualcare PPO/HMO/WC	$21.09

TEMPLATE BENDNG 9 HL 4.5 DCP

Facility

$140.60

Service Code	HCPCS C1713
Hospital Charge Code	270651509
Hospital Revenue Code	272
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$53.43
Rate for Payer: Aetna Medicare Advantage	$42.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.85
Rate for Payer: Cigna Commercial	$70.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.56
Rate for Payer: Oxford Commercial	$28.12
Rate for Payer: Qualcare PPO/HMO/WC	$21.09
Rate for Payer: UnitedHealthcare Commercial	$28.12
Rate for Payer: UnitedHealthcare Community & State	$4.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.99

TEMPLATE OCCIPITAL PLATE SMALL

Facility

$4,350.00

Service Code	HCPCS A4649
Hospital Charge Code	270697875
Hospital Revenue Code	272
Min. Negotiated Rate	$123.54
Max. Negotiated Rate	$2,175.00
Rate for Payer: Aetna Commercial	$1,653.00
Rate for Payer: Aetna Medicare Advantage	$1,305.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,109.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,109.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,109.25
Rate for Payer: Cigna Commercial	$2,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,131.00
Rate for Payer: Oxford Commercial	$870.00
Rate for Payer: Qualcare PPO/HMO/WC	$652.50
Rate for Payer: UnitedHealthcare Commercial	$870.00
Rate for Payer: UnitedHealthcare Community & State	$137.46
Rate for Payer: Wellpoint Medicaid Managed Care	$123.54

Know your out-of-pocket cost for care.

All Charges