Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TESTOSTERONE TOTAL

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	397073303
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TESTOSTERONE TOTAL

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	397073303
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$83.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.63
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.81
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.81
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	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Medicare Advantage	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TESTOSTERONE,TOTAL

Facility

$177.45

Service Code	HCPCS 84403
Hospital Charge Code	39900137
Hospital Revenue Code	301
Min. Negotiated Rate	$26.62
Max. Negotiated Rate	$26.62
Rate for Payer: Qualcare PPO/HMO/WC	$26.62

TESTOSTERONE,TOTAL

Facility

$177.45

Service Code	HCPCS 84403
Hospital Charge Code	39900137
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$83.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.63
Rate for Payer: Cigna Commercial	$88.72
Rate for Payer: Cigna Medicare Advantage	$25.81
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.62
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Medicare Advantage	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.04

TESTOSTERON,FR/TOT,LCMSMS I

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	39990075A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TESTOSTERON,FR/TOT,LCMSMS I

Facility

$390.00

Service Code	HCPCS 84402
Hospital Charge Code	39990075A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$69.28
Rate for Payer: Aetna Medicare Advantage	$82.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.39
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.47
Rate for Payer: Clover Medicare Advantage	$24.20
Rate for Payer: EmblemHealth Commercial	$76.41
Rate for Payer: Humana Medicare Advantage	$26.23
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.47
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	$20.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.47
Rate for Payer: Wellcare Medicare Advantage	$25.47
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TESTOSTERON,FR/TOT,LCMSMS II

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	39990075B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TESTOSTERON,FR/TOT,LCMSMS II

Facility

$390.00

Service Code	HCPCS 84403
Hospital Charge Code	39990075B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$70.20
Rate for Payer: Aetna Medicare Advantage	$83.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.63
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$25.81
Rate for Payer: Clover Medicare Advantage	$24.52
Rate for Payer: EmblemHealth Commercial	$77.43
Rate for Payer: Humana Medicare Advantage	$26.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.81
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	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.81
Rate for Payer: Wellcare Medicare Advantage	$25.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TETANUS ANTIBODY

Facility

$196.00

Service Code	HCPCS 86774
Hospital Charge Code	38472910
Hospital Revenue Code	302
Min. Negotiated Rate	$29.40
Max. Negotiated Rate	$29.40
Rate for Payer: Qualcare PPO/HMO/WC	$29.40

TETANUS ANTIBODY

Facility

$196.00

Service Code	HCPCS 86774
Hospital Charge Code	38472910
Hospital Revenue Code	302
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$40.26
Rate for Payer: Aetna Medicare Advantage	$47.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.69
Rate for Payer: Cigna Commercial	$98.00
Rate for Payer: Cigna Medicare Advantage	$14.80
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$29.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Medicare Advantage	$14.80
Rate for Payer: Wellpoint Medicaid Managed Care	$5.57

TETANUS ANTITOXIN ANTIBODY,IgG

Facility

$411.00

Service Code	HCPCS 86329
Hospital Charge Code	38472904
Hospital Revenue Code	302
Min. Negotiated Rate	$61.65
Max. Negotiated Rate	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$61.65

TETANUS ANTITOXIN ANTIBODY,IgG

Facility

$411.00

Service Code	HCPCS 86329
Hospital Charge Code	38472904
Hospital Revenue Code	302
Min. Negotiated Rate	$11.24
Max. Negotiated Rate	$205.50
Rate for Payer: Aetna Commercial	$38.22
Rate for Payer: Aetna Medicare Advantage	$45.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$40.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.97
Rate for Payer: Cigna Commercial	$205.50
Rate for Payer: Cigna Medicare Advantage	$14.05
Rate for Payer: Clover Medicare Advantage	$13.35
Rate for Payer: EmblemHealth Commercial	$42.15
Rate for Payer: Humana Medicare Advantage	$14.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.05
Rate for Payer: Wellcare Medicare Advantage	$14.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.67

TETANUS ANTITOXOID AB

Facility

$390.00

Service Code	HCPCS 86774
Hospital Charge Code	39900254
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$40.26
Rate for Payer: Aetna Medicare Advantage	$47.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.69
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.80
Rate for Payer: Clover Medicare Advantage	$14.06
Rate for Payer: EmblemHealth Commercial	$44.40
Rate for Payer: Humana Medicare Advantage	$15.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.80
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	$11.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.80
Rate for Payer: Wellcare Medicare Advantage	$14.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TETANUS ANTITOXOID AB

Facility

$390.00

Service Code	HCPCS 86774
Hospital Charge Code	39900254
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TETANUS IMM GLOB VACC EX

Facility

$844.20

Service Code	NDC 13533063402
Hospital Charge Code	60628311EX
Hospital Revenue Code	259
Min. Negotiated Rate	$126.63
Max. Negotiated Rate	$126.63
Rate for Payer: Qualcare PPO/HMO/WC	$126.63

TETANUS IMM GLOB VACC EX

Facility

$844.20

Service Code	NDC 13533063402
Hospital Charge Code	60628311EX
Hospital Revenue Code	259
Min. Negotiated Rate	$23.98
Max. Negotiated Rate	$422.10
Rate for Payer: Aetna Commercial	$320.80
Rate for Payer: Aetna Medicare Advantage	$253.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.27
Rate for Payer: Cigna Commercial	$422.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.49
Rate for Payer: Oxford Commercial	$168.84
Rate for Payer: Qualcare PPO/HMO/WC	$126.63
Rate for Payer: UnitedHealthcare Commercial	$168.84
Rate for Payer: UnitedHealthcare Community & State	$26.68
Rate for Payer: Wellpoint Medicaid Managed Care	$23.98

TETRACAINE 1% 2ML

Facility

$610.57

Service Code	NDC 17478004532
Hospital Charge Code	6063943310
Hospital Revenue Code	250
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$305.29
Rate for Payer: Aetna Commercial	$232.02
Rate for Payer: Aetna Medicare Advantage	$183.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.70
Rate for Payer: Cigna Commercial	$305.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.75
Rate for Payer: Oxford Commercial	$122.11
Rate for Payer: Qualcare PPO/HMO/WC	$91.59
Rate for Payer: UnitedHealthcare Commercial	$122.11
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: Wellpoint Medicaid Managed Care	$17.34

TETRACAINE 1% 2ML

Facility

$610.57

Service Code	NDC 17478004532
Hospital Charge Code	6063943310
Hospital Revenue Code	250
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$91.59
Rate for Payer: Qualcare PPO/HMO/WC	$91.59

TETRACAINE OPH SOL .5% 1ML

Facility

$67.00

Service Code	NDC 65074112
Hospital Charge Code	6005235
Hospital Revenue Code	251
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$33.50
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare Advantage	$20.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.09
Rate for Payer: Cigna Commercial	$33.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.42
Rate for Payer: Oxford Commercial	$13.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.05
Rate for Payer: UnitedHealthcare Commercial	$13.40
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

TETRACAINE OPH SOL .5% 1ML

Facility

$67.00

Service Code	NDC 65074112
Hospital Charge Code	6005235
Hospital Revenue Code	251
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$10.05
Rate for Payer: Qualcare PPO/HMO/WC	$10.05

TETRACYCLINE 250 MG CAP

Facility

$4.00

Service Code	NDC 172241660
Hospital Charge Code	60627319
Hospital Revenue Code	251
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

TETRACYCLINE 250 MG CAP

Facility

$4.00

Service Code	NDC 172241660
Hospital Charge Code	60627319
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

TETRAHYDROZOLN OPH SOL 0.05%

Facility

$28.14

Service Code	NDC 74300000803
Hospital Charge Code	60628082
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna Commercial	$10.69
Rate for Payer: Aetna Medicare Advantage	$8.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.18
Rate for Payer: Cigna Commercial	$14.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.32
Rate for Payer: Oxford Commercial	$5.63
Rate for Payer: Qualcare PPO/HMO/WC	$4.22
Rate for Payer: UnitedHealthcare Commercial	$5.63
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

TETRAHYDROZOLN OPH SOL 0.05%

Facility

$28.14

Service Code	NDC 74300000803
Hospital Charge Code	60628082
Hospital Revenue Code	250
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Qualcare PPO/HMO/WC	$4.22

TFCC FAST FIX KIT

Facility

$2,965.00

Hospital Charge Code	270675400
Hospital Revenue Code	272
Min. Negotiated Rate	$84.21
Max. Negotiated Rate	$1,482.50
Rate for Payer: Aetna Commercial	$1,126.70
Rate for Payer: Aetna Medicare Advantage	$889.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$756.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$756.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$756.08
Rate for Payer: Cigna Commercial	$1,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$770.90
Rate for Payer: Oxford Commercial	$593.00
Rate for Payer: Qualcare PPO/HMO/WC	$444.75
Rate for Payer: UnitedHealthcare Commercial	$593.00
Rate for Payer: UnitedHealthcare Community & State	$93.69
Rate for Payer: Wellpoint Medicaid Managed Care	$84.21

Know your out-of-pocket cost for care.

All Charges