Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

T-HANDLE DRIVER

Facility

$7,220.00

Hospital Charge Code	270690628
Hospital Revenue Code	272
Min. Negotiated Rate	$1,083.00
Max. Negotiated Rate	$1,083.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,083.00

T HANDLE SCREW DRIVER 6MM

Facility

$2,990.00

Hospital Charge Code	270686004
Hospital Revenue Code	272
Min. Negotiated Rate	$84.92
Max. Negotiated Rate	$1,495.00
Rate for Payer: Aetna Commercial	$1,136.20
Rate for Payer: Aetna Medicare Advantage	$897.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$762.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$762.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$762.45
Rate for Payer: Cigna Commercial	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$777.40
Rate for Payer: Oxford Commercial	$598.00
Rate for Payer: Qualcare PPO/HMO/WC	$448.50
Rate for Payer: UnitedHealthcare Commercial	$598.00
Rate for Payer: UnitedHealthcare Community & State	$94.48
Rate for Payer: Wellpoint Medicaid Managed Care	$84.92

T HANDLE SCREW DRIVER 6MM

Facility

$2,990.00

Hospital Charge Code	270686004
Hospital Revenue Code	272
Min. Negotiated Rate	$448.50
Max. Negotiated Rate	$448.50
Rate for Payer: Qualcare PPO/HMO/WC	$448.50

The Captivator COLD Single-use

Facility

$75.00

Hospital Charge Code	270688073
Hospital Revenue Code	272
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$28.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$15.00
Rate for Payer: UnitedHealthcare Community & State	$2.37
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

The Captivator COLD Single-use

Facility

$75.00

Hospital Charge Code	270688073
Hospital Revenue Code	272
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

The Klassic Knee System -Femur

Facility

$7,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685965
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

The Klassic Knee System -Femur

Facility

$7,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270685965
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

T-HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38479113
Hospital Revenue Code	311
Min. Negotiated Rate	$8.49
Max. Negotiated Rate	$224.58
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.58
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$136.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$8.49

T-HELPER/SUPPRESSOR

Facility

$299.00

Service Code	HCPCS 88182
Hospital Charge Code	38479113
Hospital Revenue Code	311
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.85

THEMAL TIP W/DRAPE

Facility

$52.00

Hospital Charge Code	270335721
Hospital Revenue Code	272
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$26.00
Rate for Payer: Aetna Commercial	$19.76
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.26
Rate for Payer: Cigna Commercial	$26.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.52
Rate for Payer: Oxford Commercial	$10.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.80
Rate for Payer: UnitedHealthcare Commercial	$10.40
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

THEMAL TIP W/DRAPE

Facility

$52.00

Hospital Charge Code	270335721
Hospital Revenue Code	272
Min. Negotiated Rate	$7.80
Max. Negotiated Rate	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.80

THEOPHYLLINE 100MG 24-HR CAPS

Facility

$13.27

Service Code	NDC 50474010001
Hospital Charge Code	606390077
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$1.99
Rate for Payer: Qualcare PPO/HMO/WC	$1.99

THEOPHYLLINE 100MG 24-HR CAPS

Facility

$13.27

Service Code	NDC 50474010001
Hospital Charge Code	606390077
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.63
Rate for Payer: Aetna Commercial	$5.04
Rate for Payer: Aetna Medicare Advantage	$3.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.38
Rate for Payer: Cigna Commercial	$6.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.45
Rate for Payer: Oxford Commercial	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.99
Rate for Payer: UnitedHealthcare Commercial	$2.65
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

THEOPHYLLINE 200 MG ER TAB

Facility

$4.69

Service Code	NDC 904588861
Hospital Charge Code	6022867
Hospital Revenue Code	251
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

THEOPHYLLINE 200 MG ER TAB

Facility

$4.69

Service Code	NDC 904588861
Hospital Charge Code	6022867
Hospital Revenue Code	251
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.22
Rate for Payer: Oxford Commercial	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.94
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

THEOPHYLLINE 300 MG ER CAP

Facility

$28.81

Service Code	NDC 62332002531
Hospital Charge Code	60628473
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna Medicare Advantage	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.35
Rate for Payer: Cigna Commercial	$14.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Oxford Commercial	$5.76
Rate for Payer: Qualcare PPO/HMO/WC	$4.32
Rate for Payer: UnitedHealthcare Commercial	$5.76
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

THEOPHYLLINE 300 MG ER CAP

Facility

$28.81

Service Code	NDC 62332002531
Hospital Charge Code	60628473
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$4.32
Rate for Payer: Qualcare PPO/HMO/WC	$4.32

THEOPHYLLINE 80 MG/15 ML LIQ

Facility

$83.75

Service Code	NDC 70408064434
Hospital Charge Code	60628476
Hospital Revenue Code	250
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$12.56
Rate for Payer: Qualcare PPO/HMO/WC	$12.56

THEOPHYLLINE 80 MG/15 ML LIQ

Facility

$83.75

Service Code	NDC 70408064434
Hospital Charge Code	60628476
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$41.88
Rate for Payer: Aetna Commercial	$31.82
Rate for Payer: Aetna Medicare Advantage	$25.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.36
Rate for Payer: Cigna Commercial	$41.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.77
Rate for Payer: Oxford Commercial	$16.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.56
Rate for Payer: UnitedHealthcare Commercial	$16.75
Rate for Payer: UnitedHealthcare Community & State	$2.65
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

THEOPHYLLINE (AMINOPHYLLINE)

Facility

$234.00

Service Code	HCPCS 80198
Hospital Charge Code	38472641
Hospital Revenue Code	301
Min. Negotiated Rate	$6.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$38.46
Rate for Payer: Aetna Medicare Advantage	$45.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.29
Rate for Payer: Cigna Commercial	$117.00
Rate for Payer: Cigna Medicare Advantage	$14.14
Rate for Payer: Clover Medicare Advantage	$13.43
Rate for Payer: EmblemHealth Commercial	$42.42
Rate for Payer: Humana Medicare Advantage	$14.56
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.14
Rate for Payer: Wellcare Medicare Advantage	$14.14
Rate for Payer: Wellpoint Medicaid Managed Care	$6.65

THEOPHYLLINE (AMINOPHYLLINE)

Facility

$234.00

Service Code	HCPCS 80198
Hospital Charge Code	38472641
Hospital Revenue Code	301
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Qualcare PPO/HMO/WC	$35.10

THEOPHYLLINE ANH 200MG CAPS ER

Facility

$19.77

Service Code	NDC 50474020001
Hospital Charge Code	606390515
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

THEOPHYLLINE ANH 200MG CAPS ER

Facility

$19.77

Service Code	NDC 50474020001
Hospital Charge Code	606390515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$9.88
Rate for Payer: Aetna Commercial	$7.51
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.14
Rate for Payer: Oxford Commercial	$3.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$3.95
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

Theophylline ER 200mg

Facility

$19.77

Service Code	NDC 50474020001
Hospital Charge Code	606390079
Hospital Revenue Code	250
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.97

Theophylline ER 200mg

Facility

$19.77

Service Code	NDC 50474020001
Hospital Charge Code	606390079
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$9.88
Rate for Payer: Aetna Commercial	$7.51
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.14
Rate for Payer: Oxford Commercial	$3.95
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$3.95
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

Know your out-of-pocket cost for care.

All Charges