Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BELLADONNA-PHENOBARBITAL TAB

Facility

$62.51

Service Code	NDC 42291024501
Hospital Charge Code	60627427
Hospital Revenue Code	251
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$31.25
Rate for Payer: Aetna Commercial	$23.75
Rate for Payer: Aetna Medicare Advantage	$18.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.94
Rate for Payer: Cigna Commercial	$31.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.25
Rate for Payer: Oxford Commercial	$12.50
Rate for Payer: Qualcare PPO/HMO/WC	$9.38
Rate for Payer: UnitedHealthcare Commercial	$12.50
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

BELLADONNA-PHENOBARBITAL TAB

Facility

$62.51

Service Code	NDC 42291024501
Hospital Charge Code	60627427
Hospital Revenue Code	251
Min. Negotiated Rate	$9.38
Max. Negotiated Rate	$9.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.38

BENADRYL 1 % CREAM

Facility

$27.00

Service Code	NDC 12547017162
Hospital Charge Code	606350977
Hospital Revenue Code	250
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

BENADRYL 1 % CREAM

Facility

$27.00

Service Code	NDC 12547017162
Hospital Charge Code	606350977
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.02
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

BENCE JONES,SCREEN

Facility

$399.00

Service Code	HCPCS 86320
Hospital Charge Code	38477029
Hospital Revenue Code	302
Min. Negotiated Rate	$59.85
Max. Negotiated Rate	$59.85
Rate for Payer: Qualcare PPO/HMO/WC	$59.85

BENCE JONES,SCREEN

Facility

$399.00

Service Code	HCPCS 86320
Hospital Charge Code	38477029
Hospital Revenue Code	302
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$81.38
Rate for Payer: Aetna Medicare Advantage	$96.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.53
Rate for Payer: Cigna Commercial	$199.50
Rate for Payer: Cigna Medicare Advantage	$29.92
Rate for Payer: Clover Medicare Advantage	$28.42
Rate for Payer: EmblemHealth Commercial	$89.76
Rate for Payer: Humana Medicare Advantage	$30.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$23.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.92
Rate for Payer: Wellcare Medicare Advantage	$29.92
Rate for Payer: Wellpoint Medicaid Managed Care	$11.33

Benchmark Ber Str 105

Facility

$4,975.00

Hospital Charge Code	270685065N
Hospital Revenue Code	272
Min. Negotiated Rate	$141.29
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,293.50
Rate for Payer: Oxford Commercial	$995.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$995.00
Rate for Payer: UnitedHealthcare Community & State	$157.21
Rate for Payer: Wellpoint Medicaid Managed Care	$141.29

Benchmark Ber Str 105

Facility

$4,975.00

Hospital Charge Code	270685065S
Hospital Revenue Code	272
Min. Negotiated Rate	$141.29
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,293.50
Rate for Payer: Oxford Commercial	$995.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$995.00
Rate for Payer: UnitedHealthcare Community & State	$157.21
Rate for Payer: Wellpoint Medicaid Managed Care	$141.29

Benchmark Ber Str 105

Facility

$4,975.00

Hospital Charge Code	270685065S
Hospital Revenue Code	272
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$746.25
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

Benchmark Ber Str 105

Facility

$4,975.00

Hospital Charge Code	270685065N
Hospital Revenue Code	272
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$746.25
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

Benchmark Ber Str 95

Facility

$4,975.00

Hospital Charge Code	270685064S
Hospital Revenue Code	272
Min. Negotiated Rate	$141.29
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,293.50
Rate for Payer: Oxford Commercial	$995.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$995.00
Rate for Payer: UnitedHealthcare Community & State	$157.21
Rate for Payer: Wellpoint Medicaid Managed Care	$141.29

Benchmark Ber Str 95

Facility

$4,975.00

Hospital Charge Code	270685064S
Hospital Revenue Code	272
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$746.25
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

Benchmark Ber Str 95

Facility

$4,975.00

Hospital Charge Code	270685064N
Hospital Revenue Code	272
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$746.25
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

Benchmark Ber Str 95

Facility

$4,975.00

Hospital Charge Code	270685064N
Hospital Revenue Code	272
Min. Negotiated Rate	$141.29
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,293.50
Rate for Payer: Oxford Commercial	$995.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$995.00
Rate for Payer: UnitedHealthcare Community & State	$157.21
Rate for Payer: Wellpoint Medicaid Managed Care	$141.29

BENDING IRON F/1.5 & 2mm PLATE

Facility

$795.70

Service Code	HCPCS C1713
Hospital Charge Code	270651502
Hospital Revenue Code	278
Min. Negotiated Rate	$119.36
Max. Negotiated Rate	$192.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.56
Rate for Payer: Qualcare PPO/HMO/WC	$119.36

BENDING IRON F/1.5 & 2mm PLATE

Facility

$795.70

Service Code	HCPCS C1713
Hospital Charge Code	270651502
Hospital Revenue Code	278
Min. Negotiated Rate	$22.60
Max. Negotiated Rate	$397.85
Rate for Payer: Aetna Commercial	$302.37
Rate for Payer: Aetna Medicare Advantage	$238.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$202.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$202.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$202.90
Rate for Payer: Cigna Commercial	$397.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.56
Rate for Payer: Qualcare PPO/HMO/WC	$119.36
Rate for Payer: UnitedHealthcare Community & State	$25.14
Rate for Payer: Wellpoint Medicaid Managed Care	$22.60

BENDING TEMPLATE 7 HOLES

Facility

$136.50

Hospital Charge Code	270675506
Hospital Revenue Code	278
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$33.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.03
Rate for Payer: Qualcare PPO/HMO/WC	$20.48

BENDING TEMPLATE 7 HOLES

Facility

$136.50

Hospital Charge Code	270675506
Hospital Revenue Code	278
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$68.25
Rate for Payer: Aetna Commercial	$51.87
Rate for Payer: Aetna Medicare Advantage	$40.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.81
Rate for Payer: Cigna Commercial	$68.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.03
Rate for Payer: Qualcare PPO/HMO/WC	$20.48
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$3.88

BENDINI ROD DIGITIZER ARRAY

Facility

$12,350.00

Hospital Charge Code	270696804
Hospital Revenue Code	272
Min. Negotiated Rate	$1,852.50
Max. Negotiated Rate	$1,852.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,852.50

BENDINI ROD DIGITIZER ARRAY

Facility

$12,350.00

Hospital Charge Code	270696804
Hospital Revenue Code	272
Min. Negotiated Rate	$350.74
Max. Negotiated Rate	$6,175.00
Rate for Payer: Aetna Commercial	$4,693.00
Rate for Payer: Aetna Medicare Advantage	$3,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,149.25
Rate for Payer: Cigna Commercial	$6,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,211.00
Rate for Payer: Oxford Commercial	$2,470.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,852.50
Rate for Payer: UnitedHealthcare Commercial	$2,470.00
Rate for Payer: UnitedHealthcare Community & State	$390.26
Rate for Payer: Wellpoint Medicaid Managed Care	$350.74

Benicar 20mg

Facility

$14.07

Service Code	NDC 63629339001
Hospital Charge Code	6063943278
Hospital Revenue Code	250
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$2.11
Rate for Payer: Qualcare PPO/HMO/WC	$2.11

Benicar 20mg

Facility

$14.07

Service Code	NDC 63629339001
Hospital Charge Code	6063943278
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$7.04
Rate for Payer: Aetna Commercial	$5.35
Rate for Payer: Aetna Medicare Advantage	$4.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.59
Rate for Payer: Cigna Commercial	$7.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.66
Rate for Payer: Oxford Commercial	$2.81
Rate for Payer: Qualcare PPO/HMO/WC	$2.11
Rate for Payer: UnitedHealthcare Commercial	$2.81
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

Benicar 40mg

Facility

$16.35

Service Code	NDC 65597010430
Hospital Charge Code	6063943279
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$8.18
Rate for Payer: Aetna Commercial	$6.21
Rate for Payer: Aetna Medicare Advantage	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.17
Rate for Payer: Cigna Commercial	$8.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.25
Rate for Payer: Oxford Commercial	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.45
Rate for Payer: UnitedHealthcare Commercial	$3.27
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

Benicar 40mg

Facility

$16.35

Service Code	NDC 65597010430
Hospital Charge Code	6063943279
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.45

Benicar 5mg

Facility

$156.04

Service Code	NDC 35356028720
Hospital Charge Code	6063943277
Hospital Revenue Code	250
Min. Negotiated Rate	$23.41
Max. Negotiated Rate	$23.41
Rate for Payer: Qualcare PPO/HMO/WC	$23.41

Know your out-of-pocket cost for care.

All Charges