Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TOBACCO USE CESSATION 3-10MIN

Facility

$178.05

Service Code	HCPCS 99406
Hospital Charge Code	451199406
Hospital Revenue Code	942
Min. Negotiated Rate	$26.71
Max. Negotiated Rate	$26.71
Rate for Payer: Qualcare PPO/HMO/WC	$26.71

TOBRA GRAFT COLLECT

Facility

$5,000.00

Hospital Charge Code	270702382
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

TOBRA GRAFT COLLECT

Facility

$5,000.00

Hospital Charge Code	270702382
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

TOBRAMYCIN

Facility

$169.00

Service Code	HCPCS 80200
Hospital Charge Code	38472650
Hospital Revenue Code	301
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

TOBRAMYCIN

Facility

$169.00

Service Code	HCPCS 80200
Hospital Charge Code	38472650
Hospital Revenue Code	301
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$43.87
Rate for Payer: Aetna Medicare Advantage	$52.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.51
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: Cigna Medicare Advantage	$16.13
Rate for Payer: Clover Medicare Advantage	$15.32
Rate for Payer: EmblemHealth Commercial	$48.39
Rate for Payer: Humana Medicare Advantage	$16.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.13
Rate for Payer: Wellcare Medicare Advantage	$16.13
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

TOBRAMYCIN DEXTHSN OPH OINT

Facility

$1,499.46

Service Code	NDC 78087601
Hospital Charge Code	60628024
Hospital Revenue Code	250
Min. Negotiated Rate	$42.58
Max. Negotiated Rate	$749.73
Rate for Payer: Aetna Commercial	$569.79
Rate for Payer: Aetna Medicare Advantage	$449.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.36
Rate for Payer: Cigna Commercial	$749.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$389.86
Rate for Payer: Oxford Commercial	$299.89
Rate for Payer: Qualcare PPO/HMO/WC	$224.92
Rate for Payer: UnitedHealthcare Commercial	$299.89
Rate for Payer: UnitedHealthcare Community & State	$47.38
Rate for Payer: Wellpoint Medicaid Managed Care	$42.58

TOBRAMYCIN DEXTHSN OPH OINT

Facility

$1,499.46

Service Code	NDC 78087601
Hospital Charge Code	60628024
Hospital Revenue Code	250
Min. Negotiated Rate	$224.92
Max. Negotiated Rate	$224.92
Rate for Payer: Qualcare PPO/HMO/WC	$224.92

TOBRAMYCIN DEXTHSN OPH SSP

Facility

$566.42

Service Code	NDC 78095340
Hospital Charge Code	60628025
Hospital Revenue Code	250
Min. Negotiated Rate	$16.09
Max. Negotiated Rate	$283.21
Rate for Payer: Aetna Commercial	$215.24
Rate for Payer: Aetna Medicare Advantage	$169.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.44
Rate for Payer: Cigna Commercial	$283.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.27
Rate for Payer: Oxford Commercial	$113.28
Rate for Payer: Qualcare PPO/HMO/WC	$84.96
Rate for Payer: UnitedHealthcare Commercial	$113.28
Rate for Payer: UnitedHealthcare Community & State	$17.90
Rate for Payer: Wellpoint Medicaid Managed Care	$16.09

TOBRAMYCIN DEXTHSN OPH SSP

Facility

$566.42

Service Code	NDC 78095340
Hospital Charge Code	60628025
Hospital Revenue Code	250
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$84.96
Rate for Payer: Qualcare PPO/HMO/WC	$84.96

TOBRAMYCIN OPTH OINT

Facility

$604.61

Service Code	NDC 65064435
Hospital Charge Code	60628022
Hospital Revenue Code	250
Min. Negotiated Rate	$17.17
Max. Negotiated Rate	$302.31
Rate for Payer: Aetna Commercial	$229.75
Rate for Payer: Aetna Medicare Advantage	$181.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.18
Rate for Payer: Cigna Commercial	$302.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.20
Rate for Payer: Oxford Commercial	$120.92
Rate for Payer: Qualcare PPO/HMO/WC	$90.69
Rate for Payer: UnitedHealthcare Commercial	$120.92
Rate for Payer: UnitedHealthcare Community & State	$19.11
Rate for Payer: Wellpoint Medicaid Managed Care	$17.17

TOBRAMYCIN OPTH OINT

Facility

$604.61

Service Code	NDC 65064435
Hospital Charge Code	60628022
Hospital Revenue Code	250
Min. Negotiated Rate	$90.69
Max. Negotiated Rate	$90.69
Rate for Payer: Qualcare PPO/HMO/WC	$90.69

TOBRAMYCIN OPTH SOL 0.3% 5ML

Facility

$98.42

Service Code	NDC 24208029005
Hospital Charge Code	60628023
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$49.21
Rate for Payer: Aetna Commercial	$37.40
Rate for Payer: Aetna Medicare Advantage	$29.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.10
Rate for Payer: Cigna Commercial	$49.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.59
Rate for Payer: Oxford Commercial	$19.68
Rate for Payer: Qualcare PPO/HMO/WC	$14.76
Rate for Payer: UnitedHealthcare Commercial	$19.68
Rate for Payer: UnitedHealthcare Community & State	$3.11
Rate for Payer: Wellpoint Medicaid Managed Care	$2.80

TOBRAMYCIN OPTH SOL 0.3% 5ML

Facility

$98.42

Service Code	NDC 24208029005
Hospital Charge Code	60628023
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$14.76
Rate for Payer: Qualcare PPO/HMO/WC	$14.76

TOCAINIDE (TONOCARD)

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38473122
Hospital Revenue Code	301
Min. Negotiated Rate	$8.26
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$145.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.26

TOCAINIDE (TONOCARD)

Facility

$291.00

Service Code	HCPCS 80299
Hospital Charge Code	38473122
Hospital Revenue Code	301
Min. Negotiated Rate	$43.65
Max. Negotiated Rate	$43.65
Rate for Payer: Qualcare PPO/HMO/WC	$43.65

TODDLER MASK

Facility

$39.00

Hospital Charge Code	270332339
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

TODDLER MASK

Facility

$39.00

Hospital Charge Code	270332339
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

TOE ARTIC COMP 15MM 2.5X4.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270696339
Hospital Revenue Code	278
Min. Negotiated Rate	$426.85
Max. Negotiated Rate	$7,515.00
Rate for Payer: Aetna Commercial	$5,711.40
Rate for Payer: Aetna Medicare Advantage	$4,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,832.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,832.65
Rate for Payer: Cigna Commercial	$7,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50
Rate for Payer: UnitedHealthcare Community & State	$474.95
Rate for Payer: Wellpoint Medicaid Managed Care	$426.85

TOE ARTIC COMP 15MM 2.5X4.5MM

Facility

$15,030.00

Service Code	HCPCS L8641
Hospital Charge Code	270696339
Hospital Revenue Code	278
Min. Negotiated Rate	$2,254.50
Max. Negotiated Rate	$3,637.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,006.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,637.26
Rate for Payer: Qualcare PPO/HMO/WC	$2,254.50

TOE FLEX HINGE W/GRMT #0

Facility

$6,280.00

Hospital Charge Code	270644931
Hospital Revenue Code	278
Min. Negotiated Rate	$942.00
Max. Negotiated Rate	$1,519.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00

TOE FLEX HINGE W/GRMT #0

Facility

$6,280.00

Hospital Charge Code	270644931
Hospital Revenue Code	278
Min. Negotiated Rate	$178.35
Max. Negotiated Rate	$3,140.00
Rate for Payer: Aetna Commercial	$2,386.40
Rate for Payer: Aetna Medicare Advantage	$1,884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.40
Rate for Payer: Cigna Commercial	$3,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00
Rate for Payer: UnitedHealthcare Community & State	$198.45
Rate for Payer: Wellpoint Medicaid Managed Care	$178.35

TOE FLEX HINGE W/GRMT #1

Facility

$6,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270668530
Hospital Revenue Code	278
Min. Negotiated Rate	$942.00
Max. Negotiated Rate	$1,519.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00

TOE FLEX HINGE W/GRMT #1

Facility

$6,280.00

Service Code	HCPCS C1776
Hospital Charge Code	270668530
Hospital Revenue Code	278
Min. Negotiated Rate	$178.35
Max. Negotiated Rate	$3,140.00
Rate for Payer: Aetna Commercial	$2,386.40
Rate for Payer: Aetna Medicare Advantage	$1,884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.40
Rate for Payer: Cigna Commercial	$3,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00
Rate for Payer: UnitedHealthcare Community & State	$198.45
Rate for Payer: Wellpoint Medicaid Managed Care	$178.35

TOE FLEX HINGE W/GRMT #2

Facility

$6,280.00

Hospital Charge Code	270611669
Hospital Revenue Code	278
Min. Negotiated Rate	$178.35
Max. Negotiated Rate	$3,140.00
Rate for Payer: Aetna Commercial	$2,386.40
Rate for Payer: Aetna Medicare Advantage	$1,884.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,601.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,601.40
Rate for Payer: Cigna Commercial	$3,140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00
Rate for Payer: UnitedHealthcare Community & State	$198.45
Rate for Payer: Wellpoint Medicaid Managed Care	$178.35

TOE FLEX HINGE W/GRMT #2

Facility

$6,280.00

Hospital Charge Code	270611669
Hospital Revenue Code	278
Min. Negotiated Rate	$942.00
Max. Negotiated Rate	$1,519.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,256.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,519.76
Rate for Payer: Qualcare PPO/HMO/WC	$942.00

Know your out-of-pocket cost for care.

All Charges