Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TOE TAC MEDIUM

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270677359
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

TOE TAC SMALL

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677360
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

TOE TAC SMALL

Facility

$9,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270677360
Hospital Revenue Code	278
Min. Negotiated Rate	$269.09
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$299.41
Rate for Payer: Wellpoint Medicaid Managed Care	$269.09

TOE WEBBING OP

Facility

$19,998.60

Service Code	HCPCS 28280
Hospital Charge Code	16000635
Hospital Revenue Code	360
Min. Negotiated Rate	$2,999.79
Max. Negotiated Rate	$2,999.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79

TOE WEBBING OP

Facility

$19,998.60

Service Code	HCPCS 28280
Hospital Charge Code	16000635
Hospital Revenue Code	360
Min. Negotiated Rate	$567.96
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,199.64
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,999.79
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$631.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$567.96

TOKEN SYNK WIRELESS

Facility

$225.00

Hospital Charge Code	270676529
Hospital Revenue Code	272
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$85.50
Rate for Payer: Aetna Medicare Advantage	$67.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.38
Rate for Payer: Cigna Commercial	$112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.50
Rate for Payer: Oxford Commercial	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.75
Rate for Payer: UnitedHealthcare Commercial	$45.00
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

TOKEN SYNK WIRELESS

Facility

$225.00

Hospital Charge Code	270676529
Hospital Revenue Code	272
Min. Negotiated Rate	$33.75
Max. Negotiated Rate	$33.75
Rate for Payer: Qualcare PPO/HMO/WC	$33.75

TOLTERODINE 1 MG TAB

Facility

$41.81

Service Code	NDC 58151009891
Hospital Charge Code	60629012
Hospital Revenue Code	250
Min. Negotiated Rate	$6.27
Max. Negotiated Rate	$6.27
Rate for Payer: Qualcare PPO/HMO/WC	$6.27

TOLTERODINE 1 MG TAB

Facility

$41.81

Service Code	NDC 58151009891
Hospital Charge Code	60629012
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$20.91
Rate for Payer: Aetna Commercial	$15.89
Rate for Payer: Aetna Medicare Advantage	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.66
Rate for Payer: Cigna Commercial	$20.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.87
Rate for Payer: Oxford Commercial	$8.36
Rate for Payer: Qualcare PPO/HMO/WC	$6.27
Rate for Payer: UnitedHealthcare Commercial	$8.36
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

TOLTERODINE 2 MG TAB

Facility

$43.35

Service Code	NDC 9454401
Hospital Charge Code	60628907
Hospital Revenue Code	250
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.50

TOLTERODINE 2 MG TAB

Facility

$43.35

Service Code	NDC 9454401
Hospital Charge Code	60628907
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$21.68
Rate for Payer: Aetna Commercial	$16.47
Rate for Payer: Aetna Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.05
Rate for Payer: Cigna Commercial	$21.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.27
Rate for Payer: Oxford Commercial	$8.67
Rate for Payer: Qualcare PPO/HMO/WC	$6.50
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Community & State	$1.37
Rate for Payer: Wellpoint Medicaid Managed Care	$1.23

TOLTERODINE 4 MG ER UD

Facility

$71.82

Service Code	NDC 9519004
Hospital Charge Code	60628968
Hospital Revenue Code	250
Min. Negotiated Rate	$10.77
Max. Negotiated Rate	$10.77
Rate for Payer: Qualcare PPO/HMO/WC	$10.77

TOLTERODINE 4 MG ER UD

Facility

$71.82

Service Code	NDC 9519004
Hospital Charge Code	60628968
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$35.91
Rate for Payer: Aetna Commercial	$27.29
Rate for Payer: Aetna Medicare Advantage	$21.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.31
Rate for Payer: Cigna Commercial	$35.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.67
Rate for Payer: Oxford Commercial	$14.36
Rate for Payer: Qualcare PPO/HMO/WC	$10.77
Rate for Payer: UnitedHealthcare Commercial	$14.36
Rate for Payer: UnitedHealthcare Community & State	$2.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

TOLTERODINE LA (DETROL LA) 2MG

Facility

$40.47

Service Code	NDC 58151010393
Hospital Charge Code	60630144
Hospital Revenue Code	250
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$20.23
Rate for Payer: Aetna Commercial	$15.38
Rate for Payer: Aetna Medicare Advantage	$12.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.32
Rate for Payer: Cigna Commercial	$20.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.52
Rate for Payer: Oxford Commercial	$8.09
Rate for Payer: Qualcare PPO/HMO/WC	$6.07
Rate for Payer: UnitedHealthcare Commercial	$8.09
Rate for Payer: UnitedHealthcare Community & State	$1.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1.15

TOLTERODINE LA (DETROL LA) 2MG

Facility

$40.47

Service Code	NDC 58151010393
Hospital Charge Code	60630144
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.07

TOLVAPTAN 15 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002050
Hospital Charge Code	60630114
Hospital Revenue Code	250
Min. Negotiated Rate	$345.76
Max. Negotiated Rate	$345.76
Rate for Payer: Qualcare PPO/HMO/WC	$345.76

TOLVAPTAN 15 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002050
Hospital Charge Code	60630114
Hospital Revenue Code	250
Min. Negotiated Rate	$65.46
Max. Negotiated Rate	$1,152.54
Rate for Payer: Aetna Commercial	$875.93
Rate for Payer: Aetna Medicare Advantage	$691.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$587.79
Rate for Payer: Cigna Commercial	$1,152.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$599.32
Rate for Payer: Oxford Commercial	$461.01
Rate for Payer: Qualcare PPO/HMO/WC	$345.76
Rate for Payer: UnitedHealthcare Commercial	$461.01
Rate for Payer: UnitedHealthcare Community & State	$72.84
Rate for Payer: Wellpoint Medicaid Managed Care	$65.46

TOLVAPTAN 30 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002150
Hospital Charge Code	60630115
Hospital Revenue Code	250
Min. Negotiated Rate	$345.76
Max. Negotiated Rate	$345.76
Rate for Payer: Qualcare PPO/HMO/WC	$345.76

TOLVAPTAN 30 MG TAB

Facility

$2,305.07

Service Code	NDC 59148002150
Hospital Charge Code	60630115
Hospital Revenue Code	250
Min. Negotiated Rate	$65.46
Max. Negotiated Rate	$1,152.54
Rate for Payer: Aetna Commercial	$875.93
Rate for Payer: Aetna Medicare Advantage	$691.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$587.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$587.79
Rate for Payer: Cigna Commercial	$1,152.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$599.32
Rate for Payer: Oxford Commercial	$461.01
Rate for Payer: Qualcare PPO/HMO/WC	$345.76
Rate for Payer: UnitedHealthcare Commercial	$461.01
Rate for Payer: UnitedHealthcare Community & State	$72.84
Rate for Payer: Wellpoint Medicaid Managed Care	$65.46

TOMO DIAG BREAST BIL

Facility

$4,500.00

Service Code	HCPCS 77062
Hospital Charge Code	94061474
Hospital Revenue Code	401
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

TOMO DIAG BREAST BIL

Facility

$4,500.00

Service Code	HCPCS 77062
Hospital Charge Code	94061474
Hospital Revenue Code	401
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

TOMO DIAG BREAST UNI

Facility

$4,500.00

Service Code	HCPCS 77061
Hospital Charge Code	94061471
Hospital Revenue Code	401
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,170.00
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

TOMO DIAG BREAST UNI

Facility

$4,500.00

Service Code	HCPCS 77061
Hospital Charge Code	94061471
Hospital Revenue Code	401
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

TOMOSYNTHESIS SCREEN BREAST BI

Facility

$260.20

Service Code	HCPCS 77063
Hospital Charge Code	94061470
Hospital Revenue Code	403
Min. Negotiated Rate	$7.39
Max. Negotiated Rate	$1,884.00
Rate for Payer: Aetna Commercial	$98.88
Rate for Payer: Aetna Medicare Advantage	$78.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.35
Rate for Payer: Cigna Commercial	$130.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.65
Rate for Payer: Oxford Commercial	$1,688.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.03
Rate for Payer: UnitedHealthcare Commercial	$1,884.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.39

TOMOSYNTHESIS SCREEN BREAST BI

Facility

$260.20

Service Code	HCPCS 77063
Hospital Charge Code	94061470
Hospital Revenue Code	403
Min. Negotiated Rate	$39.03
Max. Negotiated Rate	$39.03
Rate for Payer: Qualcare PPO/HMO/WC	$39.03

Know your out-of-pocket cost for care.

All Charges