Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TOOL METAL GUIDEWIRE INSERTION

Facility

$19.30

Hospital Charge Code	270637999S
Hospital Revenue Code	272
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

TOOL, MIDAS REX DISSECTING

Facility

$1,170.00

Hospital Charge Code	270690927
Hospital Revenue Code	272
Min. Negotiated Rate	$175.50
Max. Negotiated Rate	$175.50
Rate for Payer: Qualcare PPO/HMO/WC	$175.50

TOOL, MIDAS REX DISSECTING

Facility

$1,170.00

Hospital Charge Code	270690927
Hospital Revenue Code	272
Min. Negotiated Rate	$33.23
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$444.60
Rate for Payer: Aetna Medicare Advantage	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$298.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$298.35
Rate for Payer: Cigna Commercial	$585.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$304.20
Rate for Payer: Oxford Commercial	$234.00
Rate for Payer: Qualcare PPO/HMO/WC	$175.50
Rate for Payer: UnitedHealthcare Commercial	$234.00
Rate for Payer: UnitedHealthcare Community & State	$36.97
Rate for Payer: Wellpoint Medicaid Managed Care	$33.23

TOOTHETTE ORAL CARE KIT

Facility

$50.45

Hospital Charge Code	270302207
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$25.23
Rate for Payer: Aetna Commercial	$19.17
Rate for Payer: Aetna Medicare Advantage	$15.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.86
Rate for Payer: Cigna Commercial	$25.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.12
Rate for Payer: Oxford Commercial	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$7.57
Rate for Payer: UnitedHealthcare Commercial	$10.09
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.43

TOOTHETTE ORAL CARE KIT

Facility

$50.45

Hospital Charge Code	270302207
Hospital Revenue Code	270
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$7.57
Rate for Payer: Qualcare PPO/HMO/WC	$7.57

TOPAMAX 100MG TAB

Facility

$95.68

Service Code	NDC 50458064165
Hospital Charge Code	60635506
Hospital Revenue Code	250
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$14.35
Rate for Payer: Qualcare PPO/HMO/WC	$14.35

TOPAMAX 100MG TAB

Facility

$95.68

Service Code	NDC 50458064165
Hospital Charge Code	60635506
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Commercial	$36.36
Rate for Payer: Aetna Medicare Advantage	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.40
Rate for Payer: Cigna Commercial	$47.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.88
Rate for Payer: Oxford Commercial	$19.14
Rate for Payer: Qualcare PPO/HMO/WC	$14.35
Rate for Payer: UnitedHealthcare Commercial	$19.14
Rate for Payer: UnitedHealthcare Community & State	$3.02
Rate for Payer: Wellpoint Medicaid Managed Care	$2.72

TOPAZ MICRODEBRIDER W/IFS

Facility

$2,265.00

Hospital Charge Code	270675005
Hospital Revenue Code	272
Min. Negotiated Rate	$64.33
Max. Negotiated Rate	$1,132.50
Rate for Payer: Aetna Commercial	$860.70
Rate for Payer: Aetna Medicare Advantage	$679.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$577.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$577.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$577.58
Rate for Payer: Cigna Commercial	$1,132.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$588.90
Rate for Payer: Oxford Commercial	$453.00
Rate for Payer: Qualcare PPO/HMO/WC	$339.75
Rate for Payer: UnitedHealthcare Commercial	$453.00
Rate for Payer: UnitedHealthcare Community & State	$71.57
Rate for Payer: Wellpoint Medicaid Managed Care	$64.33

TOPAZ MICRODEBRIDER W/IFS

Facility

$2,265.00

Hospital Charge Code	270675005
Hospital Revenue Code	272
Min. Negotiated Rate	$339.75
Max. Negotiated Rate	$339.75
Rate for Payer: Qualcare PPO/HMO/WC	$339.75

TOPICAL SKIN ADHESIVE 35ML

Facility

$798.60

Hospital Charge Code	270663132
Hospital Revenue Code	270
Min. Negotiated Rate	$119.79
Max. Negotiated Rate	$119.79
Rate for Payer: Qualcare PPO/HMO/WC	$119.79

TOPICAL SKIN ADHESIVE 35ML

Facility

$798.60

Hospital Charge Code	270663132
Hospital Revenue Code	270
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$399.30
Rate for Payer: Aetna Commercial	$303.47
Rate for Payer: Aetna Medicare Advantage	$239.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.64
Rate for Payer: Cigna Commercial	$399.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.64
Rate for Payer: Oxford Commercial	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$119.79
Rate for Payer: UnitedHealthcare Commercial	$159.72
Rate for Payer: UnitedHealthcare Community & State	$25.24
Rate for Payer: Wellpoint Medicaid Managed Care	$22.68

TOPIRAMATE

Facility

$390.00

Service Code	HCPCS 80201
Hospital Charge Code	39900012
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TOPIRAMATE

Facility

$390.00

Service Code	HCPCS 80201
Hospital Charge Code	39900012
Hospital Revenue Code	301
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$32.42
Rate for Payer: Aetna Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.24
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.92
Rate for Payer: Clover Medicare Advantage	$11.32
Rate for Payer: EmblemHealth Commercial	$35.76
Rate for Payer: Humana Medicare Advantage	$12.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.92
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	$9.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.92
Rate for Payer: Wellcare Medicare Advantage	$11.92
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TOPIRAMATE 200 MG TAB

Facility

$112.02

Service Code	NDC 50458064265
Hospital Charge Code	60629916
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$16.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.80

TOPIRAMATE 200 MG TAB

Facility

$112.02

Service Code	NDC 50458064265
Hospital Charge Code	60629916
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$56.01
Rate for Payer: Aetna Commercial	$42.57
Rate for Payer: Aetna Medicare Advantage	$33.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.57
Rate for Payer: Cigna Commercial	$56.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.13
Rate for Payer: Oxford Commercial	$22.40
Rate for Payer: Qualcare PPO/HMO/WC	$16.80
Rate for Payer: UnitedHealthcare Commercial	$22.40
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

TOPIRAMATE 25 MG TAB

Facility

$35.11

Service Code	NDC 50458063965
Hospital Charge Code	60628972
Hospital Revenue Code	250
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$17.55
Rate for Payer: Aetna Commercial	$13.34
Rate for Payer: Aetna Medicare Advantage	$10.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.95
Rate for Payer: Cigna Commercial	$17.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.13
Rate for Payer: Oxford Commercial	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.27
Rate for Payer: UnitedHealthcare Commercial	$7.02
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

TOPIRAMATE 25 MG TAB

Facility

$35.11

Service Code	NDC 50458063965
Hospital Charge Code	60628972
Hospital Revenue Code	250
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$5.27
Rate for Payer: Qualcare PPO/HMO/WC	$5.27

TOPIRAMATE (TOPAMAX) 100MF TAB

Facility

$40.47

Service Code	NDC 68462010960
Hospital Charge Code	60630146
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

TOPIRAMATE (TOPAMAX) 100MF TAB

Facility

$40.47

Service Code	NDC 68462010960
Hospital Charge Code	60630146
Hospital Revenue Code	250
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$6.07
Rate for Payer: Qualcare PPO/HMO/WC	$6.07

TOPIRAMATE (TOPAMAX) 50MG TAB

Facility

$29.61

Service Code	NDC 68462015360
Hospital Charge Code	60630145
Hospital Revenue Code	250
Min. Negotiated Rate	$4.44
Max. Negotiated Rate	$4.44
Rate for Payer: Qualcare PPO/HMO/WC	$4.44

TOPIRAMATE (TOPAMAX) 50MG TAB

Facility

$29.61

Service Code	NDC 68462015360
Hospital Charge Code	60630145
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$14.80
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: Aetna Medicare Advantage	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.55
Rate for Payer: Cigna Commercial	$14.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.70
Rate for Payer: Oxford Commercial	$5.92
Rate for Payer: Qualcare PPO/HMO/WC	$4.44
Rate for Payer: UnitedHealthcare Commercial	$5.92
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$0.84

TOPROL XL 200MG

Facility

$16.88

Service Code	NDC 70347020002
Hospital Charge Code	60635251
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.44
Rate for Payer: Aetna Commercial	$6.41
Rate for Payer: Aetna Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.39
Rate for Payer: Oxford Commercial	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.38
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

TOPROL XL 200MG

Facility

$16.88

Service Code	NDC 70347020002
Hospital Charge Code	60635251
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

TORADOL/10MG/U/D

Facility

$15.21

Service Code	NDC 378113401
Hospital Charge Code	60634935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.61
Rate for Payer: Aetna Commercial	$5.78
Rate for Payer: Aetna Medicare Advantage	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.88
Rate for Payer: Cigna Commercial	$7.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.95
Rate for Payer: Oxford Commercial	$3.04
Rate for Payer: Qualcare PPO/HMO/WC	$2.28
Rate for Payer: UnitedHealthcare Commercial	$3.04
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

TORADOL/10MG/U/D

Facility

$15.21

Service Code	NDC 378113401
Hospital Charge Code	60634935
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$2.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.28

Know your out-of-pocket cost for care.

All Charges