Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BETHANACOL 5MG TAB

Facility

$4.76

Service Code	NDC 115951101
Hospital Charge Code	6063943064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Qualcare PPO/HMO/WC	$0.71

BETHANECHOL 10 MG TAB

Facility

$13.40

Service Code	NDC 832051100
Hospital Charge Code	60627411
Hospital Revenue Code	251
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Qualcare PPO/HMO/WC	$2.01

BETHANECHOL 10 MG TAB

Facility

$13.40

Service Code	NDC 832051100
Hospital Charge Code	60627411
Hospital Revenue Code	251
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.70
Rate for Payer: Aetna Commercial	$5.09
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.42
Rate for Payer: Cigna Commercial	$6.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.48
Rate for Payer: Oxford Commercial	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.01
Rate for Payer: UnitedHealthcare Commercial	$2.68
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

BETHANECHOL 25 MG TAB

Facility

$17.89

Service Code	NDC 832051201
Hospital Charge Code	60627412
Hospital Revenue Code	251
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.65
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$3.58
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

BETHANECHOL 25 MG TAB

Facility

$17.89

Service Code	NDC 832051201
Hospital Charge Code	60627412
Hospital Revenue Code	251
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

BETHANECHOL CHLORIDE 50 MG TAB

Facility

$19.10

Service Code	NDC 115954401
Hospital Charge Code	6063943187
Hospital Revenue Code	250
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$2.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.87

BETHANECHOL CHLORIDE 50 MG TAB

Facility

$19.10

Service Code	NDC 115954401
Hospital Charge Code	6063943187
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.55
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Aetna Medicare Advantage	$5.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.87
Rate for Payer: Cigna Commercial	$9.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.97
Rate for Payer: Oxford Commercial	$3.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.87
Rate for Payer: UnitedHealthcare Commercial	$3.82
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

BETOPTIC 0.5% OPHTH/5ML

Facility

$424.85

Service Code	NDC 17478070510
Hospital Charge Code	60632560
Hospital Revenue Code	250
Min. Negotiated Rate	$63.73
Max. Negotiated Rate	$63.73
Rate for Payer: Qualcare PPO/HMO/WC	$63.73

BETOPTIC 0.5% OPHTH/5ML

Facility

$424.85

Service Code	NDC 17478070510
Hospital Charge Code	60632560
Hospital Revenue Code	250
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.43
Rate for Payer: Aetna Commercial	$161.44
Rate for Payer: Aetna Medicare Advantage	$127.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.34
Rate for Payer: Cigna Commercial	$212.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.46
Rate for Payer: Oxford Commercial	$84.97
Rate for Payer: Qualcare PPO/HMO/WC	$63.73
Rate for Payer: UnitedHealthcare Commercial	$84.97
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

BETOPTIC S OPHTH SOL/.25%

Facility

$1,753.52

Service Code	NDC 78072910
Hospital Charge Code	60634287
Hospital Revenue Code	250
Min. Negotiated Rate	$49.80
Max. Negotiated Rate	$876.76
Rate for Payer: Aetna Commercial	$666.34
Rate for Payer: Aetna Medicare Advantage	$526.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.15
Rate for Payer: Cigna Commercial	$876.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.92
Rate for Payer: Oxford Commercial	$350.70
Rate for Payer: Qualcare PPO/HMO/WC	$263.03
Rate for Payer: UnitedHealthcare Commercial	$350.70
Rate for Payer: UnitedHealthcare Community & State	$55.41
Rate for Payer: Wellpoint Medicaid Managed Care	$49.80

BETOPTIC S OPHTH SOL/.25%

Facility

$1,753.52

Service Code	NDC 78072910
Hospital Charge Code	60634287
Hospital Revenue Code	250
Min. Negotiated Rate	$263.03
Max. Negotiated Rate	$263.03
Rate for Payer: Qualcare PPO/HMO/WC	$263.03

BEVEL NEEDLE KIT

Facility

$670.00

Hospital Charge Code	270704937
Hospital Revenue Code	279
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$100.50
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

BEVEL NEEDLE KIT

Facility

$670.00

Hospital Charge Code	270704937
Hospital Revenue Code	279
Min. Negotiated Rate	$19.03
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$174.20
Rate for Payer: Oxford Commercial	$134.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Commercial	$134.00
Rate for Payer: UnitedHealthcare Community & State	$21.17
Rate for Payer: Wellpoint Medicaid Managed Care	$19.03

BF CAGE 11X27X12MM

Facility

$2,890.00

Service Code	HCPCS C1713
Hospital Charge Code	270705736
Hospital Revenue Code	278
Min. Negotiated Rate	$82.08
Max. Negotiated Rate	$1,445.00
Rate for Payer: Aetna Commercial	$1,098.20
Rate for Payer: Aetna Medicare Advantage	$867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$736.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$736.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$578.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$736.95
Rate for Payer: Cigna Commercial	$1,445.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$699.38
Rate for Payer: Qualcare PPO/HMO/WC	$433.50
Rate for Payer: UnitedHealthcare Community & State	$91.32
Rate for Payer: Wellpoint Medicaid Managed Care	$82.08

BF CAGE 11X27X12MM

Facility

$2,890.00

Service Code	HCPCS C1713
Hospital Charge Code	270705736
Hospital Revenue Code	278
Min. Negotiated Rate	$433.50
Max. Negotiated Rate	$699.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$578.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$699.38
Rate for Payer: Qualcare PPO/HMO/WC	$433.50

BG PUTTY BIOACT BONE GRAFT 2CC

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686231
Hospital Revenue Code	278
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$2,812.50
Rate for Payer: Aetna Commercial	$2,137.50
Rate for Payer: Aetna Medicare Advantage	$1,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,434.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,434.38
Rate for Payer: Cigna Commercial	$2,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$177.75
Rate for Payer: Wellpoint Medicaid Managed Care	$159.75

BG PUTTY BIOACT BONE GRAFT 2CC

Facility

$5,625.00

Service Code	HCPCS C1713
Hospital Charge Code	270686231
Hospital Revenue Code	278
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

B-HCG (QUANTITATIVE)

Facility

$1,083.55

Service Code	HCPCS 84702
Hospital Charge Code	3032000
Hospital Revenue Code	301
Min. Negotiated Rate	$162.53
Max. Negotiated Rate	$162.53
Rate for Payer: Qualcare PPO/HMO/WC	$162.53

B-HCG (QUANTITATIVE)

Facility

$1,083.55

Service Code	HCPCS 84702
Hospital Charge Code	3032000
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$541.77
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.59
Rate for Payer: Cigna Commercial	$541.77
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.72
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.53
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$30.77

B. HENSELAE AB (IGG, IGM), I

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035A
Hospital Revenue Code	302
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$26.58
Rate for Payer: Aetna Medicare Advantage	$20.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.84
Rate for Payer: Cigna Commercial	$34.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.19
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.49
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

B. HENSELAE AB (IGG, IGM), I

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.49

B. HENSELAE AB (IGG, IGM), II

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$10.49
Rate for Payer: Qualcare PPO/HMO/WC	$10.49

B. HENSELAE AB (IGG, IGM), II

Facility

$69.95

Service Code	HCPCS 8661191
Hospital Charge Code	39990035B
Hospital Revenue Code	302
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$26.58
Rate for Payer: Aetna Medicare Advantage	$20.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.84
Rate for Payer: Cigna Commercial	$34.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.19
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.49
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

BICALUTAMIDE 50 MG TAB

Facility

$124.35

Service Code	NDC 93022056
Hospital Charge Code	60627365
Hospital Revenue Code	250
Min. Negotiated Rate	$18.65
Max. Negotiated Rate	$18.65
Rate for Payer: Qualcare PPO/HMO/WC	$18.65

BICALUTAMIDE 50 MG TAB

Facility

$124.35

Service Code	NDC 93022056
Hospital Charge Code	60627365
Hospital Revenue Code	250
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$62.17
Rate for Payer: Aetna Commercial	$47.25
Rate for Payer: Aetna Medicare Advantage	$37.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.71
Rate for Payer: Cigna Commercial	$62.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.33
Rate for Payer: Oxford Commercial	$24.87
Rate for Payer: Qualcare PPO/HMO/WC	$18.65
Rate for Payer: UnitedHealthcare Commercial	$24.87
Rate for Payer: UnitedHealthcare Community & State	$3.93
Rate for Payer: Wellpoint Medicaid Managed Care	$3.53

Know your out-of-pocket cost for care.

All Charges