Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BICARBONATE, URINE

Facility

$33.60

Service Code	HCPCS 82374
Hospital Charge Code	39900053
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$5.04
Rate for Payer: Qualcare PPO/HMO/WC	$5.04

BICARBONATE, URINE

Facility

$33.60

Service Code	HCPCS 82374
Hospital Charge Code	39900053
Hospital Revenue Code	301
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare Advantage	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.70
Rate for Payer: Cigna Commercial	$16.80
Rate for Payer: Cigna Medicare Advantage	$4.88
Rate for Payer: Clover Medicare Advantage	$4.64
Rate for Payer: EmblemHealth Commercial	$14.64
Rate for Payer: Humana Medicare Advantage	$5.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.04
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.88
Rate for Payer: Wellcare Medicare Advantage	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

BICILLIN L-A/600KU/1ML

Facility

$103.52

Service Code	HCPCS J2510
Hospital Charge Code	60632564
Hospital Revenue Code	636
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$25.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.53

BICILLIN L-A/600KU/1ML

Facility

$103.52

Service Code	HCPCS J2510
Hospital Charge Code	60632564
Hospital Revenue Code	636
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$51.76
Rate for Payer: Aetna Commercial	$39.34
Rate for Payer: Aetna Medicare Advantage	$31.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.40
Rate for Payer: Cigna Commercial	$51.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.53
Rate for Payer: UnitedHealthcare Community & State	$3.27
Rate for Payer: Wellpoint Medicaid Managed Care	$2.94

BICITRA 1.5G/1G

Facility

$13.47

Service Code	NDC 121059515
Hospital Charge Code	60635546
Hospital Revenue Code	250
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.74
Rate for Payer: Aetna Commercial	$5.12
Rate for Payer: Aetna Medicare Advantage	$4.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.43
Rate for Payer: Cigna Commercial	$6.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.50
Rate for Payer: Oxford Commercial	$2.69
Rate for Payer: Qualcare PPO/HMO/WC	$2.02
Rate for Payer: UnitedHealthcare Commercial	$2.69
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

BICITRA 1.5G/1G

Facility

$13.47

Service Code	NDC 121059515
Hospital Charge Code	60635546
Hospital Revenue Code	250
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.02
Rate for Payer: Qualcare PPO/HMO/WC	$2.02

BICITRA 30ML

Facility

$14.54

Service Code	NDC 121059530
Hospital Charge Code	6063943280
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

BICITRA 30ML

Facility

$14.54

Service Code	NDC 121059530
Hospital Charge Code	6063943280
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

BICORTICAL BONE STRIP

Facility

$2,558.00

Hospital Charge Code	270335503
Hospital Revenue Code	278
Min. Negotiated Rate	$72.65
Max. Negotiated Rate	$1,279.00
Rate for Payer: Aetna Commercial	$972.04
Rate for Payer: Aetna Medicare Advantage	$767.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$652.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$652.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$511.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$652.29
Rate for Payer: Cigna Commercial	$1,279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$619.04
Rate for Payer: Qualcare PPO/HMO/WC	$383.70
Rate for Payer: UnitedHealthcare Community & State	$80.83
Rate for Payer: Wellpoint Medicaid Managed Care	$72.65

BICORTICAL BONE STRIP

Facility

$2,558.00

Hospital Charge Code	270335503
Hospital Revenue Code	278
Min. Negotiated Rate	$383.70
Max. Negotiated Rate	$619.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$511.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$619.04
Rate for Payer: Qualcare PPO/HMO/WC	$383.70

BIKTARVY TABLET

Facility

$740.89

Service Code	NDC 61958250103
Hospital Charge Code	606390472
Hospital Revenue Code	250
Min. Negotiated Rate	$111.13
Max. Negotiated Rate	$111.13
Rate for Payer: Qualcare PPO/HMO/WC	$111.13

BIKTARVY TABLET

Facility

$740.89

Service Code	NDC 61958250103
Hospital Charge Code	606390472
Hospital Revenue Code	250
Min. Negotiated Rate	$21.04
Max. Negotiated Rate	$370.44
Rate for Payer: Aetna Commercial	$281.54
Rate for Payer: Aetna Medicare Advantage	$222.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.93
Rate for Payer: Cigna Commercial	$370.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.63
Rate for Payer: Oxford Commercial	$148.18
Rate for Payer: Qualcare PPO/HMO/WC	$111.13
Rate for Payer: UnitedHealthcare Commercial	$148.18
Rate for Payer: UnitedHealthcare Community & State	$23.41
Rate for Payer: Wellpoint Medicaid Managed Care	$21.04

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$193,955.89

Service Code	MSDRG 461
Min. Negotiated Rate	$59,057.08
Max. Negotiated Rate	$193,955.89
Rate for Payer: Aetna Commercial	$139,996.13
Rate for Payer: Aetna Medicare Advantage	$193,955.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188,948.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$62,165.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188,948.10
Rate for Payer: Cigna Commercial	$119,503.86
Rate for Payer: Cigna Medicare Advantage	$62,165.35
Rate for Payer: Clover Medicare Advantage	$59,057.08
Rate for Payer: EmblemHealth Commercial	$186,496.05
Rate for Payer: Humana Medicare Advantage	$64,030.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$62,165.35
Rate for Payer: Oxford Commercial	$94,453.77
Rate for Payer: UnitedHealthcare Commercial	$126,429.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$62,165.35
Rate for Payer: Wellcare Medicare Advantage	$62,165.35

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$103,503.47

Service Code	MSDRG 462
Min. Negotiated Rate	$31,515.48
Max. Negotiated Rate	$103,503.47
Rate for Payer: Aetna Commercial	$75,574.85
Rate for Payer: Aetna Medicare Advantage	$103,503.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,959.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,959.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33,174.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,959.25
Rate for Payer: Cigna Commercial	$59,299.38
Rate for Payer: Cigna Medicare Advantage	$33,174.19
Rate for Payer: Clover Medicare Advantage	$31,515.48
Rate for Payer: EmblemHealth Commercial	$99,522.57
Rate for Payer: Humana Medicare Advantage	$34,169.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33,174.19
Rate for Payer: Oxford Commercial	$46,869.20
Rate for Payer: UnitedHealthcare Commercial	$62,736.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$33,174.19
Rate for Payer: Wellcare Medicare Advantage	$33,174.19

BILAYER WOUND MATRIX 4X5

Facility

$16,665.00

Service Code	HCPCS Q4104
Hospital Charge Code	270648773
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,032.93
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,333.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,032.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,499.75
Rate for Payer: UnitedHealthcare Community & State	$526.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$473.29

BILAYER WOUND MATRIX 4X5

Facility

$16,665.00

Service Code	HCPCS Q4104
Hospital Charge Code	270648773
Hospital Revenue Code	278
Min. Negotiated Rate	$2,499.75
Max. Negotiated Rate	$4,032.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,032.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,499.75

BILE ACIDS

Facility

$343.00

Service Code	HCPCS 82240
Hospital Charge Code	38472743
Hospital Revenue Code	301
Min. Negotiated Rate	$9.39
Max. Negotiated Rate	$171.50
Rate for Payer: Aetna Commercial	$72.30
Rate for Payer: Aetna Medicare Advantage	$86.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.42
Rate for Payer: Cigna Commercial	$171.50
Rate for Payer: Cigna Medicare Advantage	$26.58
Rate for Payer: Clover Medicare Advantage	$25.25
Rate for Payer: EmblemHealth Commercial	$79.74
Rate for Payer: Humana Medicare Advantage	$27.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.18
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$21.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.58
Rate for Payer: Wellcare Medicare Advantage	$26.58
Rate for Payer: Wellpoint Medicaid Managed Care	$9.74

BILE ACIDS

Facility

$343.00

Service Code	HCPCS 82240
Hospital Charge Code	38472743
Hospital Revenue Code	301
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Qualcare PPO/HMO/WC	$51.45

BILE ACIDS FRACTIONATED

Facility

$216.00

Service Code	HCPCS 83789
Hospital Charge Code	38478104
Hospital Revenue Code	301
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$32.40
Rate for Payer: Qualcare PPO/HMO/WC	$32.40

BILE ACIDS FRACTIONATED

Facility

$216.00

Service Code	HCPCS 83789
Hospital Charge Code	38478104
Hospital Revenue Code	301
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.46
Rate for Payer: Cigna Commercial	$108.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.13

BILE ACIDS,FRACT/TOT,PREG

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900339
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.58
Rate for Payer: Aetna Medicare Advantage	$78.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.46
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.11
Rate for Payer: Clover Medicare Advantage	$22.90
Rate for Payer: EmblemHealth Commercial	$72.33
Rate for Payer: Humana Medicare Advantage	$24.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.11
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	$19.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.11
Rate for Payer: Wellcare Medicare Advantage	$24.11
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BILE ACIDS,FRACT/TOT,PREG

Facility

$390.00

Service Code	HCPCS 83789
Hospital Charge Code	39900339
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BILE ACIDS, TOTAL

Facility

$390.00

Service Code	HCPCS 82239
Hospital Charge Code	39900049
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.57
Rate for Payer: Aetna Medicare Advantage	$55.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.10
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.12
Rate for Payer: Clover Medicare Advantage	$16.26
Rate for Payer: EmblemHealth Commercial	$51.36
Rate for Payer: Humana Medicare Advantage	$17.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.12
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	$13.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.12
Rate for Payer: Wellcare Medicare Advantage	$17.12
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BILE ACIDS, TOTAL

Facility

$390.00

Service Code	HCPCS 82239
Hospital Charge Code	39900049
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BILE ACIDS;TOTAL

Facility

$121.00

Service Code	HCPCS 82239
Hospital Charge Code	38477144
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$18.15

Know your out-of-pocket cost for care.

All Charges