Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VAGINAL HYSTERECTOMY =<250 GM

Facility

$42,695.42

Service Code	HCPCS 58260
Hospital Charge Code	1600000861
Hospital Revenue Code	360
Min. Negotiated Rate	$1,212.55
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11,100.81
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,404.31
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$1,349.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04
Rate for Payer: Wellpoint Medicaid Managed Care	$1,212.55

VAGINAL HYSTERECTOMY =<250 GM

Facility

$42,695.42

Service Code	HCPCS 58260
Hospital Charge Code	1600000861
Hospital Revenue Code	360
Min. Negotiated Rate	$6,404.31
Max. Negotiated Rate	$6,404.31
Rate for Payer: Qualcare PPO/HMO/WC	$6,404.31

VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)

Facility

$21,558.38

Service Code	CPT 58262
Hospital Revenue Code	360
Min. Negotiated Rate	$3,536.00
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04

VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$21,558.38

Service Code	CPT 58291
Hospital Revenue Code	360
Min. Negotiated Rate	$3,536.00
Max. Negotiated Rate	$21,558.38
Rate for Payer: Aetna Commercial	$16,165.07
Rate for Payer: Aetna Medicare Advantage	$19,255.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,558.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,943.04
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	$21,558.38
Rate for Payer: Cigna Commercial	$11,912.81
Rate for Payer: Cigna Medicare Advantage	$5,943.04
Rate for Payer: Clover Medicare Advantage	$5,645.89
Rate for Payer: EmblemHealth Commercial	$17,829.12
Rate for Payer: Humana Medicare Advantage	$6,121.33
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,943.04
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,943.04
Rate for Payer: Wellcare Medicare Advantage	$5,943.04

VALACYCLOVIR 500 MG TAB

Facility

$66.26

Service Code	NDC 173093308
Hospital Charge Code	60628874
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$33.13
Rate for Payer: Aetna Commercial	$25.18
Rate for Payer: Aetna Medicare Advantage	$19.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.90
Rate for Payer: Cigna Commercial	$33.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.23
Rate for Payer: Oxford Commercial	$13.25
Rate for Payer: Qualcare PPO/HMO/WC	$9.94
Rate for Payer: UnitedHealthcare Commercial	$13.25
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

VALACYCLOVIR 500 MG TAB

Facility

$66.26

Service Code	NDC 173093308
Hospital Charge Code	60628874
Hospital Revenue Code	250
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$9.94
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

VALACYCLOVIR (VALTREX) 1000MG

Facility

$82.95

Service Code	NDC 65862044930
Hospital Charge Code	60630148
Hospital Revenue Code	250
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$41.48
Rate for Payer: Aetna Commercial	$31.52
Rate for Payer: Aetna Medicare Advantage	$24.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.15
Rate for Payer: Cigna Commercial	$41.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.57
Rate for Payer: Oxford Commercial	$16.59
Rate for Payer: Qualcare PPO/HMO/WC	$12.44
Rate for Payer: UnitedHealthcare Commercial	$16.59
Rate for Payer: UnitedHealthcare Community & State	$2.62
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

VALACYCLOVIR (VALTREX) 1000MG

Facility

$82.95

Service Code	NDC 65862044930
Hospital Charge Code	60630148
Hospital Revenue Code	250
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$12.44
Rate for Payer: Qualcare PPO/HMO/WC	$12.44

VALGANCICLOVIR 450 MG TAB

Facility

$517.78

Service Code	NDC 4003822
Hospital Charge Code	60629946
Hospital Revenue Code	250
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$258.89
Rate for Payer: Aetna Commercial	$196.76
Rate for Payer: Aetna Medicare Advantage	$155.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.03
Rate for Payer: Cigna Commercial	$258.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.62
Rate for Payer: Oxford Commercial	$103.56
Rate for Payer: Qualcare PPO/HMO/WC	$77.67
Rate for Payer: UnitedHealthcare Commercial	$103.56
Rate for Payer: UnitedHealthcare Community & State	$16.36
Rate for Payer: Wellpoint Medicaid Managed Care	$14.70

VALGANCICLOVIR 450 MG TAB

Facility

$517.78

Service Code	NDC 4003822
Hospital Charge Code	60629946
Hospital Revenue Code	250
Min. Negotiated Rate	$77.67
Max. Negotiated Rate	$77.67
Rate for Payer: Qualcare PPO/HMO/WC	$77.67

VALOR NAIL, RIGHT

Facility

$13,895.00

Hospital Charge Code	270702424
Hospital Revenue Code	278
Min. Negotiated Rate	$2,084.25
Max. Negotiated Rate	$3,362.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,779.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,362.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,084.25

VALOR NAIL, RIGHT

Facility

$13,895.00

Hospital Charge Code	270702424
Hospital Revenue Code	278
Min. Negotiated Rate	$394.62
Max. Negotiated Rate	$6,947.50
Rate for Payer: Aetna Commercial	$5,280.10
Rate for Payer: Aetna Medicare Advantage	$4,168.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,543.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,543.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,779.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,543.22
Rate for Payer: Cigna Commercial	$6,947.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,362.59
Rate for Payer: Qualcare PPO/HMO/WC	$2,084.25
Rate for Payer: UnitedHealthcare Community & State	$439.08
Rate for Payer: Wellpoint Medicaid Managed Care	$394.62

VALPROIC ACID 250MG/5ML 16OZ

Facility

$5.16

Service Code	NDC 121067516
Hospital Charge Code	6005581
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$1.96
Rate for Payer: Aetna Medicare Advantage	$1.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.32
Rate for Payer: Cigna Commercial	$2.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.34
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.03
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

VALPROIC ACID 250MG/5ML 16OZ

Facility

$5.16

Service Code	NDC 121067516
Hospital Charge Code	6005581
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

VALPROIC ACID 250MG/5ML SYRUP

Facility

$14.47

Service Code	NDC 121467505
Hospital Charge Code	60632173
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

VALPROIC ACID 250MG/5ML SYRUP

Facility

$14.47

Service Code	NDC 121467505
Hospital Charge Code	60632173
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$5.50
Rate for Payer: Aetna Medicare Advantage	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.69
Rate for Payer: Cigna Commercial	$7.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.76
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$2.89
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

VALPROIC ACID 250 MG CAP

Facility

$4.00

Service Code	NDC 51079029808
Hospital Charge Code	60627752
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VALPROIC ACID 250 MG CAP

Facility

$4.00

Service Code	NDC 51079029808
Hospital Charge Code	60627752
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

VALPROIC ACID 500 MG INJ

Facility

$212.73

Service Code	NDC 74156410
Hospital Charge Code	60628777
Hospital Revenue Code	250
Min. Negotiated Rate	$6.04
Max. Negotiated Rate	$106.36
Rate for Payer: Aetna Commercial	$80.84
Rate for Payer: Aetna Medicare Advantage	$63.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.25
Rate for Payer: Cigna Commercial	$106.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.31
Rate for Payer: Oxford Commercial	$42.55
Rate for Payer: Qualcare PPO/HMO/WC	$31.91
Rate for Payer: UnitedHealthcare Commercial	$42.55
Rate for Payer: UnitedHealthcare Community & State	$6.72
Rate for Payer: Wellpoint Medicaid Managed Care	$6.04

VALPROIC ACID 500 MG INJ

Facility

$212.73

Service Code	NDC 74156410
Hospital Charge Code	60628777
Hospital Revenue Code	250
Min. Negotiated Rate	$31.91
Max. Negotiated Rate	$31.91
Rate for Payer: Qualcare PPO/HMO/WC	$31.91

VALPROIC ACID (DEPAKENE)

Facility

$378.00

Service Code	HCPCS 80164
Hospital Charge Code	38472662
Hospital Revenue Code	301
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$56.70
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

VALPROIC ACID (DEPAKENE)

Facility

$378.00

Service Code	HCPCS 80164
Hospital Charge Code	38472662
Hospital Revenue Code	301
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$36.83
Rate for Payer: Aetna Medicare Advantage	$43.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.12
Rate for Payer: Cigna Commercial	$189.00
Rate for Payer: Cigna Medicare Advantage	$13.54
Rate for Payer: Clover Medicare Advantage	$12.86
Rate for Payer: EmblemHealth Commercial	$40.62
Rate for Payer: Humana Medicare Advantage	$13.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.28
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.54
Rate for Payer: Wellcare Medicare Advantage	$13.54
Rate for Payer: Wellpoint Medicaid Managed Care	$10.74

VALPROIC ACID (DEPAKENE)

Facility

$667.59

Service Code	HCPCS 80164
Hospital Charge Code	3031440
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

VALPROIC ACID (DEPAKENE)

Facility

$667.59

Service Code	HCPCS 80164
Hospital Charge Code	3031440
Hospital Revenue Code	301
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.83
Rate for Payer: Aetna Medicare Advantage	$43.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.12
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.54
Rate for Payer: Clover Medicare Advantage	$12.86
Rate for Payer: EmblemHealth Commercial	$40.62
Rate for Payer: Humana Medicare Advantage	$13.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.54
Rate for Payer: Wellcare Medicare Advantage	$13.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

VALPROIC ACID,FREE

Facility

$67.20

Service Code	HCPCS 80164
Hospital Charge Code	39900005
Hospital Revenue Code	301
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$10.08
Rate for Payer: Qualcare PPO/HMO/WC	$10.08

Know your out-of-pocket cost for care.

All Charges