Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VITAMIN E 100 IU SGL

Facility

$4.00

Service Code	NDC 904027060
Hospital Charge Code	6063943261
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VITAMIN E 400 UNITS CAP

Facility

$4.00

Service Code	NDC 62107006401
Hospital Charge Code	60628724
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

VITAMIN E 400 UNITS CAP

Facility

$4.00

Service Code	NDC 62107006401
Hospital Charge Code	60628724
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VITAMIN K

Facility

$390.00

Service Code	HCPCS 84597
Hospital Charge Code	39900151
Hospital Revenue Code	301
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.32
Rate for Payer: Aetna Medicare Advantage	$44.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.77
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.72
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.72
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	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Medicare Advantage	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VITAMIN K

Facility

$390.00

Service Code	HCPCS 84597
Hospital Charge Code	39900151
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN K

Facility

$96.00

Service Code	HCPCS 84597
Hospital Charge Code	38477118
Hospital Revenue Code	301
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.32
Rate for Payer: Aetna Medicare Advantage	$44.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$29.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.77
Rate for Payer: Cigna Commercial	$48.00
Rate for Payer: Cigna Medicare Advantage	$13.72
Rate for Payer: Clover Medicare Advantage	$13.03
Rate for Payer: EmblemHealth Commercial	$41.16
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.72
Rate for Payer: Wellcare Medicare Advantage	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.73

VITAMIN K

Facility

$96.00

Service Code	HCPCS 84597
Hospital Charge Code	38477118
Hospital Revenue Code	301
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$14.40

VITAMIN, NOS

Facility

$82.00

Service Code	HCPCS 84591
Hospital Charge Code	38477102
Hospital Revenue Code	301
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$46.40
Rate for Payer: Aetna Medicare Advantage	$55.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.89
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: Cigna Medicare Advantage	$17.06
Rate for Payer: Clover Medicare Advantage	$16.21
Rate for Payer: EmblemHealth Commercial	$51.18
Rate for Payer: Humana Medicare Advantage	$17.57
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.06
Rate for Payer: Wellcare Medicare Advantage	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

VITAMIN, NOS

Facility

$82.00

Service Code	HCPCS 84591
Hospital Charge Code	38477102
Hospital Revenue Code	301
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

VITAMINS A, D OINT UD

Facility

$4.00

Service Code	NDC 168003545
Hospital Charge Code	60628432
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VITAMINS A, D OINT UD

Facility

$4.00

Service Code	NDC 168003545
Hospital Charge Code	60628432
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

VIT B12

Facility

$380.80

Service Code	HCPCS 82607
Hospital Charge Code	38479002
Hospital Revenue Code	301
Min. Negotiated Rate	$57.12
Max. Negotiated Rate	$57.12
Rate for Payer: Qualcare PPO/HMO/WC	$57.12

VIT B12

Facility

$380.80

Service Code	HCPCS 82607
Hospital Charge Code	38479002
Hospital Revenue Code	301
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$190.40
Rate for Payer: Aetna Commercial	$41.02
Rate for Payer: Aetna Medicare Advantage	$48.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.70
Rate for Payer: Cigna Commercial	$190.40
Rate for Payer: Cigna Medicare Advantage	$15.08
Rate for Payer: Clover Medicare Advantage	$14.33
Rate for Payer: EmblemHealth Commercial	$45.24
Rate for Payer: Humana Medicare Advantage	$15.53
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.01
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$57.12
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.08
Rate for Payer: Wellcare Medicare Advantage	$15.08
Rate for Payer: Wellpoint Medicaid Managed Care	$10.81

VIT D 1,25-DIHYDROXY

Facility

$264.60

Service Code	HCPCS 82652
Hospital Charge Code	39900073
Hospital Revenue Code	301
Min. Negotiated Rate	$39.69
Max. Negotiated Rate	$39.69
Rate for Payer: Qualcare PPO/HMO/WC	$39.69

VIT D 1,25-DIHYDROXY

Facility

$264.60

Service Code	HCPCS 82652
Hospital Charge Code	39900073
Hospital Revenue Code	301
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$104.72
Rate for Payer: Aetna Medicare Advantage	$124.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$139.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$139.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$139.66
Rate for Payer: Cigna Commercial	$132.30
Rate for Payer: Cigna Medicare Advantage	$38.50
Rate for Payer: Clover Medicare Advantage	$36.58
Rate for Payer: EmblemHealth Commercial	$115.50
Rate for Payer: Humana Medicare Advantage	$39.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.69
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$30.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.50
Rate for Payer: Wellcare Medicare Advantage	$38.50
Rate for Payer: Wellpoint Medicaid Managed Care	$7.51

VITEK CARD GP

Facility

$315.55

Hospital Charge Code	270665946
Hospital Revenue Code	270
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$157.78
Rate for Payer: Aetna Commercial	$119.91
Rate for Payer: Aetna Medicare Advantage	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.47
Rate for Payer: Cigna Commercial	$157.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.04
Rate for Payer: Oxford Commercial	$63.11
Rate for Payer: Qualcare PPO/HMO/WC	$47.33
Rate for Payer: UnitedHealthcare Commercial	$63.11
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8.96

VITEK CARD GP

Facility

$315.55

Hospital Charge Code	270665946
Hospital Revenue Code	270
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$47.33
Rate for Payer: Qualcare PPO/HMO/WC	$47.33

VITEK ID CARD GN

Facility

$315.55

Hospital Charge Code	270665948
Hospital Revenue Code	270
Min. Negotiated Rate	$47.33
Max. Negotiated Rate	$47.33
Rate for Payer: Qualcare PPO/HMO/WC	$47.33

VITEK ID CARD GN

Facility

$315.55

Hospital Charge Code	270665948
Hospital Revenue Code	270
Min. Negotiated Rate	$8.96
Max. Negotiated Rate	$157.78
Rate for Payer: Aetna Commercial	$119.91
Rate for Payer: Aetna Medicare Advantage	$94.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.47
Rate for Payer: Cigna Commercial	$157.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.04
Rate for Payer: Oxford Commercial	$63.11
Rate for Payer: Qualcare PPO/HMO/WC	$47.33
Rate for Payer: UnitedHealthcare Commercial	$63.11
Rate for Payer: UnitedHealthcare Community & State	$9.97
Rate for Payer: Wellpoint Medicaid Managed Care	$8.96

VITEK SENSI CARD GN71

Facility

$357.90

Hospital Charge Code	270665949
Hospital Revenue Code	270
Min. Negotiated Rate	$53.69
Max. Negotiated Rate	$53.69
Rate for Payer: Qualcare PPO/HMO/WC	$53.69

VITEK SENSI CARD GN71

Facility

$357.90

Hospital Charge Code	270665949
Hospital Revenue Code	270
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$178.95
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare Advantage	$107.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.26
Rate for Payer: Cigna Commercial	$178.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.05
Rate for Payer: Oxford Commercial	$71.58
Rate for Payer: Qualcare PPO/HMO/WC	$53.69
Rate for Payer: UnitedHealthcare Commercial	$71.58
Rate for Payer: UnitedHealthcare Community & State	$11.31
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

VITEK SENSI CARD GP67

Facility

$357.90

Hospital Charge Code	270665947
Hospital Revenue Code	270
Min. Negotiated Rate	$53.69
Max. Negotiated Rate	$53.69
Rate for Payer: Qualcare PPO/HMO/WC	$53.69

VITEK SENSI CARD GP67

Facility

$357.90

Hospital Charge Code	270665947
Hospital Revenue Code	270
Min. Negotiated Rate	$10.16
Max. Negotiated Rate	$178.95
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare Advantage	$107.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.26
Rate for Payer: Cigna Commercial	$178.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.05
Rate for Payer: Oxford Commercial	$71.58
Rate for Payer: Qualcare PPO/HMO/WC	$53.69
Rate for Payer: UnitedHealthcare Commercial	$71.58
Rate for Payer: UnitedHealthcare Community & State	$11.31
Rate for Payer: Wellpoint Medicaid Managed Care	$10.16

VITOSS BA2X

Facility

$16,800.00

Hospital Charge Code	270339469
Hospital Revenue Code	278
Min. Negotiated Rate	$2,520.00
Max. Negotiated Rate	$4,065.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,360.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,065.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,520.00

VITOSS BA2X

Facility

$16,800.00

Hospital Charge Code	270339469
Hospital Revenue Code	278
Min. Negotiated Rate	$477.12
Max. Negotiated Rate	$8,400.00
Rate for Payer: Aetna Commercial	$6,384.00
Rate for Payer: Aetna Medicare Advantage	$5,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,284.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,284.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,284.00
Rate for Payer: Cigna Commercial	$8,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,065.60
Rate for Payer: Qualcare PPO/HMO/WC	$2,520.00
Rate for Payer: UnitedHealthcare Community & State	$530.88
Rate for Payer: Wellpoint Medicaid Managed Care	$477.12

Know your out-of-pocket cost for care.

All Charges