Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BOOT LEG FLUID PROTECTION

Facility

$106.00

Hospital Charge Code	270335514
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

BOOT MULTIPODOUS LG 303404306D

Facility

$242.50

Hospital Charge Code	270302905
Hospital Revenue Code	272
Min. Negotiated Rate	$36.38
Max. Negotiated Rate	$36.38
Rate for Payer: Qualcare PPO/HMO/WC	$36.38

BOOT MULTIPODOUS LG 303404306D

Facility

$242.50

Hospital Charge Code	270302905
Hospital Revenue Code	272
Min. Negotiated Rate	$6.89
Max. Negotiated Rate	$121.25
Rate for Payer: Aetna Commercial	$92.15
Rate for Payer: Aetna Medicare Advantage	$72.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.84
Rate for Payer: Cigna Commercial	$121.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.05
Rate for Payer: Oxford Commercial	$48.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.38
Rate for Payer: UnitedHealthcare Commercial	$48.50
Rate for Payer: UnitedHealthcare Community & State	$7.66
Rate for Payer: Wellpoint Medicaid Managed Care	$6.89

BOOT MULTIPODUS SMALL 430B

Facility

$320.00

Service Code	HCPCS L4396
Hospital Charge Code	270612640
Hospital Revenue Code	274
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$77.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: Qualcare PPO/HMO/WC	$48.00

BOOT MULTIPODUS SMALL 430B

Facility

$320.00

Service Code	HCPCS L4396
Hospital Charge Code	270612640
Hospital Revenue Code	274
Min. Negotiated Rate	$9.09
Max. Negotiated Rate	$160.00
Rate for Payer: Aetna Commercial	$121.60
Rate for Payer: Aetna Medicare Advantage	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.60
Rate for Payer: Cigna Commercial	$160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.44
Rate for Payer: Qualcare PPO/HMO/WC	$48.00
Rate for Payer: UnitedHealthcare Community & State	$10.11
Rate for Payer: Wellpoint Medicaid Managed Care	$9.09

BOOT REGULAR TCC-EX

Facility

$351.75

Hospital Charge Code	270639683
Hospital Revenue Code	270
Min. Negotiated Rate	$9.99
Max. Negotiated Rate	$175.88
Rate for Payer: Aetna Commercial	$133.66
Rate for Payer: Aetna Medicare Advantage	$105.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.70
Rate for Payer: Cigna Commercial	$175.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.45
Rate for Payer: Oxford Commercial	$70.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.76
Rate for Payer: UnitedHealthcare Commercial	$70.35
Rate for Payer: UnitedHealthcare Community & State	$11.12
Rate for Payer: Wellpoint Medicaid Managed Care	$9.99

BOOT REGULAR TCC-EX

Facility

$351.75

Hospital Charge Code	270639683
Hospital Revenue Code	270
Min. Negotiated Rate	$52.76
Max. Negotiated Rate	$52.76
Rate for Payer: Qualcare PPO/HMO/WC	$52.76

BOOT UNNA W/ZINC 3 GL30001

Facility

$28.08

Hospital Charge Code	270639056
Hospital Revenue Code	270
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.04
Rate for Payer: Aetna Commercial	$10.67
Rate for Payer: Aetna Medicare Advantage	$8.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.16
Rate for Payer: Cigna Commercial	$14.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.30
Rate for Payer: Oxford Commercial	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$4.21
Rate for Payer: UnitedHealthcare Commercial	$5.62
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

BOOT UNNA W/ZINC 3 GL30001

Facility

$28.08

Hospital Charge Code	270639056
Hospital Revenue Code	270
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$4.21
Rate for Payer: Qualcare PPO/HMO/WC	$4.21

BOOT UNNA W/ZINC 4 GL4001

Facility

$32.69

Hospital Charge Code	270639053
Hospital Revenue Code	270
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$4.90
Rate for Payer: Qualcare PPO/HMO/WC	$4.90

BOOT UNNA W/ZINC 4 GL4001

Facility

$32.69

Hospital Charge Code	270639053
Hospital Revenue Code	270
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$16.34
Rate for Payer: Aetna Commercial	$12.42
Rate for Payer: Aetna Medicare Advantage	$9.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.34
Rate for Payer: Cigna Commercial	$16.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$6.54
Rate for Payer: Qualcare PPO/HMO/WC	$4.90
Rate for Payer: UnitedHealthcare Commercial	$6.54
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

BORDETELLA PERTUSIS CULT

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475102
Hospital Revenue Code	306
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$174.50
Rate for Payer: Aetna Commercial	$23.45
Rate for Payer: Aetna Medicare Advantage	$27.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.27
Rate for Payer: Cigna Commercial	$174.50
Rate for Payer: Cigna Medicare Advantage	$8.62
Rate for Payer: Clover Medicare Advantage	$8.19
Rate for Payer: EmblemHealth Commercial	$25.86
Rate for Payer: Humana Medicare Advantage	$8.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.62
Rate for Payer: Wellcare Medicare Advantage	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$9.91

BORDETELLA PERTUSIS CULT

Facility

$349.00

Service Code	HCPCS 87070
Hospital Charge Code	38475102
Hospital Revenue Code	306
Min. Negotiated Rate	$52.35
Max. Negotiated Rate	$52.35
Rate for Payer: Qualcare PPO/HMO/WC	$52.35

BORDETELLA PERTUSSIS ANTIBODY

Facility

$175.00

Service Code	HCPCS 86615
Hospital Charge Code	38472905
Hospital Revenue Code	302
Min. Negotiated Rate	$4.97
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
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	$47.85
Rate for Payer: Cigna Commercial	$87.50
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$4.97

BORDETELLA PERTUSSIS ANTIBODY

Facility

$175.00

Service Code	HCPCS 86615
Hospital Charge Code	38472905
Hospital Revenue Code	302
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Qualcare PPO/HMO/WC	$26.25

BORDETELLA PERTUSSIS CULT

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	39900265
Hospital Revenue Code	309
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.03
Rate for Payer: Aetna Medicare Advantage	$21.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.05
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.63
Rate for Payer: Clover Medicare Advantage	$6.30
Rate for Payer: EmblemHealth Commercial	$19.89
Rate for Payer: Humana Medicare Advantage	$6.83
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.63
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	$5.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.63
Rate for Payer: Wellcare Medicare Advantage	$6.63
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

BORDETELLA PERTUSSIS CULT

Facility

$390.00

Service Code	HCPCS 87081
Hospital Charge Code	39900265
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

BORTEZOMIB 3.5 MG VIAL

Facility

$12,888.12

Service Code	HCPCS J9041
Hospital Charge Code	60629319
Hospital Revenue Code	636
Min. Negotiated Rate	$1,933.22
Max. Negotiated Rate	$3,118.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,118.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.22

BORTEZOMIB 3.5 MG VIAL

Facility

$12,888.12

Service Code	HCPCS J9041
Hospital Charge Code	60629319
Hospital Revenue Code	636
Min. Negotiated Rate	$366.02
Max. Negotiated Rate	$6,444.06
Rate for Payer: Aetna Commercial	$4,897.49
Rate for Payer: Aetna Medicare Advantage	$3,866.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,286.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,286.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,286.47
Rate for Payer: Cigna Commercial	$6,444.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,118.93
Rate for Payer: Qualcare PPO/HMO/WC	$1,933.22
Rate for Payer: UnitedHealthcare Community & State	$407.26
Rate for Payer: Wellpoint Medicaid Managed Care	$366.02

BOTOX 200 UNIT VIAL

Facility

$8,972.64

Service Code	HCPCS J0585
Hospital Charge Code	60635895
Hospital Revenue Code	636
Min. Negotiated Rate	$1,345.90
Max. Negotiated Rate	$2,171.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.90

BOTOX 200 UNIT VIAL

Facility

$8,972.64

Service Code	HCPCS J0585
Hospital Charge Code	60635895
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$2,171.38
Rate for Payer: Aetna Commercial	$17.71
Rate for Payer: Aetna Medicare Advantage	$21.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.62
Rate for Payer: Cigna Medicare Advantage	$6.51
Rate for Payer: Clover Medicare Advantage	$6.18
Rate for Payer: EmblemHealth Commercial	$19.53
Rate for Payer: Humana Medicare Advantage	$6.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,345.90
Rate for Payer: UnitedHealthcare Community & State	$283.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.51
Rate for Payer: Wellcare Medicare Advantage	$6.51
Rate for Payer: Wellpoint Medicaid Managed Care	$254.82

BOTTLE HOT WATER PERS DISP

Facility

$29.65

Hospital Charge Code	270300426
Hospital Revenue Code	272
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Qualcare PPO/HMO/WC	$4.45

BOTTLE HOT WATER PERS DISP

Facility

$29.65

Hospital Charge Code	270300426
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$14.82
Rate for Payer: Aetna Commercial	$11.27
Rate for Payer: Aetna Medicare Advantage	$8.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.56
Rate for Payer: Cigna Commercial	$14.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.71
Rate for Payer: Oxford Commercial	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.45
Rate for Payer: UnitedHealthcare Commercial	$5.93
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$0.84

BOTTLE SPRAY FILM BARRIER 28ml

Facility

$37.13

Hospital Charge Code	270641452
Hospital Revenue Code	270
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$18.57
Rate for Payer: Aetna Commercial	$14.11
Rate for Payer: Aetna Medicare Advantage	$11.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.47
Rate for Payer: Cigna Commercial	$18.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.65
Rate for Payer: Oxford Commercial	$7.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.57
Rate for Payer: UnitedHealthcare Commercial	$7.43
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

BOTTLE SPRAY FILM BARRIER 28ml

Facility

$37.13

Hospital Charge Code	270641452
Hospital Revenue Code	270
Min. Negotiated Rate	$5.57
Max. Negotiated Rate	$5.57
Rate for Payer: Qualcare PPO/HMO/WC	$5.57

Know your out-of-pocket cost for care.

All Charges