Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CAPTOPRIL 12.5MG TAB

Facility

$44.70

Hospital Charge Code	6063943072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$22.35
Rate for Payer: Aetna Commercial	$16.99
Rate for Payer: Aetna Medicare Advantage	$13.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.40
Rate for Payer: Cigna Commercial	$22.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.62
Rate for Payer: Oxford Commercial	$8.94
Rate for Payer: Qualcare PPO/HMO/WC	$6.71
Rate for Payer: UnitedHealthcare Commercial	$8.94
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

CAPTOPRIL 50MG TAB

Facility

$42.10

Hospital Charge Code	6063943074
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$16.00
Rate for Payer: Aetna Medicare Advantage	$12.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.74
Rate for Payer: Cigna Commercial	$21.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.95
Rate for Payer: Oxford Commercial	$8.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$8.42
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

CAPTOPRIL 50MG TAB

Facility

$42.10

Hospital Charge Code	6063943074
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

CAP TRILOCK HIP 44MM LP

Facility

$4,750.00

Hospital Charge Code	270655467
Hospital Revenue Code	278
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

CAP TRILOCK HIP 44MM LP

Facility

$4,750.00

Hospital Charge Code	270655467
Hospital Revenue Code	278
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$2,375.00
Rate for Payer: Aetna Commercial	$1,805.00
Rate for Payer: Aetna Medicare Advantage	$1,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,211.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,211.25
Rate for Payer: Cigna Commercial	$2,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

CARBAMAZEPINE 100 MG/5 ML SUSP

Facility

$6.57

Service Code	NDC 51672404704
Hospital Charge Code	60628753
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna Commercial	$2.50
Rate for Payer: Aetna Medicare Advantage	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.68
Rate for Payer: Cigna Commercial	$3.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.71
Rate for Payer: Oxford Commercial	$1.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$1.31
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

CARBAMAZEPINE 100 MG/5 ML SUSP

Facility

$6.57

Service Code	NDC 51672404704
Hospital Charge Code	60628753
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

CARBAMAZEPINE 100 MG CHEW TAB

Facility

$4.42

Service Code	NDC 51672404101
Hospital Charge Code	60627746
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.15
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

CARBAMAZEPINE 100 MG CHEW TAB

Facility

$4.42

Service Code	NDC 51672404101
Hospital Charge Code	60627746
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

CARBAMAZEPINE 200 MG TAB

Facility

$13.94

Service Code	NDC 78050905
Hospital Charge Code	6023162
Hospital Revenue Code	251
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$6.97
Rate for Payer: Aetna Commercial	$5.30
Rate for Payer: Aetna Medicare Advantage	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.55
Rate for Payer: Cigna Commercial	$6.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.62
Rate for Payer: Oxford Commercial	$2.79
Rate for Payer: Qualcare PPO/HMO/WC	$2.09
Rate for Payer: UnitedHealthcare Commercial	$2.79
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

CARBAMAZEPINE 200 MG TAB

Facility

$13.94

Service Code	NDC 78050905
Hospital Charge Code	6023162
Hospital Revenue Code	251
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$2.09

CARBAMAZEPINE FREE,LC/MS/MS

Facility

$90.30

Service Code	HCPCS 80157
Hospital Charge Code	3970738
Hospital Revenue Code	306
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.06
Rate for Payer: Cigna Commercial	$45.15
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.48
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.54
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CARBAMAZEPINE FREE,LC/MS/MS

Facility

$90.30

Service Code	HCPCS 80157
Hospital Charge Code	3970738
Hospital Revenue Code	306
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$13.54
Rate for Payer: Qualcare PPO/HMO/WC	$13.54

CARBAMAZEPINE (TEGRETOL)

Facility

$339.00

Service Code	HCPCS 80156
Hospital Charge Code	38472158
Hospital Revenue Code	301
Min. Negotiated Rate	$50.85
Max. Negotiated Rate	$50.85
Rate for Payer: Qualcare PPO/HMO/WC	$50.85

CARBAMAZEPINE (TEGRETOL)

Facility

$339.00

Service Code	HCPCS 80156
Hospital Charge Code	38472158
Hospital Revenue Code	301
Min. Negotiated Rate	$9.63
Max. Negotiated Rate	$169.50
Rate for Payer: Aetna Commercial	$39.63
Rate for Payer: Aetna Medicare Advantage	$47.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$169.50
Rate for Payer: Cigna Medicare Advantage	$14.57
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$88.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$50.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.57
Rate for Payer: Wellcare Medicare Advantage	$14.57
Rate for Payer: Wellpoint Medicaid Managed Care	$9.63

CARBAMAZEPINE TEGRETOL

Facility

$390.00

Service Code	HCPCS 80156
Hospital Charge Code	3006376
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARBAMAZEPINE TEGRETOL

Facility

$390.00

Service Code	HCPCS 80156
Hospital Charge Code	3006376
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$39.63
Rate for Payer: Aetna Medicare Advantage	$47.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$14.57
Rate for Payer: Clover Medicare Advantage	$13.84
Rate for Payer: EmblemHealth Commercial	$43.71
Rate for Payer: Humana Medicare Advantage	$15.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.57
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	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.57
Rate for Payer: Wellcare Medicare Advantage	$14.57
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CARBAMIDE PEROXIDE 15 ML SOL

Facility

$16.62

Service Code	NDC 904322035
Hospital Charge Code	60628085
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.31
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: Aetna Medicare Advantage	$4.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.24
Rate for Payer: Cigna Commercial	$8.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.32
Rate for Payer: Oxford Commercial	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$2.49
Rate for Payer: UnitedHealthcare Commercial	$3.32
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

CARBAMIDE PEROXIDE 15 ML SOL

Facility

$16.62

Service Code	NDC 904322035
Hospital Charge Code	60628085
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$2.49

CARBIDE CUTTER BUR AM-52

Facility

$357.00

Hospital Charge Code	270335565
Hospital Revenue Code	272
Min. Negotiated Rate	$53.55
Max. Negotiated Rate	$53.55
Rate for Payer: Qualcare PPO/HMO/WC	$53.55

CARBIDE CUTTER BUR AM-52

Facility

$357.00

Hospital Charge Code	270335565
Hospital Revenue Code	272
Min. Negotiated Rate	$10.14
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$135.66
Rate for Payer: Aetna Medicare Advantage	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.03
Rate for Payer: Cigna Commercial	$178.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.82
Rate for Payer: Oxford Commercial	$71.40
Rate for Payer: Qualcare PPO/HMO/WC	$53.55
Rate for Payer: UnitedHealthcare Commercial	$71.40
Rate for Payer: UnitedHealthcare Community & State	$11.28
Rate for Payer: Wellpoint Medicaid Managed Care	$10.14

CARBIDE DRILL 3MM

Facility

$1,075.00

Hospital Charge Code	270690527
Hospital Revenue Code	272
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$279.50
Rate for Payer: Oxford Commercial	$215.00
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Commercial	$215.00
Rate for Payer: UnitedHealthcare Community & State	$33.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.53

CARBIDE DRILL 3MM

Facility

$1,075.00

Hospital Charge Code	270690527
Hospital Revenue Code	272
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$161.25
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

CARBIDOPA/LEVODOPA 48.7-195MG

Facility

$54.35

Hospital Charge Code	606390046
Hospital Revenue Code	250
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$27.18
Rate for Payer: Aetna Commercial	$20.65
Rate for Payer: Aetna Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.86
Rate for Payer: Cigna Commercial	$27.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.13
Rate for Payer: Oxford Commercial	$10.87
Rate for Payer: Qualcare PPO/HMO/WC	$8.15
Rate for Payer: UnitedHealthcare Commercial	$10.87
Rate for Payer: UnitedHealthcare Community & State	$1.72
Rate for Payer: Wellpoint Medicaid Managed Care	$1.54

CARBIDOPA/LEVODOPA 48.7-195MG

Facility

$54.35

Hospital Charge Code	606390046
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$8.15
Rate for Payer: Qualcare PPO/HMO/WC	$8.15

Know your out-of-pocket cost for care.

All Charges