Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CARBIDOPA LEVODPA STRA50-200MG

Facility

$18.89

Service Code	NDC 6391968
Hospital Charge Code	60627869
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$9.45
Rate for Payer: Aetna Commercial	$7.18
Rate for Payer: Aetna Medicare Advantage	$5.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.82
Rate for Payer: Cigna Commercial	$9.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.91
Rate for Payer: Oxford Commercial	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$2.83
Rate for Payer: UnitedHealthcare Commercial	$3.78
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

CARBIDOPA LEVODPA STRA50-200MG

Facility

$18.89

Service Code	NDC 6391968
Hospital Charge Code	60627869
Hospital Revenue Code	250
Min. Negotiated Rate	$2.83
Max. Negotiated Rate	$2.83
Rate for Payer: Qualcare PPO/HMO/WC	$2.83

CARBIDOPA LEVODPA TAB 10-100MG

Facility

$8.11

Service Code	NDC 904771861
Hospital Charge Code	60627865
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.05
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna Medicare Advantage	$2.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.07
Rate for Payer: Cigna Commercial	$4.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.11
Rate for Payer: Oxford Commercial	$1.62
Rate for Payer: Qualcare PPO/HMO/WC	$1.22
Rate for Payer: UnitedHealthcare Commercial	$1.62
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

CARBIDOPA LEVODPA TAB 10-100MG

Facility

$8.11

Service Code	NDC 904771861
Hospital Charge Code	60627865
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$1.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.22

CARBIDOPA LEVODPA TAB 25-100MG

Facility

$8.78

Service Code	NDC 51079097820
Hospital Charge Code	60627867
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.39
Rate for Payer: Aetna Commercial	$3.34
Rate for Payer: Aetna Medicare Advantage	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.24
Rate for Payer: Cigna Commercial	$4.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.28
Rate for Payer: Oxford Commercial	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.32
Rate for Payer: UnitedHealthcare Commercial	$1.76
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

CARBIDOPA LEVODPA TAB 25-100MG

Facility

$8.78

Service Code	NDC 51079097820
Hospital Charge Code	60627867
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.32

CARBIDOPA LEVODPA TAB 25-250MG

Facility

$6.37

Service Code	NDC 68084009401
Hospital Charge Code	60627868
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$0.96
Rate for Payer: Qualcare PPO/HMO/WC	$0.96

CARBIDOPA LEVODPA TAB 25-250MG

Facility

$6.37

Service Code	NDC 68084009401
Hospital Charge Code	60627868
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna Medicare Advantage	$1.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.62
Rate for Payer: Cigna Commercial	$3.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.66
Rate for Payer: Oxford Commercial	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$0.96
Rate for Payer: UnitedHealthcare Commercial	$1.27
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

CARBOCAINE INJ 2%/50ML/VI

Facility

$41.74

Service Code	NDC 409106720
Hospital Charge Code	60634424
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$20.87
Rate for Payer: Aetna Commercial	$15.86
Rate for Payer: Aetna Medicare Advantage	$12.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.64
Rate for Payer: Cigna Commercial	$20.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.85
Rate for Payer: Oxford Commercial	$8.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.26
Rate for Payer: UnitedHealthcare Commercial	$8.35
Rate for Payer: UnitedHealthcare Community & State	$1.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.19

CARBOCAINE INJ 2%/50ML/VI

Facility

$41.74

Service Code	NDC 409106720
Hospital Charge Code	60634424
Hospital Revenue Code	250
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$6.26
Rate for Payer: Qualcare PPO/HMO/WC	$6.26

Carbohydrate Antigen (CA) 19-9

Facility

$667.59

Service Code	HCPCS 86301
Hospital Charge Code	39888023
Hospital Revenue Code	302
Min. Negotiated Rate	$16.65
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$56.60
Rate for Payer: Aetna Medicare Advantage	$67.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.49
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$20.81
Rate for Payer: Clover Medicare Advantage	$19.77
Rate for Payer: EmblemHealth Commercial	$62.43
Rate for Payer: Humana Medicare Advantage	$21.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.81
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	$16.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.81
Rate for Payer: Wellcare Medicare Advantage	$20.81
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

Carbohydrate Antigen (CA) 19-9

Facility

$667.59

Service Code	HCPCS 86301
Hospital Charge Code	39888023
Hospital Revenue Code	302
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

CARBON DIOXIDE, C02

Facility

$390.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CARBON DIOXIDE, C02

Facility

$390.00

Service Code	HCPCS 82374
Hospital Charge Code	3000619
Hospital Revenue Code	301
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$195.00
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	$195.00
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	$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	$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	$11.08

CARBON DIOXIDE (CO 2)

Facility

$83.00

Service Code	HCPCS 82374
Hospital Charge Code	38472161
Hospital Revenue Code	301
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Qualcare PPO/HMO/WC	$12.45

CARBON DIOXIDE (CO 2)

Facility

$83.00

Service Code	HCPCS 82374
Hospital Charge Code	38472161
Hospital Revenue Code	301
Min. Negotiated Rate	$2.36
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	$41.50
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	$21.58
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.45
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	$2.36

CARBON ROD 250MM

Facility

$870.35

Service Code	HCPCS C1713
Hospital Charge Code	270702322
Hospital Revenue Code	278
Min. Negotiated Rate	$24.72
Max. Negotiated Rate	$435.18
Rate for Payer: Aetna Commercial	$330.73
Rate for Payer: Aetna Medicare Advantage	$261.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$221.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$221.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$221.94
Rate for Payer: Cigna Commercial	$435.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.62
Rate for Payer: Qualcare PPO/HMO/WC	$130.55
Rate for Payer: UnitedHealthcare Community & State	$27.50
Rate for Payer: Wellpoint Medicaid Managed Care	$24.72

CARBON ROD 250MM

Facility

$870.35

Service Code	HCPCS C1713
Hospital Charge Code	270702322
Hospital Revenue Code	278
Min. Negotiated Rate	$130.55
Max. Negotiated Rate	$210.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$210.62
Rate for Payer: Qualcare PPO/HMO/WC	$130.55

CARBON ROD 300MM

Facility

$2,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270662420
Hospital Revenue Code	278
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$574.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

CARBON ROD 300MM

Facility

$2,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270662420
Hospital Revenue Code	278
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$574.75
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Community & State	$75.05
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

CARBON ROD 9.5MM X 500MM

Facility

$1,072.50

Service Code	HCPCS C1713
Hospital Charge Code	270686003
Hospital Revenue Code	278
Min. Negotiated Rate	$30.46
Max. Negotiated Rate	$536.25
Rate for Payer: Aetna Commercial	$407.55
Rate for Payer: Aetna Medicare Advantage	$321.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.49
Rate for Payer: Cigna Commercial	$536.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.55
Rate for Payer: Qualcare PPO/HMO/WC	$160.88
Rate for Payer: UnitedHealthcare Community & State	$33.89
Rate for Payer: Wellpoint Medicaid Managed Care	$30.46

CARBON ROD 9.5MM X 500MM

Facility

$1,072.50

Service Code	HCPCS C1713
Hospital Charge Code	270686003
Hospital Revenue Code	278
Min. Negotiated Rate	$160.88
Max. Negotiated Rate	$259.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.55
Rate for Payer: Qualcare PPO/HMO/WC	$160.88

CARBOPROST 250 MCG/ML INJ

Facility

$1,445.32

Service Code	NDC 9085608
Hospital Charge Code	60628519
Hospital Revenue Code	250
Min. Negotiated Rate	$41.05
Max. Negotiated Rate	$722.66
Rate for Payer: Aetna Commercial	$549.22
Rate for Payer: Aetna Medicare Advantage	$433.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$368.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$368.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$368.56
Rate for Payer: Cigna Commercial	$722.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$375.78
Rate for Payer: Oxford Commercial	$289.06
Rate for Payer: Qualcare PPO/HMO/WC	$216.80
Rate for Payer: UnitedHealthcare Commercial	$289.06
Rate for Payer: UnitedHealthcare Community & State	$45.67
Rate for Payer: Wellpoint Medicaid Managed Care	$41.05

CARBOPROST 250 MCG/ML INJ

Facility

$1,445.32

Service Code	NDC 9085608
Hospital Charge Code	60628519
Hospital Revenue Code	250
Min. Negotiated Rate	$216.80
Max. Negotiated Rate	$216.80
Rate for Payer: Qualcare PPO/HMO/WC	$216.80

CARBOXYHEMOGLOBIN

Facility

$84.70

Service Code	HCPCS 82375
Hospital Charge Code	39900054
Hospital Revenue Code	301
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$12.71
Rate for Payer: Qualcare PPO/HMO/WC	$12.71

Know your out-of-pocket cost for care.

All Charges