Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CEFEPIME (MAXIPIME) 1 G INJ

Facility

$427.06

Service Code	HCPCS J0692
Hospital Charge Code	60628986
Hospital Revenue Code	636
Min. Negotiated Rate	$64.06
Max. Negotiated Rate	$103.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.06

CEFEPIME (MAXIPIME) 1 G INJ

Facility

$427.06

Service Code	HCPCS J0692
Hospital Charge Code	60628986
Hospital Revenue Code	636
Min. Negotiated Rate	$12.13
Max. Negotiated Rate	$213.53
Rate for Payer: Aetna Commercial	$162.28
Rate for Payer: Aetna Medicare Advantage	$128.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.90
Rate for Payer: Cigna Commercial	$213.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.35
Rate for Payer: Qualcare PPO/HMO/WC	$64.06
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: Wellpoint Medicaid Managed Care	$12.13

CEFEPIME (MAXIPIME) 2 G INJ

Facility

$342.37

Service Code	HCPCS J0692
Hospital Charge Code	60628989
Hospital Revenue Code	636
Min. Negotiated Rate	$51.36
Max. Negotiated Rate	$82.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.85
Rate for Payer: Qualcare PPO/HMO/WC	$51.36

CEFEPIME (MAXIPIME) 2 G INJ

Facility

$342.37

Service Code	HCPCS J0692
Hospital Charge Code	60628989
Hospital Revenue Code	636
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$171.19
Rate for Payer: Aetna Commercial	$130.10
Rate for Payer: Aetna Medicare Advantage	$102.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.30
Rate for Payer: Cigna Commercial	$171.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$82.85
Rate for Payer: Qualcare PPO/HMO/WC	$51.36
Rate for Payer: UnitedHealthcare Community & State	$10.82
Rate for Payer: Wellpoint Medicaid Managed Care	$9.72

CEFOXITIN 1G PREMIX

Facility

$82.41

Service Code	HCPCS J0694
Hospital Charge Code	60635576
Hospital Revenue Code	636
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$19.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.94
Rate for Payer: Qualcare PPO/HMO/WC	$12.36

CEFOXITIN 1G PREMIX

Facility

$82.41

Service Code	HCPCS J0694
Hospital Charge Code	60635576
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$41.20
Rate for Payer: Aetna Commercial	$31.32
Rate for Payer: Aetna Medicare Advantage	$24.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.01
Rate for Payer: Cigna Commercial	$41.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.94
Rate for Payer: Qualcare PPO/HMO/WC	$12.36
Rate for Payer: UnitedHealthcare Community & State	$2.60
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

CEFOXITIN 2GM VIAL

Facility

$150.75

Service Code	HCPCS J0694
Hospital Charge Code	60632211
Hospital Revenue Code	636
Min. Negotiated Rate	$22.61
Max. Negotiated Rate	$36.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.61

CEFOXITIN 2GM VIAL

Facility

$150.75

Service Code	HCPCS J0694
Hospital Charge Code	60632211
Hospital Revenue Code	636
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$75.38
Rate for Payer: Aetna Commercial	$57.28
Rate for Payer: Aetna Medicare Advantage	$45.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.44
Rate for Payer: Cigna Commercial	$75.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.48
Rate for Payer: Qualcare PPO/HMO/WC	$22.61
Rate for Payer: UnitedHealthcare Community & State	$4.76
Rate for Payer: Wellpoint Medicaid Managed Care	$4.28

CEFOXITIN 2G PREMIX

Facility

$164.89

Service Code	HCPCS J0694
Hospital Charge Code	60635575
Hospital Revenue Code	636
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$82.44
Rate for Payer: Aetna Commercial	$62.66
Rate for Payer: Aetna Medicare Advantage	$49.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.05
Rate for Payer: Cigna Commercial	$82.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.73
Rate for Payer: UnitedHealthcare Community & State	$5.21
Rate for Payer: Wellpoint Medicaid Managed Care	$4.68

CEFOXITIN 2G PREMIX

Facility

$164.89

Service Code	HCPCS J0694
Hospital Charge Code	60635575
Hospital Revenue Code	636
Min. Negotiated Rate	$24.73
Max. Negotiated Rate	$39.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.73

CEFPODOXIME TAB 200MG

Facility

$56.68

Service Code	NDC 65862009620
Hospital Charge Code	60629250
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$28.34
Rate for Payer: Aetna Commercial	$21.54
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.74
Rate for Payer: Oxford Commercial	$11.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$11.34
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

CEFPODOXIME TAB 200MG

Facility

$56.68

Service Code	NDC 65862009620
Hospital Charge Code	60629250
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

CEFTAZIDIME/AVIBACTAM 2/0.5GM

Facility

$1,710.00

Hospital Charge Code	6063943370
Hospital Revenue Code	250
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna Commercial	$649.80
Rate for Payer: Aetna Medicare Advantage	$513.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$436.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$436.05
Rate for Payer: Cigna Commercial	$855.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.60
Rate for Payer: Oxford Commercial	$342.00
Rate for Payer: Qualcare PPO/HMO/WC	$256.50
Rate for Payer: UnitedHealthcare Commercial	$342.00
Rate for Payer: UnitedHealthcare Community & State	$54.04
Rate for Payer: Wellpoint Medicaid Managed Care	$48.56

CEFTAZIDIME/AVIBACTAM 2/0.5GM

Facility

$1,710.00

Hospital Charge Code	6063943370
Hospital Revenue Code	250
Min. Negotiated Rate	$256.50
Max. Negotiated Rate	$256.50
Rate for Payer: Qualcare PPO/HMO/WC	$256.50

CEFTRIAXONE 1GM/NS 100ML BAG

Facility

$493.66

Service Code	HCPCS J0696
Hospital Charge Code	6001036
Hospital Revenue Code	636
Min. Negotiated Rate	$74.05
Max. Negotiated Rate	$119.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.05

CEFTRIAXONE 1GM/NS 100ML BAG

Facility

$493.66

Service Code	HCPCS J0696
Hospital Charge Code	6001036
Hospital Revenue Code	636
Min. Negotiated Rate	$14.02
Max. Negotiated Rate	$246.83
Rate for Payer: Aetna Commercial	$187.59
Rate for Payer: Aetna Medicare Advantage	$148.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.88
Rate for Payer: Cigna Commercial	$246.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.47
Rate for Payer: Qualcare PPO/HMO/WC	$74.05
Rate for Payer: UnitedHealthcare Community & State	$15.60
Rate for Payer: Wellpoint Medicaid Managed Care	$14.02

CEFTRIAXONE 2 GM/NS 100ML BAG

Facility

$653.25

Service Code	HCPCS J0696
Hospital Charge Code	6001044
Hospital Revenue Code	636
Min. Negotiated Rate	$97.99
Max. Negotiated Rate	$158.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.09
Rate for Payer: Qualcare PPO/HMO/WC	$97.99

CEFTRIAXONE 2 GM/NS 100ML BAG

Facility

$653.25

Service Code	HCPCS J0696
Hospital Charge Code	6001044
Hospital Revenue Code	636
Min. Negotiated Rate	$18.55
Max. Negotiated Rate	$326.62
Rate for Payer: Aetna Commercial	$248.24
Rate for Payer: Aetna Medicare Advantage	$195.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.58
Rate for Payer: Cigna Commercial	$326.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.09
Rate for Payer: Qualcare PPO/HMO/WC	$97.99
Rate for Payer: UnitedHealthcare Community & State	$20.64
Rate for Payer: Wellpoint Medicaid Managed Care	$18.55

CEFTRIAXONE 500MG(ROCEPHIN) VL

Facility

$198.00

Service Code	HCPCS J0696
Hospital Charge Code	83652555
Hospital Revenue Code	636
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$75.24
Rate for Payer: Aetna Medicare Advantage	$59.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.49
Rate for Payer: Cigna Commercial	$99.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.70
Rate for Payer: UnitedHealthcare Community & State	$6.26
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

CEFTRIAXONE 500MG(ROCEPHIN) VL

Facility

$198.00

Service Code	HCPCS J0696
Hospital Charge Code	83652555
Hospital Revenue Code	636
Min. Negotiated Rate	$29.70
Max. Negotiated Rate	$47.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.92
Rate for Payer: Qualcare PPO/HMO/WC	$29.70

CEFTRIAXONE INJ 250 MG

Facility

$106.80

Service Code	HCPCS J0696
Hospital Charge Code	6001028
Hospital Revenue Code	636
Min. Negotiated Rate	$16.02
Max. Negotiated Rate	$25.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.02

CEFTRIAXONE INJ 250 MG

Facility

$106.80

Service Code	HCPCS J0696
Hospital Charge Code	6001028
Hospital Revenue Code	636
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$53.40
Rate for Payer: Aetna Commercial	$40.58
Rate for Payer: Aetna Medicare Advantage	$32.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.23
Rate for Payer: Cigna Commercial	$53.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.85
Rate for Payer: Qualcare PPO/HMO/WC	$16.02
Rate for Payer: UnitedHealthcare Community & State	$3.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.03

CEFTRIAXONE INJ 500MG

Facility

$264.68

Service Code	HCPCS J0696
Hospital Charge Code	6007140
Hospital Revenue Code	636
Min. Negotiated Rate	$39.70
Max. Negotiated Rate	$64.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$39.70

CEFTRIAXONE INJ 500MG

Facility

$264.68

Service Code	HCPCS J0696
Hospital Charge Code	6007140
Hospital Revenue Code	636
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$132.34
Rate for Payer: Aetna Commercial	$100.58
Rate for Payer: Aetna Medicare Advantage	$79.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.49
Rate for Payer: Cigna Commercial	$132.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.05
Rate for Payer: Qualcare PPO/HMO/WC	$39.70
Rate for Payer: UnitedHealthcare Community & State	$8.36
Rate for Payer: Wellpoint Medicaid Managed Care	$7.52

CELEBREX 100 MG U/D CAP

Facility

$37.65

Service Code	NDC 58151008301
Hospital Charge Code	60635325
Hospital Revenue Code	250
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

Know your out-of-pocket cost for care.

All Charges