Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CH LEVEL 5 - GROSS & MICRO

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	397061023
Hospital Revenue Code	310
Min. Negotiated Rate	$31.21
Max. Negotiated Rate	$1,544.73
Rate for Payer: Aetna Commercial	$1,158.28
Rate for Payer: Aetna Medicare Advantage	$1,379.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,544.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,544.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$425.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,544.73
Rate for Payer: Cigna Commercial	$853.60
Rate for Payer: Cigna Medicare Advantage	$425.84
Rate for Payer: Clover Medicare Advantage	$404.55
Rate for Payer: EmblemHealth Commercial	$1,277.52
Rate for Payer: Humana Medicare Advantage	$438.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$425.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$285.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$164.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$235.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$425.84
Rate for Payer: Wellcare Medicare Advantage	$425.84
Rate for Payer: Wellpoint Medicaid Managed Care	$31.21

CH LEVEL 5 - GROSS & MICRO

Facility

$1,099.00

Service Code	HCPCS 88307
Hospital Charge Code	397061023
Hospital Revenue Code	310
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$164.85
Rate for Payer: Qualcare PPO/HMO/WC	$164.85

CH LEVEL 5-GROSS & MICRO-ADD

Facility

$551.00

Service Code	HCPCS 8830791
Hospital Charge Code	397061087
Hospital Revenue Code	310
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$275.50
Rate for Payer: Aetna Commercial	$209.38
Rate for Payer: Aetna Medicare Advantage	$165.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.50
Rate for Payer: Cigna Commercial	$275.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.26
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$17.41
Rate for Payer: Wellpoint Medicaid Managed Care	$15.65

CH LEVEL 5-GROSS & MICRO-ADD

Facility

$551.00

Service Code	HCPCS 8830791
Hospital Charge Code	397061087
Hospital Revenue Code	310
Min. Negotiated Rate	$82.65
Max. Negotiated Rate	$82.65
Rate for Payer: Qualcare PPO/HMO/WC	$82.65

CH LEVEL 6 - GROSS & MICRO

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	397061024
Hospital Revenue Code	310
Min. Negotiated Rate	$62.03
Max. Negotiated Rate	$3,472.13
Rate for Payer: Aetna Commercial	$2,603.50
Rate for Payer: Aetna Medicare Advantage	$3,101.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,472.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,472.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$957.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,472.13
Rate for Payer: Cigna Commercial	$1,918.64
Rate for Payer: Cigna Medicare Advantage	$957.17
Rate for Payer: Clover Medicare Advantage	$909.31
Rate for Payer: EmblemHealth Commercial	$2,871.51
Rate for Payer: Humana Medicare Advantage	$985.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$957.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$567.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$327.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$352.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$957.17
Rate for Payer: Wellcare Medicare Advantage	$957.17
Rate for Payer: Wellpoint Medicaid Managed Care	$62.03

CH LEVEL 6 - GROSS & MICRO

Facility

$2,184.00

Service Code	HCPCS 88309
Hospital Charge Code	397061024
Hospital Revenue Code	310
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$327.60
Rate for Payer: Qualcare PPO/HMO/WC	$327.60

CH LIPASE, PLEURAL FLUID

Facility

$462.12

Service Code	HCPCS 83690
Hospital Charge Code	397071454
Hospital Revenue Code	301
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$231.06
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare Advantage	$22.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$231.06
Rate for Payer: Cigna Medicare Advantage	$6.89
Rate for Payer: Clover Medicare Advantage	$6.55
Rate for Payer: EmblemHealth Commercial	$20.67
Rate for Payer: Humana Medicare Advantage	$7.10
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.15
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.32
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.89
Rate for Payer: Wellcare Medicare Advantage	$6.89
Rate for Payer: Wellpoint Medicaid Managed Care	$13.12

CH LIPASE, PLEURAL FLUID

Facility

$462.12

Service Code	HCPCS 83690
Hospital Charge Code	397071454
Hospital Revenue Code	301
Min. Negotiated Rate	$69.32
Max. Negotiated Rate	$69.32
Rate for Payer: Qualcare PPO/HMO/WC	$69.32

CHLMYD TRACH DNA AMP PROBE

Facility

$82.95

Service Code	HCPCS 87491
Hospital Charge Code	401910123A
Hospital Revenue Code	306
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$41.48
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.44
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

CHLMYD TRACH DNA AMP PROBE

Facility

$82.95

Service Code	HCPCS 87491
Hospital Charge Code	401910123A
Hospital Revenue Code	306
Min. Negotiated Rate	$12.44
Max. Negotiated Rate	$12.44
Rate for Payer: Qualcare PPO/HMO/WC	$12.44

CHLORAL HYDRATE 5ML

Facility

$8.24

Service Code	NDC 51552052806
Hospital Charge Code	60635072
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.24

CHLORAL HYDRATE 5ML

Facility

$8.24

Service Code	NDC 51552052806
Hospital Charge Code	60635072
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare Advantage	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.10
Rate for Payer: Cigna Commercial	$4.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.14
Rate for Payer: Oxford Commercial	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.24
Rate for Payer: UnitedHealthcare Commercial	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.26
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

CHLORAMBUCIL 2 MG TAB

Facility

$85.83

Service Code	NDC 76388063550
Hospital Charge Code	60627368
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$42.91
Rate for Payer: Aetna Commercial	$32.62
Rate for Payer: Aetna Medicare Advantage	$25.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.89
Rate for Payer: Cigna Commercial	$42.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.32
Rate for Payer: Oxford Commercial	$17.17
Rate for Payer: Qualcare PPO/HMO/WC	$12.87
Rate for Payer: UnitedHealthcare Commercial	$17.17
Rate for Payer: UnitedHealthcare Community & State	$2.71
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

CHLORAMBUCIL 2 MG TAB

Facility

$85.83

Service Code	NDC 76388063550
Hospital Charge Code	60627368
Hospital Revenue Code	250
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$12.87
Rate for Payer: Qualcare PPO/HMO/WC	$12.87

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.63

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289S
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$2.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.63

CHLORAPREP 10.5 ML APPLICATOR

Facility

$18.17

Hospital Charge Code	270643289N
Hospital Revenue Code	270
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.73

CHLORAPREP 10.5 ML APPLICATOR

Facility

$18.17

Hospital Charge Code	270643289N
Hospital Revenue Code	270
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.09
Rate for Payer: Aetna Commercial	$6.90
Rate for Payer: Aetna Medicare Advantage	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.63
Rate for Payer: Cigna Commercial	$9.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.72
Rate for Payer: Oxford Commercial	$3.63
Rate for Payer: Qualcare PPO/HMO/WC	$2.73
Rate for Payer: UnitedHealthcare Commercial	$3.63
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289
Hospital Revenue Code	270
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.77
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: Aetna Medicare Advantage	$5.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.47
Rate for Payer: Cigna Commercial	$8.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Oxford Commercial	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.63
Rate for Payer: UnitedHealthcare Commercial	$3.51
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

CHLORAPREP 10.5 ML APPLICATOR

Facility

$17.53

Hospital Charge Code	270643289S
Hospital Revenue Code	270
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.77
Rate for Payer: Aetna Commercial	$6.66
Rate for Payer: Aetna Medicare Advantage	$5.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.47
Rate for Payer: Cigna Commercial	$8.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.56
Rate for Payer: Oxford Commercial	$3.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.63
Rate for Payer: UnitedHealthcare Commercial	$3.51
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

CHLORAPREP 1 STEP

Facility

$372.10

Hospital Charge Code	270652026
Hospital Revenue Code	272
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$55.81
Rate for Payer: Qualcare PPO/HMO/WC	$55.81

CHLORAPREP 1 STEP

Facility

$372.10

Hospital Charge Code	270652026
Hospital Revenue Code	272
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$186.05
Rate for Payer: Aetna Commercial	$141.40
Rate for Payer: Aetna Medicare Advantage	$111.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.89
Rate for Payer: Cigna Commercial	$186.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.75
Rate for Payer: Oxford Commercial	$74.42
Rate for Payer: Qualcare PPO/HMO/WC	$55.81
Rate for Payer: UnitedHealthcare Commercial	$74.42
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: Wellpoint Medicaid Managed Care	$10.57

CHLORAPREP ORNG 26 APPL 260815

Facility

$31.99

Hospital Charge Code	270301990C
Hospital Revenue Code	270
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$15.99
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$15.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

CHLORAPREP ORNG 26 APPL 260815

Facility

$31.99

Hospital Charge Code	270301990C
Hospital Revenue Code	270
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

CHLORAPREP ORNG TINT APPL 26ml

Facility

$778.75

Hospital Charge Code	270301990
Hospital Revenue Code	270
Min. Negotiated Rate	$22.12
Max. Negotiated Rate	$389.38
Rate for Payer: Aetna Commercial	$295.93
Rate for Payer: Aetna Medicare Advantage	$233.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.58
Rate for Payer: Cigna Commercial	$389.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$202.47
Rate for Payer: Oxford Commercial	$155.75
Rate for Payer: Qualcare PPO/HMO/WC	$116.81
Rate for Payer: UnitedHealthcare Commercial	$155.75
Rate for Payer: UnitedHealthcare Community & State	$24.61
Rate for Payer: Wellpoint Medicaid Managed Care	$22.12

Know your out-of-pocket cost for care.

All Charges