Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CILOSTAZOL 50 MG TAB UD

Facility

$12.19

Service Code	NDC 185012360
Hospital Charge Code	60629893
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.09
Rate for Payer: Aetna Commercial	$4.63
Rate for Payer: Aetna Medicare Advantage	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.11
Rate for Payer: Cigna Commercial	$6.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.17
Rate for Payer: Oxford Commercial	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$2.44
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

CINACALCET 30 MG TAB

Facility

$147.13

Service Code	NDC 55513007330
Hospital Charge Code	60629919
Hospital Revenue Code	250
Min. Negotiated Rate	$22.07
Max. Negotiated Rate	$22.07
Rate for Payer: Qualcare PPO/HMO/WC	$22.07

CINACALCET 30 MG TAB

Facility

$147.13

Service Code	NDC 55513007330
Hospital Charge Code	60629919
Hospital Revenue Code	250
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$73.56
Rate for Payer: Aetna Commercial	$55.91
Rate for Payer: Aetna Medicare Advantage	$44.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.52
Rate for Payer: Cigna Commercial	$73.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.25
Rate for Payer: Oxford Commercial	$29.43
Rate for Payer: Qualcare PPO/HMO/WC	$22.07
Rate for Payer: UnitedHealthcare Commercial	$29.43
Rate for Payer: UnitedHealthcare Community & State	$4.65
Rate for Payer: Wellpoint Medicaid Managed Care	$4.18

CINCHPAD GEL SINGLE

Facility

$82.00

Hospital Charge Code	270690111
Hospital Revenue Code	272
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$41.00
Rate for Payer: Aetna Commercial	$31.16
Rate for Payer: Aetna Medicare Advantage	$24.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.91
Rate for Payer: Cigna Commercial	$41.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.32
Rate for Payer: Oxford Commercial	$16.40
Rate for Payer: Qualcare PPO/HMO/WC	$12.30
Rate for Payer: UnitedHealthcare Commercial	$16.40
Rate for Payer: UnitedHealthcare Community & State	$2.59
Rate for Payer: Wellpoint Medicaid Managed Care	$2.33

CINCHPAD GEL SINGLE

Facility

$82.00

Hospital Charge Code	270690111
Hospital Revenue Code	272
Min. Negotiated Rate	$12.30
Max. Negotiated Rate	$12.30
Rate for Payer: Qualcare PPO/HMO/WC	$12.30

CIPRO-DEXAMETHASONE OTIC

Facility

$1,343.89

Service Code	NDC 78079975
Hospital Charge Code	60629949
Hospital Revenue Code	250
Min. Negotiated Rate	$38.17
Max. Negotiated Rate	$671.95
Rate for Payer: Aetna Commercial	$510.68
Rate for Payer: Aetna Medicare Advantage	$403.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$342.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$342.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$342.69
Rate for Payer: Cigna Commercial	$671.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$349.41
Rate for Payer: Oxford Commercial	$268.78
Rate for Payer: Qualcare PPO/HMO/WC	$201.58
Rate for Payer: UnitedHealthcare Commercial	$268.78
Rate for Payer: UnitedHealthcare Community & State	$42.47
Rate for Payer: Wellpoint Medicaid Managed Care	$38.17

CIPRO-DEXAMETHASONE OTIC

Facility

$1,343.89

Service Code	NDC 78079975
Hospital Charge Code	60629949
Hospital Revenue Code	250
Min. Negotiated Rate	$201.58
Max. Negotiated Rate	$201.58
Rate for Payer: Qualcare PPO/HMO/WC	$201.58

CIPROFLOXACIN 0.3% OPHTH SOLN

Facility

$166.83

Service Code	NDC 50383028202
Hospital Charge Code	60628033
Hospital Revenue Code	250
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$83.42
Rate for Payer: Aetna Commercial	$63.40
Rate for Payer: Aetna Medicare Advantage	$50.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.54
Rate for Payer: Cigna Commercial	$83.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.38
Rate for Payer: Oxford Commercial	$33.37
Rate for Payer: Qualcare PPO/HMO/WC	$25.02
Rate for Payer: UnitedHealthcare Commercial	$33.37
Rate for Payer: UnitedHealthcare Community & State	$5.27
Rate for Payer: Wellpoint Medicaid Managed Care	$4.74

CIPROFLOXACIN 0.3% OPHTH SOLN

Facility

$166.83

Service Code	NDC 50383028202
Hospital Charge Code	60628033
Hospital Revenue Code	250
Min. Negotiated Rate	$25.02
Max. Negotiated Rate	$25.02
Rate for Payer: Qualcare PPO/HMO/WC	$25.02

CIPROFLOXACIN 0.3% OP SOL/DROP

Facility

$2.88

Hospital Charge Code	606361100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Qualcare PPO/HMO/WC	$0.43

CIPROFLOXACIN 0.3% OP SOL/DROP

Facility

$2.88

Hospital Charge Code	606361100
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.44
Rate for Payer: Aetna Commercial	$1.09
Rate for Payer: Aetna Medicare Advantage	$0.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.73
Rate for Payer: Cigna Commercial	$1.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.75
Rate for Payer: Oxford Commercial	$0.58
Rate for Payer: Qualcare PPO/HMO/WC	$0.43
Rate for Payer: UnitedHealthcare Commercial	$0.58
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

CIPROFLOXACIN 200MG/100ML

Facility

$104.59

Service Code	HCPCS J0744
Hospital Charge Code	60627346
Hospital Revenue Code	636
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$52.30
Rate for Payer: Aetna Commercial	$39.74
Rate for Payer: Aetna Medicare Advantage	$31.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.67
Rate for Payer: Cigna Commercial	$52.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.69
Rate for Payer: UnitedHealthcare Community & State	$3.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.97

CIPROFLOXACIN 200MG/100ML

Facility

$104.59

Service Code	HCPCS J0744
Hospital Charge Code	60627346
Hospital Revenue Code	636
Min. Negotiated Rate	$15.69
Max. Negotiated Rate	$25.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.69

CIPROFLOXACIN 250 MG TAB

Facility

$30.42

Service Code	NDC 16252051401
Hospital Charge Code	6008619
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$15.21
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$9.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.76
Rate for Payer: Cigna Commercial	$15.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.91
Rate for Payer: Oxford Commercial	$6.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.56
Rate for Payer: UnitedHealthcare Commercial	$6.08
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

CIPROFLOXACIN 250 MG TAB

Facility

$30.42

Service Code	NDC 16252051401
Hospital Charge Code	6008619
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$4.56

CIPROFLOXACIN 400MG/200ML

Facility

$201.07

Service Code	HCPCS J0744
Hospital Charge Code	60627347
Hospital Revenue Code	636
Min. Negotiated Rate	$30.16
Max. Negotiated Rate	$48.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.66
Rate for Payer: Qualcare PPO/HMO/WC	$30.16

CIPROFLOXACIN 400MG/200ML

Facility

$201.07

Service Code	HCPCS J0744
Hospital Charge Code	60627347
Hospital Revenue Code	636
Min. Negotiated Rate	$5.71
Max. Negotiated Rate	$100.53
Rate for Payer: Aetna Commercial	$76.41
Rate for Payer: Aetna Medicare Advantage	$60.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.27
Rate for Payer: Cigna Commercial	$100.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.66
Rate for Payer: Qualcare PPO/HMO/WC	$30.16
Rate for Payer: UnitedHealthcare Community & State	$6.35
Rate for Payer: Wellpoint Medicaid Managed Care	$5.71

CIPROFLOXACIN 500 MG TAB

Facility

$35.58

Service Code	NDC 16252051501
Hospital Charge Code	6008635
Hospital Revenue Code	250
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.34

CIPROFLOXACIN 500 MG TAB

Facility

$35.58

Service Code	NDC 16252051501
Hospital Charge Code	6008635
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$17.79
Rate for Payer: Aetna Commercial	$13.52
Rate for Payer: Aetna Medicare Advantage	$10.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.07
Rate for Payer: Cigna Commercial	$17.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.25
Rate for Payer: Oxford Commercial	$7.12
Rate for Payer: Qualcare PPO/HMO/WC	$5.34
Rate for Payer: UnitedHealthcare Commercial	$7.12
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

CIRCUIT BREATHING COAXIAL

Facility

$38.59

Hospital Charge Code	270651820
Hospital Revenue Code	272
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$19.30
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$11.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.84
Rate for Payer: Cigna Commercial	$19.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.03
Rate for Payer: Oxford Commercial	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$5.79
Rate for Payer: UnitedHealthcare Commercial	$7.72
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

CIRCUIT BREATHING COAXIAL

Facility

$38.59

Hospital Charge Code	270651820
Hospital Revenue Code	272
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$5.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.79

CIRCUIT BREATHING DUAL HEATED

Facility

$135.63

Hospital Charge Code	270688978
Hospital Revenue Code	272
Min. Negotiated Rate	$20.34
Max. Negotiated Rate	$20.34
Rate for Payer: Qualcare PPO/HMO/WC	$20.34

CIRCUIT BREATHING DUAL HEATED

Facility

$135.63

Hospital Charge Code	270688978
Hospital Revenue Code	272
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$67.81
Rate for Payer: Aetna Commercial	$51.54
Rate for Payer: Aetna Medicare Advantage	$40.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.59
Rate for Payer: Cigna Commercial	$67.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.26
Rate for Payer: Oxford Commercial	$27.13
Rate for Payer: Qualcare PPO/HMO/WC	$20.34
Rate for Payer: UnitedHealthcare Commercial	$27.13
Rate for Payer: UnitedHealthcare Community & State	$4.29
Rate for Payer: Wellpoint Medicaid Managed Care	$3.85

CIRCUIT BREATHING SNG LIMB 72

Facility

$91.30

Hospital Charge Code	270669514
Hospital Revenue Code	272
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$45.65
Rate for Payer: Aetna Commercial	$34.69
Rate for Payer: Aetna Medicare Advantage	$27.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.28
Rate for Payer: Cigna Commercial	$45.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.74
Rate for Payer: Oxford Commercial	$18.26
Rate for Payer: Qualcare PPO/HMO/WC	$13.70
Rate for Payer: UnitedHealthcare Commercial	$18.26
Rate for Payer: UnitedHealthcare Community & State	$2.89
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

CIRCUIT BREATHING SNG LIMB 72

Facility

$91.30

Hospital Charge Code	270669514
Hospital Revenue Code	272
Min. Negotiated Rate	$13.70
Max. Negotiated Rate	$13.70
Rate for Payer: Qualcare PPO/HMO/WC	$13.70

Know your out-of-pocket cost for care.

All Charges