Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CISATRACURIUM 10MG/5ML

Facility

$126.03

Service Code	NDC 74437805
Hospital Charge Code	60635765
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

CISATRACURIUM INJ 20MG/10ML

Facility

$221.17

Service Code	NDC 74438010
Hospital Charge Code	6017636
Hospital Revenue Code	250
Min. Negotiated Rate	$6.28
Max. Negotiated Rate	$110.58
Rate for Payer: Aetna Commercial	$84.04
Rate for Payer: Aetna Medicare Advantage	$66.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.40
Rate for Payer: Cigna Commercial	$110.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.50
Rate for Payer: Oxford Commercial	$44.23
Rate for Payer: Qualcare PPO/HMO/WC	$33.18
Rate for Payer: UnitedHealthcare Commercial	$44.23
Rate for Payer: UnitedHealthcare Community & State	$6.99
Rate for Payer: Wellpoint Medicaid Managed Care	$6.28

CISATRACURIUM INJ 20MG/10ML

Facility

$221.17

Service Code	NDC 74438010
Hospital Charge Code	6017636
Hospital Revenue Code	250
Min. Negotiated Rate	$33.18
Max. Negotiated Rate	$33.18
Rate for Payer: Qualcare PPO/HMO/WC	$33.18

CITALOPRAM 20 MG TAB

Facility

$17.15

Service Code	NDC 65162005350
Hospital Charge Code	60628873
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$8.57
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: Aetna Medicare Advantage	$5.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.37
Rate for Payer: Cigna Commercial	$8.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.46
Rate for Payer: Oxford Commercial	$3.43
Rate for Payer: Qualcare PPO/HMO/WC	$2.57
Rate for Payer: UnitedHealthcare Commercial	$3.43
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

CITALOPRAM 20 MG TAB

Facility

$17.15

Service Code	NDC 65162005350
Hospital Charge Code	60628873
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$2.57

CITALOPRAM (CELEXA)10MG TAB

Facility

$16.42

Service Code	NDC 378623101
Hospital Charge Code	60630129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.21
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Aetna Medicare Advantage	$4.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.19
Rate for Payer: Cigna Commercial	$8.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.27
Rate for Payer: Oxford Commercial	$3.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.46
Rate for Payer: UnitedHealthcare Commercial	$3.28
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

CITALOPRAM (CELEXA)10MG TAB

Facility

$16.42

Service Code	NDC 378623101
Hospital Charge Code	60630129
Hospital Revenue Code	250
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.46

CITRACAL D TAB

Facility

$4.00

Service Code	NDC 904546061
Hospital Charge Code	6063943080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

CITRACAL D TAB

Facility

$4.00

Service Code	NDC 904546061
Hospital Charge Code	6063943080
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CITRATE

Facility

$390.00

Service Code	HCPCS 82507
Hospital Charge Code	39990241C
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CITRATE

Facility

$390.00

Service Code	HCPCS 82507
Hospital Charge Code	39990241C
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$75.62
Rate for Payer: Aetna Medicare Advantage	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$27.80
Rate for Payer: Clover Medicare Advantage	$26.41
Rate for Payer: EmblemHealth Commercial	$83.40
Rate for Payer: Humana Medicare Advantage	$28.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.80
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	$22.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.80
Rate for Payer: Wellcare Medicare Advantage	$27.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CITRATE,24HR URINE

Facility

$390.00

Service Code	HCPCS 82507
Hospital Charge Code	39900062
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$75.62
Rate for Payer: Aetna Medicare Advantage	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$27.80
Rate for Payer: Clover Medicare Advantage	$26.41
Rate for Payer: EmblemHealth Commercial	$83.40
Rate for Payer: Humana Medicare Advantage	$28.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.80
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	$22.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.80
Rate for Payer: Wellcare Medicare Advantage	$27.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CITRATE,24HR URINE

Facility

$390.00

Service Code	HCPCS 82507
Hospital Charge Code	39900062
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CITRATE URINE

Facility

$431.00

Service Code	HCPCS 82507
Hospital Charge Code	38473125
Hospital Revenue Code	301
Min. Negotiated Rate	$64.65
Max. Negotiated Rate	$64.65
Rate for Payer: Qualcare PPO/HMO/WC	$64.65

CITRATE URINE

Facility

$431.00

Service Code	HCPCS 82507
Hospital Charge Code	38473125
Hospital Revenue Code	301
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$215.50
Rate for Payer: Aetna Commercial	$75.62
Rate for Payer: Aetna Medicare Advantage	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.84
Rate for Payer: Cigna Commercial	$215.50
Rate for Payer: Cigna Medicare Advantage	$27.80
Rate for Payer: Clover Medicare Advantage	$26.41
Rate for Payer: EmblemHealth Commercial	$83.40
Rate for Payer: Humana Medicare Advantage	$28.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$27.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$64.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$22.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.80
Rate for Payer: Wellcare Medicare Advantage	$27.80
Rate for Payer: Wellpoint Medicaid Managed Care	$12.24

CITREFIX IMPLANT 2.9X12.5MM

Facility

$3,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270700363
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

CITREFIX IMPLANT 2.9X12.5MM

Facility

$3,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270700363
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

CITREFIX IMPLANT 3.5X15.5MM

Facility

$3,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270700361
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

CITREFIX IMPLANT 3.5X15.5MM

Facility

$3,750.00

Service Code	HCPCS C1889
Hospital Charge Code	270700361
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

CITREFIX XPRESS IMPL2.9X12.5MM

Facility

$7,855.00

Service Code	HCPCS C1889
Hospital Charge Code	270700362
Hospital Revenue Code	278
Min. Negotiated Rate	$1,178.25
Max. Negotiated Rate	$1,900.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,571.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,900.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,178.25

CITREFIX XPRESS IMPL2.9X12.5MM

Facility

$7,855.00

Service Code	HCPCS C1889
Hospital Charge Code	270700362
Hospital Revenue Code	278
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$3,927.50
Rate for Payer: Aetna Commercial	$2,984.90
Rate for Payer: Aetna Medicare Advantage	$2,356.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,003.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,003.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,571.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,003.03
Rate for Payer: Cigna Commercial	$3,927.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,900.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,178.25
Rate for Payer: UnitedHealthcare Community & State	$248.22
Rate for Payer: Wellpoint Medicaid Managed Care	$223.08

CITREFIX XPRESS IMPL3.5X15.5MM

Facility

$7,855.00

Service Code	HCPCS C1889
Hospital Charge Code	270700364
Hospital Revenue Code	278
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$3,927.50
Rate for Payer: Aetna Commercial	$2,984.90
Rate for Payer: Aetna Medicare Advantage	$2,356.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,003.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,003.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,571.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,003.03
Rate for Payer: Cigna Commercial	$3,927.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,900.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,178.25
Rate for Payer: UnitedHealthcare Community & State	$248.22
Rate for Payer: Wellpoint Medicaid Managed Care	$223.08

CITREFIX XPRESS IMPL3.5X15.5MM

Facility

$7,855.00

Service Code	HCPCS C1889
Hospital Charge Code	270700364
Hospital Revenue Code	278
Min. Negotiated Rate	$1,178.25
Max. Negotiated Rate	$1,900.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,571.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,900.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,178.25

CITREFIX XPRESS SYS 2.9X12.5MM

Facility

$7,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270700346
Hospital Revenue Code	278
Min. Negotiated Rate	$1,178.25
Max. Negotiated Rate	$1,900.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,571.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,900.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,178.25

CITREFIX XPRESS SYS 2.9X12.5MM

Facility

$7,855.00

Service Code	HCPCS C1713
Hospital Charge Code	270700346
Hospital Revenue Code	278
Min. Negotiated Rate	$223.08
Max. Negotiated Rate	$3,927.50
Rate for Payer: Aetna Commercial	$2,984.90
Rate for Payer: Aetna Medicare Advantage	$2,356.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,003.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,003.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,571.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,003.03
Rate for Payer: Cigna Commercial	$3,927.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,900.91
Rate for Payer: Qualcare PPO/HMO/WC	$1,178.25
Rate for Payer: UnitedHealthcare Community & State	$248.22
Rate for Payer: Wellpoint Medicaid Managed Care	$223.08

Know your out-of-pocket cost for care.

All Charges