Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACETAMINOPHEN 325 MG TAB

Facility

$4.00

Service Code	NDC 50580049660
Hospital Charge Code	60627728
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

ACETAMINOPHEN 325 MG TAB

Facility

$4.00

Service Code	NDC 50580049660
Hospital Charge Code	60627728
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN 35MG TAB(TYLENOL

Facility

$2.00

Hospital Charge Code	83652545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.00
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.51
Rate for Payer: Cigna Commercial	$1.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.52
Rate for Payer: Oxford Commercial	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.30
Rate for Payer: UnitedHealthcare Commercial	$0.40
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

ACETAMINOPHEN 35MG TAB(TYLENOL

Facility

$2.00

Hospital Charge Code	83652545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.30

ACETAMINOPHEN 650MG/20.3ML LIQ

Facility

$10.72

Service Code	NDC 121065721
Hospital Charge Code	60629185
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.61

ACETAMINOPHEN 650MG/20.3ML LIQ

Facility

$10.72

Service Code	NDC 121065721
Hospital Charge Code	60629185
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$4.07
Rate for Payer: Aetna Medicare Advantage	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.73
Rate for Payer: Cigna Commercial	$5.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.79
Rate for Payer: Oxford Commercial	$2.14
Rate for Payer: Qualcare PPO/HMO/WC	$1.61
Rate for Payer: UnitedHealthcare Commercial	$2.14
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

ACETAMINOPHEN 650 MG SUPP

Facility

$4.00

Service Code	NDC 45802073033
Hospital Charge Code	6023063
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN 650 MG SUPP

Facility

$4.00

Service Code	NDC 45802073033
Hospital Charge Code	6023063
Hospital Revenue Code	251
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

ACETAMINOPHEN 80MG/2.5ML

Facility

$5.76

Service Code	NDC 50580019101
Hospital Charge Code	606390048
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

ACETAMINOPHEN 80MG/2.5ML

Facility

$5.76

Service Code	NDC 50580019101
Hospital Charge Code	606390048
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.15
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

ACETAMINOPHEN COD300-30MG/12.5

Facility

$8.91

Service Code	NDC 121100800
Hospital Charge Code	60627700
Hospital Revenue Code	250
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.34

ACETAMINOPHEN COD300-30MG/12.5

Facility

$8.91

Service Code	NDC 121100800
Hospital Charge Code	60627700
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.46
Rate for Payer: Aetna Commercial	$3.39
Rate for Payer: Aetna Medicare Advantage	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.27
Rate for Payer: Cigna Commercial	$4.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.32
Rate for Payer: Oxford Commercial	$1.78
Rate for Payer: Qualcare PPO/HMO/WC	$1.34
Rate for Payer: UnitedHealthcare Commercial	$1.78
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

ACETAMINOPHEN COD TAB 325-30MG

Facility

$4.00

Service Code	NDC 51079016101
Hospital Charge Code	60627701
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

ACETAMINOPHEN COD TAB 325-30MG

Facility

$4.00

Service Code	NDC 51079016101
Hospital Charge Code	60627701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ACETAMINOPHEN QUAL URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3004066
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ACETAMINOPHEN QUAL URINE

Facility

$190.45

Service Code	HCPCS 80300
Hospital Charge Code	3004066
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.02
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ACETAMINOPHEN SERUM

Facility

$782.28

Service Code	HCPCS 80329
Hospital Charge Code	3004892
Hospital Revenue Code	301
Min. Negotiated Rate	$117.34
Max. Negotiated Rate	$117.34
Rate for Payer: Qualcare PPO/HMO/WC	$117.34

ACETAMINOPHEN SERUM

Facility

$782.28

Service Code	HCPCS 80329
Hospital Charge Code	3004892
Hospital Revenue Code	301
Min. Negotiated Rate	$16.48
Max. Negotiated Rate	$391.14
Rate for Payer: Aetna Commercial	$297.27
Rate for Payer: Aetna Medicare Advantage	$234.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$199.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$199.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$199.48
Rate for Payer: Cigna Commercial	$391.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$203.39
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$117.34
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$22.22

ACETAMINOPHEN (TYLENOL)

Facility

$457.00

Service Code	HCPCS 80329
Hospital Charge Code	38472026
Hospital Revenue Code	301
Min. Negotiated Rate	$12.98
Max. Negotiated Rate	$228.50
Rate for Payer: Aetna Commercial	$173.66
Rate for Payer: Aetna Medicare Advantage	$137.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.53
Rate for Payer: Cigna Commercial	$228.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$12.98

ACETAMINOPHEN (TYLENOL)

Facility

$457.00

Service Code	HCPCS 80329
Hospital Charge Code	38472026
Hospital Revenue Code	301
Min. Negotiated Rate	$68.55
Max. Negotiated Rate	$68.55
Rate for Payer: Qualcare PPO/HMO/WC	$68.55

ACETAMINOPHEN UDC 160MG/5ML

Facility

$8.58

Service Code	NDC 121065705
Hospital Charge Code	60630207
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

ACETAMINOPHEN UDC 160MG/5ML

Facility

$8.58

Service Code	NDC 121065705
Hospital Charge Code	60630207
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.72
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

ACETAZOLAMIDE 250 MG TAB

Facility

$19.30

Service Code	NDC 51672402301
Hospital Charge Code	60628043
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

ACETAZOLAMIDE 250 MG TAB

Facility

$19.30

Service Code	NDC 51672402301
Hospital Charge Code	60628043
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

ACETAZOLAMIDE 500 MG INJ

Facility

$293.46

Service Code	HCPCS J1120
Hospital Charge Code	60628045
Hospital Revenue Code	636
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$146.73
Rate for Payer: Aetna Commercial	$111.51
Rate for Payer: Aetna Medicare Advantage	$88.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.83
Rate for Payer: Cigna Commercial	$146.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.02
Rate for Payer: Qualcare PPO/HMO/WC	$44.02
Rate for Payer: UnitedHealthcare Community & State	$9.27
Rate for Payer: Wellpoint Medicaid Managed Care	$8.33

Know your out-of-pocket cost for care.

All Charges