Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACETAZOLAMIDE 500 MG INJ

Facility

$293.46

Service Code	HCPCS J1120
Hospital Charge Code	60628045
Hospital Revenue Code	636
Min. Negotiated Rate	$44.02
Max. Negotiated Rate	$71.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.02
Rate for Payer: Qualcare PPO/HMO/WC	$44.02

ACETAZOLAMIDE 500 MG SR CAP

Facility

$28.74

Service Code	NDC 23155012001
Hospital Charge Code	60628044
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$14.37
Rate for Payer: Aetna Commercial	$10.92
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.33
Rate for Payer: Cigna Commercial	$14.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.47
Rate for Payer: Oxford Commercial	$5.75
Rate for Payer: Qualcare PPO/HMO/WC	$4.31
Rate for Payer: UnitedHealthcare Commercial	$5.75
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

ACETAZOLAMIDE 500 MG SR CAP

Facility

$28.74

Service Code	NDC 23155012001
Hospital Charge Code	60628044
Hospital Revenue Code	250
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$4.31
Rate for Payer: Qualcare PPO/HMO/WC	$4.31

ACETIC ACID 0.25% IRRIG SOL

Facility

$19.30

Service Code	NDC 990614309
Hospital Charge Code	60627980
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

ACETIC ACID 0.25% IRRIG SOL

Facility

$19.30

Service Code	NDC 990614309
Hospital Charge Code	60627980
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

ACETIC ACID 2% OTIC SOLUTION

Facility

$267.93

Service Code	NDC 603703841
Hospital Charge Code	60631016
Hospital Revenue Code	250
Min. Negotiated Rate	$40.19
Max. Negotiated Rate	$40.19
Rate for Payer: Qualcare PPO/HMO/WC	$40.19

ACETIC ACID 2% OTIC SOLUTION

Facility

$267.93

Service Code	NDC 603703841
Hospital Charge Code	60631016
Hospital Revenue Code	250
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$133.97
Rate for Payer: Aetna Commercial	$101.81
Rate for Payer: Aetna Medicare Advantage	$80.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.32
Rate for Payer: Cigna Commercial	$133.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.66
Rate for Payer: Oxford Commercial	$53.59
Rate for Payer: Qualcare PPO/HMO/WC	$40.19
Rate for Payer: UnitedHealthcare Commercial	$53.59
Rate for Payer: UnitedHealthcare Community & State	$8.47
Rate for Payer: Wellpoint Medicaid Managed Care	$7.61

ACETIC ACID 5% 473 ML

Facility

$28.21

Service Code	NDC 51552005506
Hospital Charge Code	606350937
Hospital Revenue Code	250
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$14.11
Rate for Payer: Aetna Commercial	$10.72
Rate for Payer: Aetna Medicare Advantage	$8.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.19
Rate for Payer: Cigna Commercial	$14.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.33
Rate for Payer: Oxford Commercial	$5.64
Rate for Payer: Qualcare PPO/HMO/WC	$4.23
Rate for Payer: UnitedHealthcare Commercial	$5.64
Rate for Payer: UnitedHealthcare Community & State	$0.89
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

ACETIC ACID 5% 473 ML

Facility

$28.21

Service Code	NDC 51552005506
Hospital Charge Code	606350937
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Qualcare PPO/HMO/WC	$4.23

ACETONE/KETONE SERUM QUANT

Facility

$58.00

Service Code	HCPCS 82010
Hospital Charge Code	38477052
Hospital Revenue Code	307
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

ACETONE/KETONE SERUM QUANT

Facility

$58.00

Service Code	HCPCS 82010
Hospital Charge Code	38477052
Hospital Revenue Code	307
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare Advantage	$26.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.64
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: Cigna Medicare Advantage	$8.17
Rate for Payer: Clover Medicare Advantage	$7.76
Rate for Payer: EmblemHealth Commercial	$24.51
Rate for Payer: Humana Medicare Advantage	$8.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.08
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.17
Rate for Payer: Wellcare Medicare Advantage	$8.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

ACETYLCHOLINE REC BIND AB

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900333
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACETYLCHOLINE REC BIND AB

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900333
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
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	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACETYLCHOLINE REC BINDING AB

Facility

$888.00

Service Code	HCPCS 83519
Hospital Charge Code	38473081
Hospital Revenue Code	301
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$444.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
Rate for Payer: Cigna Commercial	$444.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.20
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$25.22

ACETYLCHOLINE REC BINDING AB

Facility

$888.00

Service Code	HCPCS 83519
Hospital Charge Code	38473081
Hospital Revenue Code	301
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$133.20
Rate for Payer: Qualcare PPO/HMO/WC	$133.20

ACETYLCHOLINE RECEPTOR BLOCKIN

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900471
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
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	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACETYLCHOLINE RECEPTOR BLOCKIN

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900471
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACETYLCHOLINE RECEPTOR MODULAT

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900472
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.05
Rate for Payer: Aetna Medicare Advantage	$59.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.75
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.40
Rate for Payer: Clover Medicare Advantage	$17.48
Rate for Payer: EmblemHealth Commercial	$55.20
Rate for Payer: Humana Medicare Advantage	$18.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.40
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	$14.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.40
Rate for Payer: Wellcare Medicare Advantage	$18.40
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACETYLCHOLINE RECEPTOR MODULAT

Facility

$390.00

Service Code	HCPCS 83519
Hospital Charge Code	39900472
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACETYLCHOL SOL OPH

Facility

$308.27

Service Code	NDC 24208053920
Hospital Charge Code	60628051
Hospital Revenue Code	250
Min. Negotiated Rate	$46.24
Max. Negotiated Rate	$46.24
Rate for Payer: Qualcare PPO/HMO/WC	$46.24

ACETYLCHOL SOL OPH

Facility

$308.27

Service Code	NDC 24208053920
Hospital Charge Code	60628051
Hospital Revenue Code	250
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$154.13
Rate for Payer: Aetna Commercial	$117.14
Rate for Payer: Aetna Medicare Advantage	$92.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.61
Rate for Payer: Cigna Commercial	$154.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$80.15
Rate for Payer: Oxford Commercial	$61.65
Rate for Payer: Qualcare PPO/HMO/WC	$46.24
Rate for Payer: UnitedHealthcare Commercial	$61.65
Rate for Payer: UnitedHealthcare Community & State	$9.74
Rate for Payer: Wellpoint Medicaid Managed Care	$8.75

ACETYLCYSTEINE 10% 100MG/ML4ML

Facility

$17.15

Service Code	NDC 63323069504
Hospital Charge Code	606361025
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$2.57
Rate for Payer: Qualcare PPO/HMO/WC	$2.57

ACETYLCYSTEINE 10% 100MG/ML4ML

Facility

$17.15

Service Code	NDC 63323069504
Hospital Charge Code	606361025
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

ACETYLCYSTEINE 20% 10ML

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	60635744
Hospital Revenue Code	250
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$56.28
Rate for Payer: Aetna Commercial	$42.77
Rate for Payer: Aetna Medicare Advantage	$33.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.70
Rate for Payer: Cigna Commercial	$56.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.27
Rate for Payer: Oxford Commercial	$22.51
Rate for Payer: Qualcare PPO/HMO/WC	$16.88
Rate for Payer: UnitedHealthcare Commercial	$22.51
Rate for Payer: UnitedHealthcare Community & State	$3.56
Rate for Payer: Wellpoint Medicaid Managed Care	$3.20

ACETYLCYSTEINE 20% 10ML

Facility

$112.56

Service Code	NDC 63256010030
Hospital Charge Code	60635744
Hospital Revenue Code	250
Min. Negotiated Rate	$16.88
Max. Negotiated Rate	$16.88
Rate for Payer: Qualcare PPO/HMO/WC	$16.88

Know your out-of-pocket cost for care.

All Charges