Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACETYLCYSTEINE 20% SOL (10 ML)

Facility

$54.61

Service Code	NDC 63323069210
Hospital Charge Code	60630103
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$8.19
Rate for Payer: Qualcare PPO/HMO/WC	$8.19

ACETYLCYSTEINE 20% SOL (10 ML)

Facility

$54.61

Service Code	NDC 63323069210
Hospital Charge Code	60630103
Hospital Revenue Code	250
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$27.30
Rate for Payer: Aetna Commercial	$20.75
Rate for Payer: Aetna Medicare Advantage	$16.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.93
Rate for Payer: Cigna Commercial	$27.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.20
Rate for Payer: Oxford Commercial	$10.92
Rate for Payer: Qualcare PPO/HMO/WC	$8.19
Rate for Payer: UnitedHealthcare Commercial	$10.92
Rate for Payer: UnitedHealthcare Community & State	$1.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.55

ACETYLCYSTEINE 6GM/30ML IV

Facility

$208.37

Service Code	HCPCS J0132
Hospital Charge Code	60629831
Hospital Revenue Code	636
Min. Negotiated Rate	$31.26
Max. Negotiated Rate	$50.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.43
Rate for Payer: Qualcare PPO/HMO/WC	$31.26

ACETYLCYSTEINE 6GM/30ML IV

Facility

$208.37

Service Code	HCPCS J0132
Hospital Charge Code	60629831
Hospital Revenue Code	636
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$104.19
Rate for Payer: Aetna Commercial	$79.18
Rate for Payer: Aetna Medicare Advantage	$62.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.13
Rate for Payer: Cigna Commercial	$104.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.43
Rate for Payer: Qualcare PPO/HMO/WC	$31.26
Rate for Payer: UnitedHealthcare Community & State	$6.58
Rate for Payer: Wellpoint Medicaid Managed Care	$5.92

ACETYLCYSTEINE SOL 20% 4ML

Facility

$100.23

Service Code	NDC 517760425
Hospital Charge Code	60628005
Hospital Revenue Code	250
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$50.12
Rate for Payer: Aetna Commercial	$38.09
Rate for Payer: Aetna Medicare Advantage	$30.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.56
Rate for Payer: Cigna Commercial	$50.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.06
Rate for Payer: Oxford Commercial	$20.05
Rate for Payer: Qualcare PPO/HMO/WC	$15.03
Rate for Payer: UnitedHealthcare Commercial	$20.05
Rate for Payer: UnitedHealthcare Community & State	$3.17
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

ACETYLCYSTEINE SOL 20% 4ML

Facility

$100.23

Service Code	NDC 517760425
Hospital Charge Code	60628005
Hospital Revenue Code	250
Min. Negotiated Rate	$15.03
Max. Negotiated Rate	$15.03
Rate for Payer: Qualcare PPO/HMO/WC	$15.03

ACE WRAP ELASTIC BANDAGE

Facility

$7.98

Hospital Charge Code	270667805
Hospital Revenue Code	270
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

ACE WRAP ELASTIC BANDAGE

Facility

$7.98

Hospital Charge Code	270667805
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.99
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.07
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

ACHALASIA BALLOON CATHETERS

Facility

$2,392.00

Hospital Charge Code	270330638
Hospital Revenue Code	272
Min. Negotiated Rate	$358.80
Max. Negotiated Rate	$358.80
Rate for Payer: Qualcare PPO/HMO/WC	$358.80

ACHALASIA BALLOON CATHETERS

Facility

$2,392.00

Hospital Charge Code	270330638
Hospital Revenue Code	272
Min. Negotiated Rate	$67.93
Max. Negotiated Rate	$1,196.00
Rate for Payer: Aetna Commercial	$908.96
Rate for Payer: Aetna Medicare Advantage	$717.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$609.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$609.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$609.96
Rate for Payer: Cigna Commercial	$1,196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.92
Rate for Payer: Oxford Commercial	$478.40
Rate for Payer: Qualcare PPO/HMO/WC	$358.80
Rate for Payer: UnitedHealthcare Commercial	$478.40
Rate for Payer: UnitedHealthcare Community & State	$75.59
Rate for Payer: Wellpoint Medicaid Managed Care	$67.93

ACHILLES SPEEDBRIDGE

Facility

$8,575.00

Hospital Charge Code	270656487
Hospital Revenue Code	278
Min. Negotiated Rate	$1,286.25
Max. Negotiated Rate	$2,075.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25

ACHILLES SPEEDBRIDGE

Facility

$8,575.00

Hospital Charge Code	270656487
Hospital Revenue Code	278
Min. Negotiated Rate	$243.53
Max. Negotiated Rate	$4,287.50
Rate for Payer: Aetna Commercial	$3,258.50
Rate for Payer: Aetna Medicare Advantage	$2,572.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,186.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,715.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,186.62
Rate for Payer: Cigna Commercial	$4,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,075.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,286.25
Rate for Payer: UnitedHealthcare Community & State	$270.97
Rate for Payer: Wellpoint Medicaid Managed Care	$243.53

ACHILLES SPEEDBRIDGE KIT

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270648346
Hospital Revenue Code	278
Min. Negotiated Rate	$247.08
Max. Negotiated Rate	$4,350.00
Rate for Payer: Aetna Commercial	$3,306.00
Rate for Payer: Aetna Medicare Advantage	$2,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,218.50
Rate for Payer: Cigna Commercial	$4,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00
Rate for Payer: UnitedHealthcare Community & State	$274.92
Rate for Payer: Wellpoint Medicaid Managed Care	$247.08

ACHILLES SPEEDBRIDGE KIT

Facility

$8,700.00

Service Code	HCPCS C1713
Hospital Charge Code	270648346
Hospital Revenue Code	278
Min. Negotiated Rate	$1,305.00
Max. Negotiated Rate	$2,105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,105.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,305.00

ACHILLES SPEEDBRIDGEW/JUMPSTAR

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270682063
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

ACHILLES SPEEDBRIDGEW/JUMPSTAR

Facility

$9,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270682063
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

ACHILLES TEN-BONE BLOCK

Facility

$13,026.25

Hospital Charge Code	270666869
Hospital Revenue Code	272
Min. Negotiated Rate	$1,953.94
Max. Negotiated Rate	$1,953.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.94

ACHILLES TEN-BONE BLOCK

Facility

$13,026.25

Hospital Charge Code	270666869
Hospital Revenue Code	272
Min. Negotiated Rate	$369.95
Max. Negotiated Rate	$6,513.12
Rate for Payer: Aetna Commercial	$4,949.98
Rate for Payer: Aetna Medicare Advantage	$3,907.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,321.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,321.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,321.69
Rate for Payer: Cigna Commercial	$6,513.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,386.82
Rate for Payer: Oxford Commercial	$2,605.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.94
Rate for Payer: UnitedHealthcare Commercial	$2,605.25
Rate for Payer: UnitedHealthcare Community & State	$411.63
Rate for Payer: Wellpoint Medicaid Managed Care	$369.95

ACID FAST BACILLI STAIN

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	3000072
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACID FAST BACILLI STAIN

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	3000072
Hospital Revenue Code	306
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.55
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
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	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Acid-fast (Mycobacteria) Smear

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	39880004A
Hospital Revenue Code	309
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare Advantage	$34.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$10.80
Rate for Payer: Clover Medicare Advantage	$10.26
Rate for Payer: EmblemHealth Commercial	$32.40
Rate for Payer: Humana Medicare Advantage	$11.12
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.80
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	$8.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80
Rate for Payer: Wellcare Medicare Advantage	$10.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

Acid-fast (Mycobacteria) Smear

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	39880004B
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Acid-fast (Mycobacteria) Smear

Facility

$390.00

Service Code	HCPCS 87116
Hospital Charge Code	39880004A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Acid-fast (Mycobacteria) Smear

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	39880004B
Hospital Revenue Code	309
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.55
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
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	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACID HEMOLYSIN (HAMS)

Facility

$159.00

Service Code	HCPCS 85475
Hospital Charge Code	38476041
Hospital Revenue Code	305
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$24.13
Rate for Payer: Aetna Medicare Advantage	$28.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.18
Rate for Payer: Cigna Commercial	$79.50
Rate for Payer: Cigna Medicare Advantage	$8.87
Rate for Payer: Clover Medicare Advantage	$8.43
Rate for Payer: EmblemHealth Commercial	$26.61
Rate for Payer: Humana Medicare Advantage	$9.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.34
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.87
Rate for Payer: Wellcare Medicare Advantage	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

Know your out-of-pocket cost for care.

All Charges