Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACTEMRA 162MG/0.9ML SYRINGE

Facility

$8,399.32

Service Code	HCPCS J3262
Hospital Charge Code	606390312
Hospital Revenue Code	636
Min. Negotiated Rate	$1,259.90
Max. Negotiated Rate	$2,032.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,032.64
Rate for Payer: Qualcare PPO/HMO/WC	$1,259.90

Actemra 80mg/4ml (tocilizumab)

Facility

$1,882.25

Hospital Charge Code	6063943332
Hospital Revenue Code	636
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$941.12
Rate for Payer: Aetna Commercial	$715.25
Rate for Payer: Aetna Medicare Advantage	$564.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$479.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$479.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$479.97
Rate for Payer: Cigna Commercial	$941.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.50
Rate for Payer: Qualcare PPO/HMO/WC	$282.34
Rate for Payer: UnitedHealthcare Community & State	$59.48
Rate for Payer: Wellpoint Medicaid Managed Care	$53.46

Actemra 80mg/4ml (tocilizumab)

Facility

$1,882.25

Hospital Charge Code	6063943332
Hospital Revenue Code	636
Min. Negotiated Rate	$282.34
Max. Negotiated Rate	$455.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.50
Rate for Payer: Qualcare PPO/HMO/WC	$282.34

ACTH

Facility

$390.00

Service Code	HCPCS 82533
Hospital Charge Code	39708049A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACTH

Facility

$390.00

Service Code	HCPCS 82533
Hospital Charge Code	39708049A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$44.34
Rate for Payer: Aetna Medicare Advantage	$52.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$28.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.13
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$16.30
Rate for Payer: Clover Medicare Advantage	$15.48
Rate for Payer: EmblemHealth Commercial	$48.90
Rate for Payer: Humana Medicare Advantage	$16.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16.30
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	$13.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.30
Rate for Payer: Wellcare Medicare Advantage	$16.30
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACTH,PLASMA

Facility

$667.59

Service Code	HCPCS 82024
Hospital Charge Code	39900032
Hospital Revenue Code	309
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ACTH,PLASMA

Facility

$667.59

Service Code	HCPCS 82024
Hospital Charge Code	39900032
Hospital Revenue Code	309
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$105.05
Rate for Payer: Aetna Medicare Advantage	$125.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$38.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$49.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.09
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$38.62
Rate for Payer: Clover Medicare Advantage	$36.69
Rate for Payer: EmblemHealth Commercial	$115.86
Rate for Payer: Humana Medicare Advantage	$39.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$38.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$30.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.62
Rate for Payer: Wellcare Medicare Advantage	$38.62
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ACTIDOSE AQUA 120ML

Facility

$111.89

Service Code	NDC 574012174
Hospital Charge Code	6063943305
Hospital Revenue Code	250
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$16.78
Rate for Payer: Qualcare PPO/HMO/WC	$16.78

ACTIDOSE AQUA 120ML

Facility

$111.89

Service Code	NDC 574012174
Hospital Charge Code	6063943305
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$55.95
Rate for Payer: Aetna Commercial	$42.52
Rate for Payer: Aetna Medicare Advantage	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.53
Rate for Payer: Cigna Commercial	$55.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.09
Rate for Payer: Oxford Commercial	$22.38
Rate for Payer: Qualcare PPO/HMO/WC	$16.78
Rate for Payer: UnitedHealthcare Commercial	$22.38
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

ACTIDOSE W/ SORBITOL 120ML

Facility

$111.89

Service Code	NDC 574012074
Hospital Charge Code	6063943307
Hospital Revenue Code	250
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$16.78
Rate for Payer: Qualcare PPO/HMO/WC	$16.78

ACTIDOSE W/ SORBITOL 120ML

Facility

$111.89

Service Code	NDC 574012074
Hospital Charge Code	6063943307
Hospital Revenue Code	250
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$55.95
Rate for Payer: Aetna Commercial	$42.52
Rate for Payer: Aetna Medicare Advantage	$33.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.53
Rate for Payer: Cigna Commercial	$55.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.09
Rate for Payer: Oxford Commercial	$22.38
Rate for Payer: Qualcare PPO/HMO/WC	$16.78
Rate for Payer: UnitedHealthcare Commercial	$22.38
Rate for Payer: UnitedHealthcare Community & State	$3.54
Rate for Payer: Wellpoint Medicaid Managed Care	$3.18

ACTIFUSE BN GRAFT REFILL 7.5ML

Facility

$7,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694719
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

ACTIFUSE BN GRAFT REFILL 7.5ML

Facility

$7,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694719
Hospital Revenue Code	278
Min. Negotiated Rate	$209.45
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,802.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25
Rate for Payer: UnitedHealthcare Community & State	$233.05
Rate for Payer: Wellpoint Medicaid Managed Care	$209.45

ACTIFUSE BONE GRAFT SUB 7.5ML

Facility

$11,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694718
Hospital Revenue Code	278
Min. Negotiated Rate	$1,706.25
Max. Negotiated Rate	$2,752.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,752.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,706.25

ACTIFUSE BONE GRAFT SUB 7.5ML

Facility

$11,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270694718
Hospital Revenue Code	278
Min. Negotiated Rate	$323.05
Max. Negotiated Rate	$5,687.50
Rate for Payer: Aetna Commercial	$4,322.50
Rate for Payer: Aetna Medicare Advantage	$3,412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,900.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,900.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,900.62
Rate for Payer: Cigna Commercial	$5,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,752.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,706.25
Rate for Payer: UnitedHealthcare Community & State	$359.45
Rate for Payer: Wellpoint Medicaid Managed Care	$323.05

ACTIFUSE SHAPE LG CYL 15x45MM

Facility

$7,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270672053
Hospital Revenue Code	278
Min. Negotiated Rate	$206.89
Max. Negotiated Rate	$3,642.50
Rate for Payer: Aetna Commercial	$2,768.30
Rate for Payer: Aetna Medicare Advantage	$2,185.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,857.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,857.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,457.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,857.67
Rate for Payer: Cigna Commercial	$3,642.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,762.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.75
Rate for Payer: UnitedHealthcare Community & State	$230.21
Rate for Payer: Wellpoint Medicaid Managed Care	$206.89

ACTIFUSE SHAPE LG CYL 15x45MM

Facility

$7,285.00

Service Code	HCPCS C1713
Hospital Charge Code	270672053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,092.75
Max. Negotiated Rate	$1,762.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,457.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,762.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,092.75

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	7411175
Hospital Revenue Code	305
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.28
Rate for Payer: Clover Medicare Advantage	$4.07
Rate for Payer: EmblemHealth Commercial	$12.84
Rate for Payer: Humana Medicare Advantage	$4.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.28
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	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.28
Rate for Payer: Wellcare Medicare Advantage	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	366885347
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	366885347
Hospital Revenue Code	305
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$13.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.53
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.28
Rate for Payer: Clover Medicare Advantage	$4.07
Rate for Payer: EmblemHealth Commercial	$12.84
Rate for Payer: Humana Medicare Advantage	$4.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.28
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	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.28
Rate for Payer: Wellcare Medicare Advantage	$4.28
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACT-INITIAL EA DAY

Facility

$390.00

Service Code	HCPCS 85347
Hospital Charge Code	7411175
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACTIN(SMOOTH MUSCLE) AB IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900524
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ACTIN(SMOOTH MUSCLE) AB IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39900524
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
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	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ACTISHD AMN BARRIER MEM 4X8CM

Facility

$31,545.00

Service Code	HCPCS C1734
Hospital Charge Code	270693700
Hospital Revenue Code	278
Min. Negotiated Rate	$895.88
Max. Negotiated Rate	$15,772.50
Rate for Payer: Aetna Commercial	$11,987.10
Rate for Payer: Aetna Medicare Advantage	$9,463.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,043.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,043.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,309.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,043.98
Rate for Payer: Cigna Commercial	$15,772.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,633.89
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.75
Rate for Payer: UnitedHealthcare Community & State	$996.82
Rate for Payer: Wellpoint Medicaid Managed Care	$895.88

ACTISHD AMN BARRIER MEM 4X8CM

Facility

$31,545.00

Service Code	HCPCS C1734
Hospital Charge Code	270693700
Hospital Revenue Code	278
Min. Negotiated Rate	$4,731.75
Max. Negotiated Rate	$7,633.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,633.89
Rate for Payer: Qualcare PPO/HMO/WC	$4,731.75

Know your out-of-pocket cost for care.

All Charges