Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CYANOCOBALAMIN 1000 MCG/ML INJ

Facility

$58.56

Service Code	HCPCS J3420
Hospital Charge Code	60628481
Hospital Revenue Code	636
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$29.28
Rate for Payer: Aetna Commercial	$22.25
Rate for Payer: Aetna Medicare Advantage	$17.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.93
Rate for Payer: Cigna Commercial	$29.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.78
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

CYANOCOBALAMIN 1000 MCG/ML INJ

Facility

$58.56

Service Code	HCPCS J3420
Hospital Charge Code	60628481
Hospital Revenue Code	636
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$14.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.17
Rate for Payer: Qualcare PPO/HMO/WC	$8.78

CYANOCOBALAMIN 1000 MCG TAB

Facility

$4.00

Service Code	NDC 536355601
Hospital Charge Code	60630068
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CYANOCOBALAMIN 1000 MCG TAB

Facility

$4.00

Service Code	NDC 536355601
Hospital Charge Code	60630068
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

CYANOCOBALAMIN 100 MCG TAB

Facility

$4.00

Service Code	NDC 904113213
Hospital Charge Code	60629046
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

CYANOCOBALAMIN 100 MCG TAB

Facility

$4.00

Service Code	NDC 904113213
Hospital Charge Code	60629046
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

CYANOCOBALAMIN 500MCG TAB

Facility

$4.00

Service Code	NDC 904320713
Hospital Charge Code	6063943090
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

CYANOCOBALAMIN 500MCG TAB

Facility

$4.00

Service Code	NDC 904320713
Hospital Charge Code	6063943090
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Cyanokit 5g vial (Hydroxocobal

Facility

$5,502.84

Service Code	NDC 11704037001
Hospital Charge Code	606351012
Hospital Revenue Code	250
Min. Negotiated Rate	$825.43
Max. Negotiated Rate	$825.43
Rate for Payer: Qualcare PPO/HMO/WC	$825.43

Cyanokit 5g vial (Hydroxocobal

Facility

$5,502.84

Service Code	NDC 11704037001
Hospital Charge Code	606351012
Hospital Revenue Code	250
Min. Negotiated Rate	$156.28
Max. Negotiated Rate	$2,751.42
Rate for Payer: Aetna Commercial	$2,091.08
Rate for Payer: Aetna Medicare Advantage	$1,650.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,403.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,403.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,403.22
Rate for Payer: Cigna Commercial	$2,751.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,430.74
Rate for Payer: Oxford Commercial	$1,100.57
Rate for Payer: Qualcare PPO/HMO/WC	$825.43
Rate for Payer: UnitedHealthcare Commercial	$1,100.57
Rate for Payer: UnitedHealthcare Community & State	$173.89
Rate for Payer: Wellpoint Medicaid Managed Care	$156.28

CYCLIC AMP

Facility

$391.00

Service Code	HCPCS 82090
Hospital Charge Code	38473068
Hospital Revenue Code	301
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

CYCLIC AMP

Facility

$391.00

Service Code	HCPCS 82090
Hospital Charge Code	38473068
Hospital Revenue Code	301
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$195.50
Rate for Payer: Aetna Commercial	$148.58
Rate for Payer: Aetna Medicare Advantage	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.10

CYCLIC CITRULLINE PEP IGG

Facility

$89.00

Service Code	HCPCS 86200
Hospital Charge Code	39900198
Hospital Revenue Code	302
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.22
Rate for Payer: Aetna Medicare Advantage	$41.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.98
Rate for Payer: Cigna Commercial	$44.50
Rate for Payer: Cigna Medicare Advantage	$12.95
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Medicare Advantage	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

CYCLIC CITRULLINE PEP IGG

Facility

$89.00

Service Code	HCPCS 86200
Hospital Charge Code	39900198
Hospital Revenue Code	302
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$13.35
Rate for Payer: Qualcare PPO/HMO/WC	$13.35

CYCLIC CITRU PEPTIDE AB

Facility

$91.00

Service Code	HCPCS 86200
Hospital Charge Code	38478107
Hospital Revenue Code	300
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.22
Rate for Payer: Aetna Medicare Advantage	$41.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.98
Rate for Payer: Cigna Commercial	$45.50
Rate for Payer: Cigna Medicare Advantage	$12.95
Rate for Payer: Clover Medicare Advantage	$12.30
Rate for Payer: EmblemHealth Commercial	$38.85
Rate for Payer: Humana Medicare Advantage	$13.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.66
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.95
Rate for Payer: Wellcare Medicare Advantage	$12.95
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

CYCLIC CITRU PEPTIDE AB

Facility

$91.00

Service Code	HCPCS 86200
Hospital Charge Code	38478107
Hospital Revenue Code	300
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

CYCLOBENZAPRINE 10 MG TAB

Facility

$6.50

Service Code	NDC 51079064420
Hospital Charge Code	60627482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$2.47
Rate for Payer: Aetna Medicare Advantage	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.66
Rate for Payer: Cigna Commercial	$3.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$1.30
Rate for Payer: Qualcare PPO/HMO/WC	$0.98
Rate for Payer: UnitedHealthcare Commercial	$1.30
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

CYCLOBENZAPRINE 10 MG TAB

Facility

$6.50

Service Code	NDC 51079064420
Hospital Charge Code	60627482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$0.98
Rate for Payer: Qualcare PPO/HMO/WC	$0.98

CYCLOPENTOLATE 1% OPHTH SOLN

Facility

$107.20

Service Code	NDC 65039602
Hospital Charge Code	6001457
Hospital Revenue Code	251
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$53.60
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna Medicare Advantage	$32.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.34
Rate for Payer: Cigna Commercial	$53.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.87
Rate for Payer: Oxford Commercial	$21.44
Rate for Payer: Qualcare PPO/HMO/WC	$16.08
Rate for Payer: UnitedHealthcare Commercial	$21.44
Rate for Payer: UnitedHealthcare Community & State	$3.39
Rate for Payer: Wellpoint Medicaid Managed Care	$3.04

CYCLOPENTOLATE 1% OPHTH SOLN

Facility

$107.20

Service Code	NDC 65039602
Hospital Charge Code	6001457
Hospital Revenue Code	251
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$16.08
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

CYCLOPENTOLATE 2% EYE DROPS

Facility

$197.72

Service Code	NDC 17478009702
Hospital Charge Code	60632359
Hospital Revenue Code	250
Min. Negotiated Rate	$29.66
Max. Negotiated Rate	$29.66
Rate for Payer: Qualcare PPO/HMO/WC	$29.66

CYCLOPENTOLATE 2% EYE DROPS

Facility

$197.72

Service Code	NDC 17478009702
Hospital Charge Code	60632359
Hospital Revenue Code	250
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$98.86
Rate for Payer: Aetna Commercial	$75.13
Rate for Payer: Aetna Medicare Advantage	$59.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.42
Rate for Payer: Cigna Commercial	$98.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.41
Rate for Payer: Oxford Commercial	$39.54
Rate for Payer: Qualcare PPO/HMO/WC	$29.66
Rate for Payer: UnitedHealthcare Commercial	$39.54
Rate for Payer: UnitedHealthcare Community & State	$6.25
Rate for Payer: Wellpoint Medicaid Managed Care	$5.62

CYCLOPHOSPHAMIDE 25 MG TAB

Facility

$62.71

Service Code	HCPCS J8530
Hospital Charge Code	60627372
Hospital Revenue Code	636
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$31.36
Rate for Payer: Aetna Commercial	$23.83
Rate for Payer: Aetna Medicare Advantage	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.99
Rate for Payer: Cigna Commercial	$31.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.18
Rate for Payer: Qualcare PPO/HMO/WC	$9.41
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

CYCLOPHOSPHAMIDE 25 MG TAB

Facility

$62.71

Service Code	HCPCS J8530
Hospital Charge Code	60627372
Hospital Revenue Code	636
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$15.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.18
Rate for Payer: Qualcare PPO/HMO/WC	$9.41

CYCLOPHOSPHAMIDE 500 MG INJ

Facility

$2,944.65

Service Code	HCPCS J9070
Hospital Charge Code	6001515
Hospital Revenue Code	636
Min. Negotiated Rate	$441.70
Max. Negotiated Rate	$712.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.61
Rate for Payer: Qualcare PPO/HMO/WC	$441.70

Know your out-of-pocket cost for care.

All Charges