Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CYCLOPHOSPHAMIDE 500 MG INJ

Facility

$2,944.65

Service Code	HCPCS J9070
Hospital Charge Code	6001515
Hospital Revenue Code	636
Min. Negotiated Rate	$83.63
Max. Negotiated Rate	$1,472.33
Rate for Payer: Aetna Commercial	$1,118.97
Rate for Payer: Aetna Medicare Advantage	$883.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$750.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$750.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$750.89
Rate for Payer: Cigna Commercial	$1,472.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$712.61
Rate for Payer: Qualcare PPO/HMO/WC	$441.70
Rate for Payer: UnitedHealthcare Community & State	$93.05
Rate for Payer: Wellpoint Medicaid Managed Care	$83.63

CYCLOSPORA

Facility

$142.00

Service Code	HCPCS 87015
Hospital Charge Code	38475103
Hospital Revenue Code	309
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

CYCLOSPORA

Facility

$142.00

Service Code	HCPCS 87015
Hospital Charge Code	38475103
Hospital Revenue Code	309
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

CYCLOSPORA ID I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39990111A
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYCLOSPORA ID I

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	39990111A
Hospital Revenue Code	309
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
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	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CYCLOSPORA ID II

Facility

$390.00

Service Code	HCPCS 87207
Hospital Charge Code	39990111B
Hospital Revenue Code	309
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$16.29
Rate for Payer: Aetna Medicare Advantage	$19.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.73
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.99
Rate for Payer: Clover Medicare Advantage	$5.69
Rate for Payer: EmblemHealth Commercial	$17.97
Rate for Payer: Humana Medicare Advantage	$6.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.99
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	$4.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.99
Rate for Payer: Wellcare Medicare Advantage	$5.99
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CYCLOSPORA ID II

Facility

$390.00

Service Code	HCPCS 87207
Hospital Charge Code	39990111B
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYCLOSPORINE 100 MG CAP

Facility

$71.62

Service Code	HCPCS J7502
Hospital Charge Code	6001531
Hospital Revenue Code	636
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$17.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.33
Rate for Payer: Qualcare PPO/HMO/WC	$10.74

CYCLOSPORINE 100 MG CAP

Facility

$71.62

Service Code	HCPCS J7502
Hospital Charge Code	6001531
Hospital Revenue Code	636
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$35.81
Rate for Payer: Aetna Commercial	$27.22
Rate for Payer: Aetna Medicare Advantage	$21.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.26
Rate for Payer: Cigna Commercial	$35.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.33
Rate for Payer: Qualcare PPO/HMO/WC	$10.74
Rate for Payer: UnitedHealthcare Community & State	$2.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.03

CYCLOSPORINE100MG/ML ORAL 50ML

Facility

$87.03

Service Code	HCPCS J7502
Hospital Charge Code	6001523
Hospital Revenue Code	636
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$21.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.06
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

CYCLOSPORINE100MG/ML ORAL 50ML

Facility

$87.03

Service Code	HCPCS J7502
Hospital Charge Code	6001523
Hospital Revenue Code	636
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$43.52
Rate for Payer: Aetna Commercial	$33.07
Rate for Payer: Aetna Medicare Advantage	$26.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.19
Rate for Payer: Cigna Commercial	$43.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.06
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
Rate for Payer: UnitedHealthcare Community & State	$2.75
Rate for Payer: Wellpoint Medicaid Managed Care	$2.47

CYCLOSPORINE 250 MG/5ML INJ

Facility

$314.43

Service Code	HCPCS J7516
Hospital Charge Code	60628523
Hospital Revenue Code	636
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$76.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.09
Rate for Payer: Qualcare PPO/HMO/WC	$47.16

CYCLOSPORINE 250 MG/5ML INJ

Facility

$314.43

Service Code	HCPCS J7516
Hospital Charge Code	60628523
Hospital Revenue Code	636
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$157.22
Rate for Payer: Aetna Commercial	$119.48
Rate for Payer: Aetna Medicare Advantage	$94.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.18
Rate for Payer: Cigna Commercial	$157.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.09
Rate for Payer: Qualcare PPO/HMO/WC	$47.16
Rate for Payer: UnitedHealthcare Community & State	$9.94
Rate for Payer: Wellpoint Medicaid Managed Care	$8.93

CYCLOSPORINE 25 MG CAP

Facility

$22.45

Service Code	HCPCS J7515
Hospital Charge Code	60628599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$8.53
Rate for Payer: Aetna Medicare Advantage	$6.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.72
Rate for Payer: Cigna Commercial	$11.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

CYCLOSPORINE 25 MG CAP

Facility

$22.45

Service Code	HCPCS J7515
Hospital Charge Code	60628599
Hospital Revenue Code	636
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$5.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.37

CYCLOSPORINE,BLOOD

Facility

$566.00

Service Code	HCPCS 80158
Hospital Charge Code	38473095
Hospital Revenue Code	301
Min. Negotiated Rate	$14.44
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$49.10
Rate for Payer: Aetna Medicare Advantage	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$283.00
Rate for Payer: Cigna Medicare Advantage	$18.05
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$147.16
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Medicare Advantage	$18.05
Rate for Payer: Wellpoint Medicaid Managed Care	$16.07

CYCLOSPORINE,BLOOD

Facility

$566.00

Service Code	HCPCS 80158
Hospital Charge Code	38473095
Hospital Revenue Code	301
Min. Negotiated Rate	$84.90
Max. Negotiated Rate	$84.90
Rate for Payer: Qualcare PPO/HMO/WC	$84.90

CYCLOSPORINE,LCMSMS,BLOOD

Facility

$390.00

Service Code	HCPCS 80158
Hospital Charge Code	39900004
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

CYCLOSPORINE,LCMSMS,BLOOD

Facility

$390.00

Service Code	HCPCS 80158
Hospital Charge Code	39900004
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$49.10
Rate for Payer: Aetna Medicare Advantage	$58.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.48
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.05
Rate for Payer: Clover Medicare Advantage	$17.15
Rate for Payer: EmblemHealth Commercial	$54.15
Rate for Payer: Humana Medicare Advantage	$18.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.05
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	$14.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.05
Rate for Payer: Wellcare Medicare Advantage	$18.05
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CYGNUS CERV PLATE SYS 30MM 2LV

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705106
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

CYGNUS CERV PLATE SYS 30MM 2LV

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270705106
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

CYGNUS MORE CERV PLATE SYS 10M

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704630
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

CYGNUS MORE CERV PLATE SYS 10M

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704630
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

CYLINDER 700LGX 15CM

Facility

$41,460.00

Service Code	HCPCS C1813
Hospital Charge Code	270651347
Hospital Revenue Code	278
Min. Negotiated Rate	$1,177.46
Max. Negotiated Rate	$20,730.00
Rate for Payer: Aetna Commercial	$15,754.80
Rate for Payer: Aetna Medicare Advantage	$12,438.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,572.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,572.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,292.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,572.30
Rate for Payer: Cigna Commercial	$20,730.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,033.32
Rate for Payer: Qualcare PPO/HMO/WC	$6,219.00
Rate for Payer: UnitedHealthcare Community & State	$1,310.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1,177.46

CYLINDER 700LGX 15CM

Facility

$41,460.00

Service Code	HCPCS C1813
Hospital Charge Code	270651347
Hospital Revenue Code	278
Min. Negotiated Rate	$6,219.00
Max. Negotiated Rate	$10,033.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,292.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,033.32
Rate for Payer: Qualcare PPO/HMO/WC	$6,219.00

Know your out-of-pocket cost for care.

All Charges