Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DRIVER SHAFT T8 HEXALOBE CANN

Facility

$975.00

Hospital Charge Code	270690958
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

DRIVER SHAFT T8 HEXALOBE CANN

Facility

$975.00

Hospital Charge Code	270690958
Hospital Revenue Code	272
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$30.81
Rate for Payer: Wellpoint Medicaid Managed Care	$27.69

DRIVER SHAFT T8 HEXLOBE CANN

Facility

$790.00

Hospital Charge Code	270690956
Hospital Revenue Code	272
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.40
Rate for Payer: Oxford Commercial	$158.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$158.00
Rate for Payer: UnitedHealthcare Community & State	$24.96
Rate for Payer: Wellpoint Medicaid Managed Care	$22.44

DRIVER SHAFT T8 HEXLOBE CANN

Facility

$790.00

Hospital Charge Code	270690956
Hospital Revenue Code	272
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

DRIVER STEP HEX 2/3.5 mm

Facility

$645.00

Hospital Charge Code	270680474
Hospital Revenue Code	272
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$322.50
Rate for Payer: Aetna Commercial	$245.10
Rate for Payer: Aetna Medicare Advantage	$193.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$164.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$164.47
Rate for Payer: Cigna Commercial	$322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$167.70
Rate for Payer: Oxford Commercial	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$96.75
Rate for Payer: UnitedHealthcare Commercial	$129.00
Rate for Payer: UnitedHealthcare Community & State	$20.38
Rate for Payer: Wellpoint Medicaid Managed Care	$18.32

DRIVER STEP HEX 2/3.5 mm

Facility

$645.00

Hospital Charge Code	270680474
Hospital Revenue Code	272
Min. Negotiated Rate	$96.75
Max. Negotiated Rate	$96.75
Rate for Payer: Qualcare PPO/HMO/WC	$96.75

DRIVER TORQUE T6 MSP STERILE

Facility

$1,080.00

Hospital Charge Code	270688569
Hospital Revenue Code	272
Min. Negotiated Rate	$30.67
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$410.40
Rate for Payer: Aetna Medicare Advantage	$324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$275.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$275.40
Rate for Payer: Cigna Commercial	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$280.80
Rate for Payer: Oxford Commercial	$216.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00
Rate for Payer: UnitedHealthcare Commercial	$216.00
Rate for Payer: UnitedHealthcare Community & State	$34.13
Rate for Payer: Wellpoint Medicaid Managed Care	$30.67

DRIVER TORQUE T6 MSP STERILE

Facility

$1,080.00

Hospital Charge Code	270688569
Hospital Revenue Code	272
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$162.00
Rate for Payer: Qualcare PPO/HMO/WC	$162.00

DRIVER UNIVERSAL QC T-20

Facility

$360.00

Hospital Charge Code	270679707
Hospital Revenue Code	272
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00

DRIVER UNIVERSAL QC T-20

Facility

$360.00

Hospital Charge Code	270679707
Hospital Revenue Code	272
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$136.80
Rate for Payer: Aetna Medicare Advantage	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.80
Rate for Payer: Cigna Commercial	$180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.60
Rate for Payer: Oxford Commercial	$72.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.00
Rate for Payer: UnitedHealthcare Commercial	$72.00
Rate for Payer: UnitedHealthcare Community & State	$11.38
Rate for Payer: Wellpoint Medicaid Managed Care	$10.22

DRIVER UNIVERSAL QUICK CONNECT

Facility

$603.00

Hospital Charge Code	270661790
Hospital Revenue Code	272
Min. Negotiated Rate	$17.13
Max. Negotiated Rate	$301.50
Rate for Payer: Aetna Commercial	$229.14
Rate for Payer: Aetna Medicare Advantage	$180.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.76
Rate for Payer: Cigna Commercial	$301.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.78
Rate for Payer: Oxford Commercial	$120.60
Rate for Payer: Qualcare PPO/HMO/WC	$90.45
Rate for Payer: UnitedHealthcare Commercial	$120.60
Rate for Payer: UnitedHealthcare Community & State	$19.05
Rate for Payer: Wellpoint Medicaid Managed Care	$17.13

DRIVER UNIVERSAL QUICK CONNECT

Facility

$603.00

Hospital Charge Code	270661790
Hospital Revenue Code	272
Min. Negotiated Rate	$90.45
Max. Negotiated Rate	$90.45
Rate for Payer: Qualcare PPO/HMO/WC	$90.45

DRIVE SHAFT SEAL RIA

Facility

$89.25

Hospital Charge Code	270671815
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$44.62
Rate for Payer: Aetna Commercial	$33.91
Rate for Payer: Aetna Medicare Advantage	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.76
Rate for Payer: Cigna Commercial	$44.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.20
Rate for Payer: Oxford Commercial	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$13.39
Rate for Payer: UnitedHealthcare Commercial	$17.85
Rate for Payer: UnitedHealthcare Community & State	$2.82
Rate for Payer: Wellpoint Medicaid Managed Care	$2.53

DRIVE SHAFT SEAL RIA

Facility

$89.25

Hospital Charge Code	270671815
Hospital Revenue Code	272
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$13.39
Rate for Payer: Qualcare PPO/HMO/WC	$13.39

DRIVE SHAFT T10 HEXALOBE

Facility

$790.00

Hospital Charge Code	270690955
Hospital Revenue Code	272
Min. Negotiated Rate	$22.44
Max. Negotiated Rate	$395.00
Rate for Payer: Aetna Commercial	$300.20
Rate for Payer: Aetna Medicare Advantage	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$201.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$201.45
Rate for Payer: Cigna Commercial	$395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.40
Rate for Payer: Oxford Commercial	$158.00
Rate for Payer: Qualcare PPO/HMO/WC	$118.50
Rate for Payer: UnitedHealthcare Commercial	$158.00
Rate for Payer: UnitedHealthcare Community & State	$24.96
Rate for Payer: Wellpoint Medicaid Managed Care	$22.44

DRIVE SHAFT T10 HEXALOBE

Facility

$790.00

Hospital Charge Code	270690955
Hospital Revenue Code	272
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

DRONEDARONE HCL 400MGTAB

Facility

$57.29

Service Code	NDC 24414210
Hospital Charge Code	60632222
Hospital Revenue Code	250
Min. Negotiated Rate	$8.59
Max. Negotiated Rate	$8.59
Rate for Payer: Qualcare PPO/HMO/WC	$8.59

DRONEDARONE HCL 400MGTAB

Facility

$57.29

Service Code	NDC 24414210
Hospital Charge Code	60632222
Hospital Revenue Code	250
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$28.64
Rate for Payer: Aetna Commercial	$21.77
Rate for Payer: Aetna Medicare Advantage	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.61
Rate for Payer: Cigna Commercial	$28.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.90
Rate for Payer: Oxford Commercial	$11.46
Rate for Payer: Qualcare PPO/HMO/WC	$8.59
Rate for Payer: UnitedHealthcare Commercial	$11.46
Rate for Payer: UnitedHealthcare Community & State	$1.81
Rate for Payer: Wellpoint Medicaid Managed Care	$1.63

DROPERIDOL 2.5MG/ML

Facility

$14.27

Service Code	HCPCS J1790
Hospital Charge Code	60630212
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$3.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.14

DROPERIDOL 2.5MG/ML

Facility

$14.27

Service Code	HCPCS J1790
Hospital Charge Code	60630212
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.13
Rate for Payer: Aetna Commercial	$5.42
Rate for Payer: Aetna Medicare Advantage	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.64
Rate for Payer: Cigna Commercial	$7.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.14
Rate for Payer: UnitedHealthcare Community & State	$0.45
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

DRSG 3X8 OIL EMULSN NON250381

Facility

$5.00

Hospital Charge Code	270641457W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

DRSG 3X8 OIL EMULSN NON250381

Facility

$5.00

Hospital Charge Code	270641457W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

DRSG ALLEVYN NON ADH 66927637

Facility

$16.75

Hospital Charge Code	270632166
Hospital Revenue Code	272
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.51

DRSG ALLEVYN NON ADH 66927637

Facility

$16.75

Hospital Charge Code	270632166
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.38
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Aetna Medicare Advantage	$5.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.27
Rate for Payer: Cigna Commercial	$8.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.36
Rate for Payer: Oxford Commercial	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.51
Rate for Payer: UnitedHealthcare Commercial	$3.35
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DRSG DUODERM EXTRA THIN 187955

Facility

$9.39

Hospital Charge Code	270350289
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.70
Rate for Payer: Aetna Commercial	$3.57
Rate for Payer: Aetna Medicare Advantage	$2.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.44
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

Know your out-of-pocket cost for care.

All Charges