Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DUAL LUMEN URETERAL CATHETER

Facility

$168.65

Service Code	HCPCS C1758
Hospital Charge Code	270682456
Hospital Revenue Code	278
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$40.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.81
Rate for Payer: Qualcare PPO/HMO/WC	$25.30

DUAL LUMEN URETERAL CATHETER

Facility

$168.65

Service Code	HCPCS C1758
Hospital Charge Code	270682456
Hospital Revenue Code	278
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$84.33
Rate for Payer: Aetna Commercial	$64.09
Rate for Payer: Aetna Medicare Advantage	$50.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.01
Rate for Payer: Cigna Commercial	$84.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.81
Rate for Payer: Qualcare PPO/HMO/WC	$25.30
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$4.79

DUAL MOBILITY LINER 64/53

Facility

$25,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270700357
Hospital Revenue Code	278
Min. Negotiated Rate	$3,785.25
Max. Negotiated Rate	$6,106.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,047.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,106.87
Rate for Payer: Qualcare PPO/HMO/WC	$3,785.25

DUAL MOBILITY LINER 64/53

Facility

$25,235.00

Service Code	HCPCS C1776
Hospital Charge Code	270700357
Hospital Revenue Code	278
Min. Negotiated Rate	$716.67
Max. Negotiated Rate	$12,617.50
Rate for Payer: Aetna Commercial	$9,589.30
Rate for Payer: Aetna Medicare Advantage	$7,570.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,434.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,434.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,047.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,434.93
Rate for Payer: Cigna Commercial	$12,617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,106.87
Rate for Payer: Qualcare PPO/HMO/WC	$3,785.25
Rate for Payer: UnitedHealthcare Community & State	$797.43
Rate for Payer: Wellpoint Medicaid Managed Care	$716.67

DUAL SPIKE ADAPTER

Facility

$72.10

Hospital Charge Code	270681126
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$36.05
Rate for Payer: Aetna Commercial	$27.40
Rate for Payer: Aetna Medicare Advantage	$21.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.39
Rate for Payer: Cigna Commercial	$36.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.75
Rate for Payer: Oxford Commercial	$14.42
Rate for Payer: Qualcare PPO/HMO/WC	$10.81
Rate for Payer: UnitedHealthcare Commercial	$14.42
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

DUAL SPIKE ADAPTER

Facility

$72.10

Hospital Charge Code	270681126
Hospital Revenue Code	272
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$10.81
Rate for Payer: Qualcare PPO/HMO/WC	$10.81

DUET DRAINAGE EXTERNAL SYS KIT

Facility

$1,125.00

Hospital Charge Code	270670959
Hospital Revenue Code	272
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$292.50
Rate for Payer: Oxford Commercial	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Commercial	$225.00
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

DUET DRAINAGE EXTERNAL SYS KIT

Facility

$1,125.00

Hospital Charge Code	270670959
Hospital Revenue Code	272
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$168.75
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

DULOXETINE 20 MG

Facility

$52.13

Service Code	NDC 2323560
Hospital Charge Code	60629913
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$26.07
Rate for Payer: Aetna Commercial	$19.81
Rate for Payer: Aetna Medicare Advantage	$15.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.29
Rate for Payer: Cigna Commercial	$26.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.55
Rate for Payer: Oxford Commercial	$10.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.82
Rate for Payer: UnitedHealthcare Commercial	$10.43
Rate for Payer: UnitedHealthcare Community & State	$1.65
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

DULOXETINE 20 MG

Facility

$52.13

Service Code	NDC 2323560
Hospital Charge Code	60629913
Hospital Revenue Code	250
Min. Negotiated Rate	$7.82
Max. Negotiated Rate	$7.82
Rate for Payer: Qualcare PPO/HMO/WC	$7.82

DULOXETINE 30 MG

Facility

$58.42

Service Code	NDC 2324030
Hospital Charge Code	60629904
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.76

DULOXETINE 30 MG

Facility

$58.42

Service Code	NDC 2324030
Hospital Charge Code	60629904
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$29.21
Rate for Payer: Aetna Commercial	$22.20
Rate for Payer: Aetna Medicare Advantage	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Oxford Commercial	$11.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$11.68
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

DULOXETINE 60 MG

Facility

$58.42

Service Code	NDC 2327030
Hospital Charge Code	60629857
Hospital Revenue Code	250
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.76

DULOXETINE 60 MG

Facility

$58.42

Service Code	NDC 2327030
Hospital Charge Code	60629857
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$29.21
Rate for Payer: Aetna Commercial	$22.20
Rate for Payer: Aetna Medicare Advantage	$17.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.90
Rate for Payer: Cigna Commercial	$29.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Oxford Commercial	$11.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$11.68
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

DULOXETINE(CYMBALTA)QUANTITA

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472348
Hospital Revenue Code	301
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.50
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$2.13

DULOXETINE(CYMBALTA)QUANTITA

Facility

$75.00

Service Code	HCPCS 80299
Hospital Charge Code	38472348
Hospital Revenue Code	301
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

DUODENAL WALLFLX STENT 22X60MM

Facility

$3,743.00

Hospital Charge Code	270334804
Hospital Revenue Code	278
Min. Negotiated Rate	$561.45
Max. Negotiated Rate	$905.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$748.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45

DUODENAL WALLFLX STENT 22X60MM

Facility

$3,743.00

Hospital Charge Code	270334804
Hospital Revenue Code	278
Min. Negotiated Rate	$106.30
Max. Negotiated Rate	$1,871.50
Rate for Payer: Aetna Commercial	$1,422.34
Rate for Payer: Aetna Medicare Advantage	$1,122.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$748.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$954.47
Rate for Payer: Cigna Commercial	$1,871.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45
Rate for Payer: UnitedHealthcare Community & State	$118.28
Rate for Payer: Wellpoint Medicaid Managed Care	$106.30

DUODENOTOMY- EXPLORE BX FB REM

Facility

$10,701.75

Service Code	HCPCS 44010
Hospital Charge Code	1600000363
Hospital Revenue Code	360
Min. Negotiated Rate	$1,605.26
Max. Negotiated Rate	$1,605.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.26

DUODENOTOMY- EXPLORE BX FB REM

Facility

$10,701.75

Service Code	HCPCS 44010
Hospital Charge Code	1600000363
Hospital Revenue Code	360
Min. Negotiated Rate	$303.93
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$4,066.66
Rate for Payer: Aetna Medicare Advantage	$3,210.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,728.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,728.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,728.95
Rate for Payer: Cigna Commercial	$5,350.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,782.45
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.26
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$338.18
Rate for Payer: Wellpoint Medicaid Managed Care	$303.93

DUODERM CFG CONTROL GEL 4X4

Facility

$39.00

Hospital Charge Code	270332250
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

DUODERM CFG CONTROL GEL 4X4

Facility

$39.00

Hospital Charge Code	270332250
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

DUODERM HYDROACTIVE DRESSING

Facility

$126.00

Hospital Charge Code	270331694
Hospital Revenue Code	272
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

DUODERM HYDROACTIVE DRESSING

Facility

$126.00

Hospital Charge Code	270331694
Hospital Revenue Code	272
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$47.88
Rate for Payer: Aetna Medicare Advantage	$37.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.13
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.76
Rate for Payer: Oxford Commercial	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$25.20
Rate for Payer: UnitedHealthcare Community & State	$3.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

DUOVISC 0.5-0.55 ML

Facility

$1,338.39

Service Code	NDC 8065183150
Hospital Charge Code	60632265
Hospital Revenue Code	250
Min. Negotiated Rate	$200.76
Max. Negotiated Rate	$200.76
Rate for Payer: Qualcare PPO/HMO/WC	$200.76

Know your out-of-pocket cost for care.

All Charges