Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CYTO SPUTUM

Facility

$390.00

Service Code	HCPCS 88108
Hospital Charge Code	3001336
Hospital Revenue Code	311
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$160.95
Rate for Payer: Aetna Commercial	$120.69
Rate for Payer: Aetna Medicare Advantage	$143.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.95
Rate for Payer: Cigna Commercial	$88.94
Rate for Payer: Cigna Medicare Advantage	$44.37
Rate for Payer: Clover Medicare Advantage	$42.15
Rate for Payer: EmblemHealth Commercial	$133.11
Rate for Payer: Humana Medicare Advantage	$45.70
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.37
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	$55.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.37
Rate for Payer: Wellcare Medicare Advantage	$44.37
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

CYTOTEC/100MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60634757
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.41
Rate for Payer: Aetna Commercial	$7.16
Rate for Payer: Aetna Medicare Advantage	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.80
Rate for Payer: Cigna Commercial	$9.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.90
Rate for Payer: Oxford Commercial	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.82
Rate for Payer: UnitedHealthcare Commercial	$3.77
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

CYTOTEC/100MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60634757
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.82

CYTOTEC 200MCG TABLET

Facility

$27.40

Service Code	NDC 25146134
Hospital Charge Code	60632358
Hospital Revenue Code	250
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.11
Rate for Payer: Qualcare PPO/HMO/WC	$4.11

CYTOTEC 200MCG TABLET

Facility

$27.40

Service Code	NDC 25146134
Hospital Charge Code	60632358
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.70
Rate for Payer: Aetna Commercial	$10.41
Rate for Payer: Aetna Medicare Advantage	$8.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.99
Rate for Payer: Cigna Commercial	$13.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.12
Rate for Payer: Oxford Commercial	$5.48
Rate for Payer: Qualcare PPO/HMO/WC	$4.11
Rate for Payer: UnitedHealthcare Commercial	$5.48
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

CYTOTEC 25MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60635563
Hospital Revenue Code	250
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$2.82
Rate for Payer: Qualcare PPO/HMO/WC	$2.82

CYTOTEC 25MCG/TAB

Facility

$18.83

Service Code	NDC 25145134
Hospital Charge Code	60635563
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$9.41
Rate for Payer: Aetna Commercial	$7.16
Rate for Payer: Aetna Medicare Advantage	$5.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.80
Rate for Payer: Cigna Commercial	$9.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.90
Rate for Payer: Oxford Commercial	$3.77
Rate for Payer: Qualcare PPO/HMO/WC	$2.82
Rate for Payer: UnitedHealthcare Commercial	$3.77
Rate for Payer: UnitedHealthcare Community & State	$0.60
Rate for Payer: Wellpoint Medicaid Managed Care	$0.53

CYTOXAN 50MG ORAL

Facility

$115.11

Service Code	NDC 54038325
Hospital Charge Code	60634363
Hospital Revenue Code	250
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$57.55
Rate for Payer: Aetna Commercial	$43.74
Rate for Payer: Aetna Medicare Advantage	$34.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.35
Rate for Payer: Cigna Commercial	$57.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.93
Rate for Payer: Oxford Commercial	$23.02
Rate for Payer: Qualcare PPO/HMO/WC	$17.27
Rate for Payer: UnitedHealthcare Commercial	$23.02
Rate for Payer: UnitedHealthcare Community & State	$3.64
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

CYTOXAN 50MG ORAL

Facility

$115.11

Service Code	NDC 54038325
Hospital Charge Code	60634363
Hospital Revenue Code	250
Min. Negotiated Rate	$17.27
Max. Negotiated Rate	$17.27
Rate for Payer: Qualcare PPO/HMO/WC	$17.27

CYT PATH THIN LAYER AUTO,MD SU

Facility

$149.00

Service Code	HCPCS 88174
Hospital Charge Code	38478091
Hospital Revenue Code	311
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.01
Rate for Payer: Aetna Medicare Advantage	$82.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.03
Rate for Payer: Cigna Commercial	$74.50
Rate for Payer: Cigna Medicare Advantage	$25.37
Rate for Payer: Clover Medicare Advantage	$24.10
Rate for Payer: EmblemHealth Commercial	$76.11
Rate for Payer: Humana Medicare Advantage	$26.13
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.37
Rate for Payer: Wellcare Medicare Advantage	$25.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.23

CYT PATH THIN LAYER AUTO,MD SU

Facility

$149.00

Service Code	HCPCS 88174
Hospital Charge Code	38478091
Hospital Revenue Code	311
Min. Negotiated Rate	$22.35
Max. Negotiated Rate	$22.35
Rate for Payer: Qualcare PPO/HMO/WC	$22.35

D10 W NACL 0.2% 250ML

Facility

$45.69

Service Code	NDC 264762320
Hospital Charge Code	606390152
Hospital Revenue Code	258
Min. Negotiated Rate	$6.85
Max. Negotiated Rate	$6.85
Rate for Payer: Qualcare PPO/HMO/WC	$6.85

D10 W NACL 0.2% 250ML

Facility

$45.69

Service Code	NDC 264762320
Hospital Charge Code	606390152
Hospital Revenue Code	258
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$22.84
Rate for Payer: Aetna Commercial	$17.36
Rate for Payer: Aetna Medicare Advantage	$13.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.65
Rate for Payer: Cigna Commercial	$22.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.88
Rate for Payer: Oxford Commercial	$9.14
Rate for Payer: Qualcare PPO/HMO/WC	$6.85
Rate for Payer: UnitedHealthcare Commercial	$9.14
Rate for Payer: UnitedHealthcare Community & State	$1.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

D50 SYRINGE

Facility

$36.00

Hospital Charge Code	60627956W
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$18.00
Rate for Payer: Aetna Commercial	$13.68
Rate for Payer: Aetna Medicare Advantage	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.18
Rate for Payer: Cigna Commercial	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.36
Rate for Payer: Oxford Commercial	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$5.40
Rate for Payer: UnitedHealthcare Commercial	$7.20
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

D50 SYRINGE

Facility

$36.00

Hospital Charge Code	60627956W
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.40

DABIGATRA ETEX MESYLAT 150 CAP

Facility

$42.14

Service Code	NDC 597036082
Hospital Charge Code	60630061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$21.07
Rate for Payer: Aetna Commercial	$16.01
Rate for Payer: Aetna Medicare Advantage	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.75
Rate for Payer: Cigna Commercial	$21.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.96
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$8.43
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

DABIGATRA ETEX MESYLAT 150 CAP

Facility

$42.14

Service Code	NDC 597036082
Hospital Charge Code	60630061
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

DABIGATRAN ETEX MESYLAT 75 CAP

Facility

$42.14

Service Code	NDC 597035556
Hospital Charge Code	60630062
Hospital Revenue Code	250
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$6.32
Rate for Payer: Qualcare PPO/HMO/WC	$6.32

DABIGATRAN ETEX MESYLAT 75 CAP

Facility

$42.14

Service Code	NDC 597035556
Hospital Charge Code	60630062
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$21.07
Rate for Payer: Aetna Commercial	$16.01
Rate for Payer: Aetna Medicare Advantage	$12.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.75
Rate for Payer: Cigna Commercial	$21.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.96
Rate for Payer: Oxford Commercial	$8.43
Rate for Payer: Qualcare PPO/HMO/WC	$6.32
Rate for Payer: UnitedHealthcare Commercial	$8.43
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

DACARBAZINE 200 MG INJ

Facility

$131.92

Service Code	HCPCS J9130
Hospital Charge Code	6001598
Hospital Revenue Code	636
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$31.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.79

DACARBAZINE 200 MG INJ

Facility

$131.92

Service Code	HCPCS J9130
Hospital Charge Code	6001598
Hospital Revenue Code	636
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$65.96
Rate for Payer: Aetna Commercial	$50.13
Rate for Payer: Aetna Medicare Advantage	$39.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.64
Rate for Payer: Cigna Commercial	$65.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$31.92
Rate for Payer: Qualcare PPO/HMO/WC	$19.79
Rate for Payer: UnitedHealthcare Community & State	$4.17
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

DACTINOMYCIN 0.5 MG INJ

Facility

$4,997.93

Service Code	HCPCS J9120
Hospital Charge Code	60627375
Hospital Revenue Code	636
Min. Negotiated Rate	$141.94
Max. Negotiated Rate	$1,224.90
Rate for Payer: Aetna Commercial	$918.46
Rate for Payer: Aetna Medicare Advantage	$1,094.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,224.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,224.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$337.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$357.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,224.90
Rate for Payer: Cigna Medicare Advantage	$337.67
Rate for Payer: Clover Medicare Advantage	$320.79
Rate for Payer: EmblemHealth Commercial	$1,013.01
Rate for Payer: Humana Medicare Advantage	$347.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$337.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,209.50
Rate for Payer: Qualcare PPO/HMO/WC	$749.69
Rate for Payer: UnitedHealthcare Community & State	$157.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$337.67
Rate for Payer: Wellcare Medicare Advantage	$337.67
Rate for Payer: Wellpoint Medicaid Managed Care	$141.94

DACTINOMYCIN 0.5 MG INJ

Facility

$4,997.93

Service Code	HCPCS J9120
Hospital Charge Code	60627375
Hospital Revenue Code	636
Min. Negotiated Rate	$749.69
Max. Negotiated Rate	$1,209.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,209.50
Rate for Payer: Qualcare PPO/HMO/WC	$749.69

DAIN HUBLESS BLAKE 15FR

Facility

$3,209.20

Hospital Charge Code	270657433
Hospital Revenue Code	278
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$1,604.60
Rate for Payer: Aetna Commercial	$1,219.50
Rate for Payer: Aetna Medicare Advantage	$962.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$818.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$818.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$818.35
Rate for Payer: Cigna Commercial	$1,604.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$776.63
Rate for Payer: Qualcare PPO/HMO/WC	$481.38
Rate for Payer: UnitedHealthcare Community & State	$101.41
Rate for Payer: Wellpoint Medicaid Managed Care	$91.14

DAIN HUBLESS BLAKE 15FR

Facility

$3,209.20

Hospital Charge Code	270657433
Hospital Revenue Code	278
Min. Negotiated Rate	$481.38
Max. Negotiated Rate	$776.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$641.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$776.63
Rate for Payer: Qualcare PPO/HMO/WC	$481.38

Know your out-of-pocket cost for care.

All Charges