Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DAKIN'S 0.25% SOL

Facility

$115.58

Service Code	NDC 436093616
Hospital Charge Code	60629895
Hospital Revenue Code	250
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$17.34
Rate for Payer: Qualcare PPO/HMO/WC	$17.34

DAKIN'S 0.25% SOL

Facility

$115.58

Service Code	NDC 436093616
Hospital Charge Code	60629895
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$57.79
Rate for Payer: Aetna Commercial	$43.92
Rate for Payer: Aetna Medicare Advantage	$34.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.47
Rate for Payer: Cigna Commercial	$57.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.05
Rate for Payer: Oxford Commercial	$23.12
Rate for Payer: Qualcare PPO/HMO/WC	$17.34
Rate for Payer: UnitedHealthcare Commercial	$23.12
Rate for Payer: UnitedHealthcare Community & State	$3.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

DAKINS SOLUTION 0.125%

Facility

$113.90

Service Code	NDC 436067216
Hospital Charge Code	606350997
Hospital Revenue Code	250
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$56.95
Rate for Payer: Aetna Commercial	$43.28
Rate for Payer: Aetna Medicare Advantage	$34.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.04
Rate for Payer: Cigna Commercial	$56.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.61
Rate for Payer: Oxford Commercial	$22.78
Rate for Payer: Qualcare PPO/HMO/WC	$17.09
Rate for Payer: UnitedHealthcare Commercial	$22.78
Rate for Payer: UnitedHealthcare Community & State	$3.60
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

DAKINS SOLUTION 0.125%

Facility

$113.90

Service Code	NDC 436067216
Hospital Charge Code	606350997
Hospital Revenue Code	250
Min. Negotiated Rate	$17.09
Max. Negotiated Rate	$17.09
Rate for Payer: Qualcare PPO/HMO/WC	$17.09

DAKIN'S TOPICAL 0.5% SOL

Facility

$115.58

Service Code	NDC 436094616
Hospital Charge Code	60629896
Hospital Revenue Code	250
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$17.34
Rate for Payer: Qualcare PPO/HMO/WC	$17.34

DAKIN'S TOPICAL 0.5% SOL

Facility

$115.58

Service Code	NDC 436094616
Hospital Charge Code	60629896
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$57.79
Rate for Payer: Aetna Commercial	$43.92
Rate for Payer: Aetna Medicare Advantage	$34.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.47
Rate for Payer: Cigna Commercial	$57.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.05
Rate for Payer: Oxford Commercial	$23.12
Rate for Payer: Qualcare PPO/HMO/WC	$17.34
Rate for Payer: UnitedHealthcare Commercial	$23.12
Rate for Payer: UnitedHealthcare Community & State	$3.65
Rate for Payer: Wellpoint Medicaid Managed Care	$3.28

DALBAVANCIN 500MG VIAL

Facility

$11,979.60

Service Code	HCPCS J0875
Hospital Charge Code	606390045
Hospital Revenue Code	636
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$2,899.06
Rate for Payer: Aetna Commercial	$40.80
Rate for Payer: Aetna Medicare Advantage	$48.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.41
Rate for Payer: Cigna Medicare Advantage	$15.00
Rate for Payer: Clover Medicare Advantage	$14.25
Rate for Payer: EmblemHealth Commercial	$45.00
Rate for Payer: Humana Medicare Advantage	$15.45
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.94
Rate for Payer: UnitedHealthcare Community & State	$378.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.00
Rate for Payer: Wellcare Medicare Advantage	$15.00
Rate for Payer: Wellpoint Medicaid Managed Care	$340.22

DALBAVANCIN 500MG VIAL

Facility

$11,979.60

Service Code	HCPCS J0875
Hospital Charge Code	606390045
Hospital Revenue Code	636
Min. Negotiated Rate	$1,796.94
Max. Negotiated Rate	$2,899.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,899.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.94

DANAZOL 100 MG CAP

Facility

$36.45

Service Code	NDC 555063402
Hospital Charge Code	60628212
Hospital Revenue Code	250
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$5.47
Rate for Payer: Qualcare PPO/HMO/WC	$5.47

DANAZOL 100 MG CAP

Facility

$36.45

Service Code	NDC 555063402
Hospital Charge Code	60628212
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.23
Rate for Payer: Aetna Commercial	$13.85
Rate for Payer: Aetna Medicare Advantage	$10.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.29
Rate for Payer: Cigna Commercial	$18.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.48
Rate for Payer: Oxford Commercial	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$5.47
Rate for Payer: UnitedHealthcare Commercial	$7.29
Rate for Payer: UnitedHealthcare Community & State	$1.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DANTRIUM/100MG

Facility

$14.54

Service Code	NDC 115443301
Hospital Charge Code	60634475
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.27
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare Advantage	$4.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.71
Rate for Payer: Cigna Commercial	$7.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.78
Rate for Payer: Oxford Commercial	$2.91
Rate for Payer: Qualcare PPO/HMO/WC	$2.18
Rate for Payer: UnitedHealthcare Commercial	$2.91
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

DANTRIUM/100MG

Facility

$14.54

Service Code	NDC 115443301
Hospital Charge Code	60634475
Hospital Revenue Code	250
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$2.18
Rate for Payer: Qualcare PPO/HMO/WC	$2.18

DANTRIUM/25MG

Facility

$8.58

Service Code	NDC 42023012401
Hospital Charge Code	60634474
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$4.29
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna Medicare Advantage	$2.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.19
Rate for Payer: Cigna Commercial	$4.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.23
Rate for Payer: Oxford Commercial	$1.72
Rate for Payer: Qualcare PPO/HMO/WC	$1.29
Rate for Payer: UnitedHealthcare Commercial	$1.72
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

DANTRIUM/25MG

Facility

$8.58

Service Code	NDC 42023012401
Hospital Charge Code	60634474
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Qualcare PPO/HMO/WC	$1.29

DANTROLENE 20 MG INJ

Facility

$712.68

Service Code	NDC 42023012306
Hospital Charge Code	60627483
Hospital Revenue Code	250
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$356.34
Rate for Payer: Aetna Commercial	$270.82
Rate for Payer: Aetna Medicare Advantage	$213.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$181.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$181.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$181.73
Rate for Payer: Cigna Commercial	$356.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$185.30
Rate for Payer: Oxford Commercial	$142.54
Rate for Payer: Qualcare PPO/HMO/WC	$106.90
Rate for Payer: UnitedHealthcare Commercial	$142.54
Rate for Payer: UnitedHealthcare Community & State	$22.52
Rate for Payer: Wellpoint Medicaid Managed Care	$20.24

DANTROLENE 20 MG INJ

Facility

$712.68

Service Code	NDC 42023012306
Hospital Charge Code	60627483
Hospital Revenue Code	250
Min. Negotiated Rate	$106.90
Max. Negotiated Rate	$106.90
Rate for Payer: Qualcare PPO/HMO/WC	$106.90

DAPAGLIFLOZIN 10MG TABLET

Facility

$95.14

Service Code	NDC 310621030
Hospital Charge Code	606390425
Hospital Revenue Code	250
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$14.27

DAPAGLIFLOZIN 10MG TABLET

Facility

$95.14

Service Code	NDC 310621030
Hospital Charge Code	606390425
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$47.57
Rate for Payer: Aetna Commercial	$36.15
Rate for Payer: Aetna Medicare Advantage	$28.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.26
Rate for Payer: Cigna Commercial	$47.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.74
Rate for Payer: Oxford Commercial	$19.03
Rate for Payer: Qualcare PPO/HMO/WC	$14.27
Rate for Payer: UnitedHealthcare Commercial	$19.03
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

DAPAGLIFLOZIN 5MG TABLET

Facility

$95.14

Service Code	NDC 310620530
Hospital Charge Code	606390424
Hospital Revenue Code	250
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$14.27
Rate for Payer: Qualcare PPO/HMO/WC	$14.27

DAPAGLIFLOZIN 5MG TABLET

Facility

$95.14

Service Code	NDC 310620530
Hospital Charge Code	606390424
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$47.57
Rate for Payer: Aetna Commercial	$36.15
Rate for Payer: Aetna Medicare Advantage	$28.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.26
Rate for Payer: Cigna Commercial	$47.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.74
Rate for Payer: Oxford Commercial	$19.03
Rate for Payer: Qualcare PPO/HMO/WC	$14.27
Rate for Payer: UnitedHealthcare Commercial	$19.03
Rate for Payer: UnitedHealthcare Community & State	$3.01
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

DAPSONE 100 MG TAB

Facility

$22.51

Service Code	NDC 49938010130
Hospital Charge Code	60628600
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DAPSONE 100 MG TAB

Facility

$22.51

Service Code	NDC 49938010130
Hospital Charge Code	60628600
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.26
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DAPSONE,25MG,TAB

Facility

$18.36

Service Code	NDC 49938010230
Hospital Charge Code	60635435
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.75

DAPSONE,25MG,TAB

Facility

$18.36

Service Code	NDC 49938010230
Hospital Charge Code	60635435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$6.98
Rate for Payer: Aetna Medicare Advantage	$5.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.68
Rate for Payer: Cigna Commercial	$9.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.77
Rate for Payer: Oxford Commercial	$3.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.75
Rate for Payer: UnitedHealthcare Commercial	$3.67
Rate for Payer: UnitedHealthcare Community & State	$0.58
Rate for Payer: Wellpoint Medicaid Managed Care	$0.52

DAPTOMYCIN 500MG INJ (CUBICIN)

Facility

$3,048.77

Service Code	HCPCS J0878
Hospital Charge Code	60629365
Hospital Revenue Code	636
Min. Negotiated Rate	$457.32
Max. Negotiated Rate	$737.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.80
Rate for Payer: Qualcare PPO/HMO/WC	$457.32

Know your out-of-pocket cost for care.

All Charges