Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DAPTOMYCIN 500MG INJ (CUBICIN)

Facility

$3,048.77

Service Code	HCPCS J0878
Hospital Charge Code	60629365
Hospital Revenue Code	636
Min. Negotiated Rate	$86.59
Max. Negotiated Rate	$1,524.38
Rate for Payer: Aetna Commercial	$1,158.53
Rate for Payer: Aetna Medicare Advantage	$914.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.44
Rate for Payer: Cigna Commercial	$1,524.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$737.80
Rate for Payer: Qualcare PPO/HMO/WC	$457.32
Rate for Payer: UnitedHealthcare Community & State	$96.34
Rate for Payer: Wellpoint Medicaid Managed Care	$86.59

DARAPRIM

Facility

$109.01

Service Code	NDC 69413033010
Hospital Charge Code	60634464
Hospital Revenue Code	250
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

DARAPRIM

Facility

$109.01

Service Code	NDC 69413033010
Hospital Charge Code	60634464
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$54.51
Rate for Payer: Aetna Commercial	$41.42
Rate for Payer: Aetna Medicare Advantage	$32.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.80
Rate for Payer: Cigna Commercial	$54.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$21.80
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Commercial	$21.80
Rate for Payer: UnitedHealthcare Community & State	$3.44
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

DARFENACIN 15MG TAB

Facility

$65.12

Service Code	NDC 430017115
Hospital Charge Code	6063943091
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$32.56
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.61
Rate for Payer: Cigna Commercial	$32.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.93
Rate for Payer: Oxford Commercial	$13.02
Rate for Payer: Qualcare PPO/HMO/WC	$9.77
Rate for Payer: UnitedHealthcare Commercial	$13.02
Rate for Payer: UnitedHealthcare Community & State	$2.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

DARFENACIN 15MG TAB

Facility

$65.12

Service Code	NDC 430017115
Hospital Charge Code	6063943091
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.77

DARFENACIN 7.5MG TAB

Facility

$65.12

Service Code	NDC 430017015
Hospital Charge Code	6063943092
Hospital Revenue Code	250
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$32.56
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare Advantage	$19.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.61
Rate for Payer: Cigna Commercial	$32.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.93
Rate for Payer: Oxford Commercial	$13.02
Rate for Payer: Qualcare PPO/HMO/WC	$9.77
Rate for Payer: UnitedHealthcare Commercial	$13.02
Rate for Payer: UnitedHealthcare Community & State	$2.06
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

DARFENACIN 7.5MG TAB

Facility

$65.12

Service Code	NDC 430017015
Hospital Charge Code	6063943092
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$9.77
Rate for Payer: Qualcare PPO/HMO/WC	$9.77

DART ATX CHONDRAL 18 AR4005B18

Facility

$865.00

Hospital Charge Code	270627255
Hospital Revenue Code	272
Min. Negotiated Rate	$129.75
Max. Negotiated Rate	$129.75
Rate for Payer: Qualcare PPO/HMO/WC	$129.75

DART ATX CHONDRAL 18 AR4005B18

Facility

$865.00

Hospital Charge Code	270627255
Hospital Revenue Code	272
Min. Negotiated Rate	$24.57
Max. Negotiated Rate	$432.50
Rate for Payer: Aetna Commercial	$328.70
Rate for Payer: Aetna Medicare Advantage	$259.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$220.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$220.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$220.57
Rate for Payer: Cigna Commercial	$432.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$224.90
Rate for Payer: Oxford Commercial	$173.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.75
Rate for Payer: UnitedHealthcare Commercial	$173.00
Rate for Payer: UnitedHealthcare Community & State	$27.33
Rate for Payer: Wellpoint Medicaid Managed Care	$24.57

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704583
Hospital Revenue Code	278
Min. Negotiated Rate	$402.47
Max. Negotiated Rate	$649.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: Qualcare PPO/HMO/WC	$402.47

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704583
Hospital Revenue Code	278
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$1,341.58
Rate for Payer: Aetna Commercial	$1,019.60
Rate for Payer: Aetna Medicare Advantage	$804.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.20
Rate for Payer: Cigna Commercial	$1,341.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: Qualcare PPO/HMO/WC	$402.47
Rate for Payer: UnitedHealthcare Community & State	$84.79
Rate for Payer: Wellpoint Medicaid Managed Care	$76.20

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704582
Hospital Revenue Code	278
Min. Negotiated Rate	$402.47
Max. Negotiated Rate	$649.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: Qualcare PPO/HMO/WC	$402.47

DARTFIRE CANNULATED SCREW SHOR

Facility

$2,683.15

Service Code	HCPCS C1713
Hospital Charge Code	270704582
Hospital Revenue Code	278
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$1,341.58
Rate for Payer: Aetna Commercial	$1,019.60
Rate for Payer: Aetna Medicare Advantage	$804.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$684.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$536.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$684.20
Rate for Payer: Cigna Commercial	$1,341.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.32
Rate for Payer: Qualcare PPO/HMO/WC	$402.47
Rate for Payer: UnitedHealthcare Community & State	$84.79
Rate for Payer: Wellpoint Medicaid Managed Care	$76.20

DARTFIRE EDGE INSTRUMENT PACK

Facility

$8,224.55

Service Code	HCPCS C1713
Hospital Charge Code	270699041
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.68
Max. Negotiated Rate	$1,990.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.68

DARTFIRE EDGE INSTRUMENT PACK

Facility

$8,224.55

Service Code	HCPCS C1713
Hospital Charge Code	270699041
Hospital Revenue Code	278
Min. Negotiated Rate	$233.58
Max. Negotiated Rate	$4,112.27
Rate for Payer: Aetna Commercial	$3,125.33
Rate for Payer: Aetna Medicare Advantage	$2,467.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,644.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.26
Rate for Payer: Cigna Commercial	$4,112.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.68
Rate for Payer: UnitedHealthcare Community & State	$259.90
Rate for Payer: Wellpoint Medicaid Managed Care	$233.58

DARTFIRE EDGE SCRDVR S 2-2.7MM

Facility

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	270702547
Hospital Revenue Code	278
Min. Negotiated Rate	$27.75
Max. Negotiated Rate	$44.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Qualcare PPO/HMO/WC	$27.75

DARTFIRE EDGE SCRDVR S 2-2.7MM

Facility

$185.00

Service Code	HCPCS C1713
Hospital Charge Code	270702547
Hospital Revenue Code	278
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$92.50
Rate for Payer: Aetna Commercial	$70.30
Rate for Payer: Aetna Medicare Advantage	$55.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$37.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.17
Rate for Payer: Cigna Commercial	$92.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.77
Rate for Payer: Qualcare PPO/HMO/WC	$27.75
Rate for Payer: UnitedHealthcare Community & State	$5.85
Rate for Payer: Wellpoint Medicaid Managed Care	$5.25

DART SNP-OFF 2X13MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270704250
Hospital Revenue Code	278
Min. Negotiated Rate	$31.81
Max. Negotiated Rate	$560.00
Rate for Payer: Aetna Commercial	$425.60
Rate for Payer: Aetna Medicare Advantage	$336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$285.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$285.60
Rate for Payer: Cigna Commercial	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: Qualcare PPO/HMO/WC	$168.00
Rate for Payer: UnitedHealthcare Community & State	$35.39
Rate for Payer: Wellpoint Medicaid Managed Care	$31.81

DART SNP-OFF 2X13MM

Facility

$1,120.00

Service Code	HCPCS C1713
Hospital Charge Code	270704250
Hospital Revenue Code	278
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$271.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.04
Rate for Payer: Qualcare PPO/HMO/WC	$168.00

DARUNAVIR 600MG TAB

Facility

$168.57

Service Code	NDC 59676056201
Hospital Charge Code	60632210
Hospital Revenue Code	250
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$84.28
Rate for Payer: Aetna Commercial	$64.06
Rate for Payer: Aetna Medicare Advantage	$50.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.99
Rate for Payer: Cigna Commercial	$84.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.83
Rate for Payer: Oxford Commercial	$33.71
Rate for Payer: Qualcare PPO/HMO/WC	$25.29
Rate for Payer: UnitedHealthcare Commercial	$33.71
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$4.79

DARUNAVIR 600MG TAB

Facility

$168.57

Service Code	NDC 59676056201
Hospital Charge Code	60632210
Hospital Revenue Code	250
Min. Negotiated Rate	$25.29
Max. Negotiated Rate	$25.29
Rate for Payer: Qualcare PPO/HMO/WC	$25.29

DARUNAVIR ETHANOLATE 800 MG TA

Facility

$510.34

Service Code	NDC 54569636600
Hospital Charge Code	6063943192
Hospital Revenue Code	250
Min. Negotiated Rate	$14.49
Max. Negotiated Rate	$255.17
Rate for Payer: Aetna Commercial	$193.93
Rate for Payer: Aetna Medicare Advantage	$153.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$130.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$130.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$130.14
Rate for Payer: Cigna Commercial	$255.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$132.69
Rate for Payer: Oxford Commercial	$102.07
Rate for Payer: Qualcare PPO/HMO/WC	$76.55
Rate for Payer: UnitedHealthcare Commercial	$102.07
Rate for Payer: UnitedHealthcare Community & State	$16.13
Rate for Payer: Wellpoint Medicaid Managed Care	$14.49

DARUNAVIR ETHANOLATE 800 MG TA

Facility

$510.34

Service Code	NDC 54569636600
Hospital Charge Code	6063943192
Hospital Revenue Code	250
Min. Negotiated Rate	$76.55
Max. Negotiated Rate	$76.55
Rate for Payer: Qualcare PPO/HMO/WC	$76.55

DAVAL HICKMAN PORT

Facility

$1,515.00

Hospital Charge Code	270335124
Hospital Revenue Code	278
Min. Negotiated Rate	$43.03
Max. Negotiated Rate	$757.50
Rate for Payer: Aetna Commercial	$575.70
Rate for Payer: Aetna Medicare Advantage	$454.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$386.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$386.32
Rate for Payer: Cigna Commercial	$757.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.63
Rate for Payer: Qualcare PPO/HMO/WC	$227.25
Rate for Payer: UnitedHealthcare Community & State	$47.87
Rate for Payer: Wellpoint Medicaid Managed Care	$43.03

DAVAL HICKMAN PORT

Facility

$1,515.00

Hospital Charge Code	270335124
Hospital Revenue Code	278
Min. Negotiated Rate	$227.25
Max. Negotiated Rate	$366.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$303.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.63
Rate for Payer: Qualcare PPO/HMO/WC	$227.25

Know your out-of-pocket cost for care.

All Charges