Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DBX CONNECTIVE TISSUE,H 0.5 CC

Facility

$263.00

Hospital Charge Code	27038005
Hospital Revenue Code	278
Min. Negotiated Rate	$7.47
Max. Negotiated Rate	$131.50
Rate for Payer: Aetna Commercial	$99.94
Rate for Payer: Aetna Medicare Advantage	$78.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.06
Rate for Payer: Cigna Commercial	$131.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.65
Rate for Payer: Qualcare PPO/HMO/WC	$39.45
Rate for Payer: UnitedHealthcare Community & State	$8.31
Rate for Payer: Wellpoint Medicaid Managed Care	$7.47

DBX MIX 5CC

Facility

$5,231.10

Hospital Charge Code	270673044
Hospital Revenue Code	278
Min. Negotiated Rate	$784.66
Max. Negotiated Rate	$1,265.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,265.93
Rate for Payer: Qualcare PPO/HMO/WC	$784.66

DBX MIX 5CC

Facility

$5,231.10

Hospital Charge Code	270673044
Hospital Revenue Code	278
Min. Negotiated Rate	$148.56
Max. Negotiated Rate	$2,615.55
Rate for Payer: Aetna Commercial	$1,987.82
Rate for Payer: Aetna Medicare Advantage	$1,569.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,333.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,333.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,046.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,333.93
Rate for Payer: Cigna Commercial	$2,615.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,265.93
Rate for Payer: Qualcare PPO/HMO/WC	$784.66
Rate for Payer: UnitedHealthcare Community & State	$165.30
Rate for Payer: Wellpoint Medicaid Managed Care	$148.56

DBX PUTTY CONNECTIVE TIS 5 CC

Facility

$1,806.00

Hospital Charge Code	27038050
Hospital Revenue Code	278
Min. Negotiated Rate	$270.90
Max. Negotiated Rate	$437.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.05
Rate for Payer: Qualcare PPO/HMO/WC	$270.90

DBX PUTTY CONNECTIVE TIS 5 CC

Facility

$1,806.00

Hospital Charge Code	27038050
Hospital Revenue Code	278
Min. Negotiated Rate	$51.29
Max. Negotiated Rate	$903.00
Rate for Payer: Aetna Commercial	$686.28
Rate for Payer: Aetna Medicare Advantage	$541.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$460.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$460.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$361.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$460.53
Rate for Payer: Cigna Commercial	$903.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$437.05
Rate for Payer: Qualcare PPO/HMO/WC	$270.90
Rate for Payer: UnitedHealthcare Community & State	$57.07
Rate for Payer: Wellpoint Medicaid Managed Care	$51.29

DBX PUTTY CONNECTIVE TISS 2.5

Facility

$1,038.00

Hospital Charge Code	27038025
Hospital Revenue Code	278
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$251.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.20
Rate for Payer: Qualcare PPO/HMO/WC	$155.70

DBX PUTTY CONNECTIVE TISS 2.5

Facility

$1,038.00

Hospital Charge Code	27038025
Hospital Revenue Code	278
Min. Negotiated Rate	$29.48
Max. Negotiated Rate	$519.00
Rate for Payer: Aetna Commercial	$394.44
Rate for Payer: Aetna Medicare Advantage	$311.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$264.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$264.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$207.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$264.69
Rate for Payer: Cigna Commercial	$519.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$251.20
Rate for Payer: Qualcare PPO/HMO/WC	$155.70
Rate for Payer: UnitedHealthcare Community & State	$32.80
Rate for Payer: Wellpoint Medicaid Managed Care	$29.48

DBX PUTTY CONNECT TISS 1 CC

Facility

$468.00

Hospital Charge Code	27038010
Hospital Revenue Code	278
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$177.84
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20
Rate for Payer: UnitedHealthcare Community & State	$14.79
Rate for Payer: Wellpoint Medicaid Managed Care	$13.29

DBX PUTTY CONNECT TISS 1 CC

Facility

$468.00

Hospital Charge Code	27038010
Hospital Revenue Code	278
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$113.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$84,202.97

Service Code	MSDRG 744
Min. Negotiated Rate	$25,638.72
Max. Negotiated Rate	$84,202.97
Rate for Payer: Aetna Commercial	$61,828.83
Rate for Payer: Aetna Medicare Advantage	$84,202.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52,085.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52,085.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$26,988.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52,085.40
Rate for Payer: Cigna Commercial	$45,680.59
Rate for Payer: Cigna Medicare Advantage	$26,988.13
Rate for Payer: Clover Medicare Advantage	$25,638.72
Rate for Payer: EmblemHealth Commercial	$80,964.39
Rate for Payer: Humana Medicare Advantage	$27,797.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$26,988.13
Rate for Payer: Oxford Commercial	$36,105.14
Rate for Payer: UnitedHealthcare Commercial	$48,328.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$26,988.13
Rate for Payer: Wellcare Medicare Advantage	$26,988.13

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$55,402.34

Service Code	MSDRG 745
Min. Negotiated Rate	$16,869.30
Max. Negotiated Rate	$55,402.34
Rate for Payer: Aetna Commercial	$41,316.66
Rate for Payer: Aetna Medicare Advantage	$55,402.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,813.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,757.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,813.20
Rate for Payer: Cigna Commercial	$25,358.29
Rate for Payer: Cigna Medicare Advantage	$17,757.16
Rate for Payer: Clover Medicare Advantage	$16,869.30
Rate for Payer: EmblemHealth Commercial	$53,271.48
Rate for Payer: Humana Medicare Advantage	$18,289.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,757.16
Rate for Payer: Oxford Commercial	$20,042.75
Rate for Payer: UnitedHealthcare Commercial	$26,827.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,757.16
Rate for Payer: Wellcare Medicare Advantage	$17,757.16

D&C DIAG OR THERAP NOT OB

Facility

$16,333.80

Service Code	HCPCS 58120
Hospital Charge Code	16000760
Hospital Revenue Code	360
Min. Negotiated Rate	$2,450.07
Max. Negotiated Rate	$2,450.07
Rate for Payer: Qualcare PPO/HMO/WC	$2,450.07

D&C DIAG OR THERAP NOT OB

Facility

$16,333.80

Service Code	HCPCS 58120
Hospital Charge Code	16000760
Hospital Revenue Code	360
Min. Negotiated Rate	$463.88
Max. Negotiated Rate	$13,950.60
Rate for Payer: Aetna Commercial	$10,460.55
Rate for Payer: Aetna Medicare Advantage	$12,460.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13,950.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,845.79
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	$13,950.60
Rate for Payer: Cigna Commercial	$7,708.87
Rate for Payer: Cigna Medicare Advantage	$3,845.79
Rate for Payer: Clover Medicare Advantage	$3,653.50
Rate for Payer: EmblemHealth Commercial	$11,537.37
Rate for Payer: Humana Medicare Advantage	$3,961.16
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,845.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,246.79
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,450.07
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$516.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,845.79
Rate for Payer: Wellcare Medicare Advantage	$3,845.79
Rate for Payer: Wellpoint Medicaid Managed Care	$463.88

DCP DES GAMMA CARBXY PROTHRMBN

Facility

$1,495.05

Service Code	HCPCS 83951
Hospital Charge Code	39990238
Hospital Revenue Code	301
Min. Negotiated Rate	$42.46
Max. Negotiated Rate	$747.52
Rate for Payer: Aetna Commercial	$175.20
Rate for Payer: Aetna Medicare Advantage	$208.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$64.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.65
Rate for Payer: Cigna Commercial	$747.52
Rate for Payer: Cigna Medicare Advantage	$64.41
Rate for Payer: Clover Medicare Advantage	$61.19
Rate for Payer: EmblemHealth Commercial	$193.23
Rate for Payer: Humana Medicare Advantage	$66.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$64.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.71
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$224.26
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.41
Rate for Payer: Wellcare Medicare Advantage	$64.41
Rate for Payer: Wellpoint Medicaid Managed Care	$42.46

DCP DES GAMMA CARBXY PROTHRMBN

Facility

$1,495.05

Service Code	HCPCS 83951
Hospital Charge Code	39990238
Hospital Revenue Code	301
Min. Negotiated Rate	$224.26
Max. Negotiated Rate	$224.26
Rate for Payer: Qualcare PPO/HMO/WC	$224.26

DDAVP, 0.1MG,TAB

Facility

$54.81

Service Code	NDC 55566220000
Hospital Charge Code	60635434
Hospital Revenue Code	250
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$27.41
Rate for Payer: Aetna Commercial	$20.83
Rate for Payer: Aetna Medicare Advantage	$16.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.98
Rate for Payer: Cigna Commercial	$27.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.25
Rate for Payer: Oxford Commercial	$10.96
Rate for Payer: Qualcare PPO/HMO/WC	$8.22
Rate for Payer: UnitedHealthcare Commercial	$10.96
Rate for Payer: UnitedHealthcare Community & State	$1.73
Rate for Payer: Wellpoint Medicaid Managed Care	$1.56

DDAVP, 0.1MG,TAB

Facility

$54.81

Service Code	NDC 55566220000
Hospital Charge Code	60635434
Hospital Revenue Code	250
Min. Negotiated Rate	$8.22
Max. Negotiated Rate	$8.22
Rate for Payer: Qualcare PPO/HMO/WC	$8.22

D - DIMER,QUANT

Facility

$131.00

Service Code	HCPCS 85379
Hospital Charge Code	38478027
Hospital Revenue Code	305
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$27.69
Rate for Payer: Aetna Medicare Advantage	$32.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$10.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.93
Rate for Payer: Cigna Commercial	$65.50
Rate for Payer: Cigna Medicare Advantage	$10.18
Rate for Payer: Clover Medicare Advantage	$9.67
Rate for Payer: EmblemHealth Commercial	$30.54
Rate for Payer: Humana Medicare Advantage	$10.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$10.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.65
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$8.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.18
Rate for Payer: Wellcare Medicare Advantage	$10.18
Rate for Payer: Wellpoint Medicaid Managed Care	$3.72

D - DIMER,QUANT

Facility

$131.00

Service Code	HCPCS 85379
Hospital Charge Code	38478027
Hospital Revenue Code	305
Min. Negotiated Rate	$19.65
Max. Negotiated Rate	$19.65
Rate for Payer: Qualcare PPO/HMO/WC	$19.65

DEBAKEY HEPARIN CANN.

Facility

$207.50

Hospital Charge Code	270667114
Hospital Revenue Code	272
Min. Negotiated Rate	$31.12
Max. Negotiated Rate	$31.12
Rate for Payer: Qualcare PPO/HMO/WC	$31.12

DEBAKEY HEPARIN CANN.

Facility

$207.50

Hospital Charge Code	270667114
Hospital Revenue Code	272
Min. Negotiated Rate	$5.89
Max. Negotiated Rate	$103.75
Rate for Payer: Aetna Commercial	$78.85
Rate for Payer: Aetna Medicare Advantage	$62.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.91
Rate for Payer: Cigna Commercial	$103.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.95
Rate for Payer: Oxford Commercial	$41.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.12
Rate for Payer: UnitedHealthcare Commercial	$41.50
Rate for Payer: UnitedHealthcare Community & State	$6.56
Rate for Payer: Wellpoint Medicaid Managed Care	$5.89

DEB BONE 20 SQ CM/<

Facility

$6,929.76

Service Code	HCPCS 11044
Hospital Charge Code	16000223
Hospital Revenue Code	360
Min. Negotiated Rate	$218.98
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,801.74
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.46
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$218.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$394.27
Rate for Payer: Wellpoint Medicaid Managed Care	$386.54

DEB BONE 20 SQ CM/<

Facility

$6,929.76

Service Code	HCPCS 11044
Hospital Charge Code	16000223
Hospital Revenue Code	360
Min. Negotiated Rate	$1,039.46
Max. Negotiated Rate	$1,039.46
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.46

DEB MUSC/FASCIA 20 SQ CM/<

Facility

$2,989.82

Service Code	HCPCS 11043
Hospital Charge Code	16000205
Hospital Revenue Code	360
Min. Negotiated Rate	$84.91
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
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	$3,185.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$777.35
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$448.47
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$94.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$84.91

DEB MUSC/FASCIA 20 SQ CM/<

Facility

$2,989.82

Service Code	HCPCS 11043
Hospital Charge Code	16000205
Hospital Revenue Code	360
Min. Negotiated Rate	$448.47
Max. Negotiated Rate	$448.47
Rate for Payer: Qualcare PPO/HMO/WC	$448.47

Know your out-of-pocket cost for care.

All Charges