Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEL VBAC

Facility

$10,100.00

Service Code	HCPCS 59612
Hospital Charge Code	73190047
Hospital Revenue Code	720
Min. Negotiated Rate	$1,515.00
Max. Negotiated Rate	$1,515.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,515.00

DEMA-BAND SSB 4CMX5

Facility

$23.15

Hospital Charge Code	270636423
Hospital Revenue Code	272
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$3.47
Rate for Payer: Qualcare PPO/HMO/WC	$3.47

DEMA-BAND SSB 4CMX5

Facility

$23.15

Hospital Charge Code	270636423
Hospital Revenue Code	272
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$11.57
Rate for Payer: Aetna Commercial	$8.80
Rate for Payer: Aetna Medicare Advantage	$6.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.90
Rate for Payer: Cigna Commercial	$11.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.02
Rate for Payer: Oxford Commercial	$4.63
Rate for Payer: Qualcare PPO/HMO/WC	$3.47
Rate for Payer: UnitedHealthcare Commercial	$4.63
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

DEMADEX 100 MG U/D TAB

Facility

$20.37

Service Code	NDC 31722053201
Hospital Charge Code	60635309
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$3.06

DEMADEX 100 MG U/D TAB

Facility

$20.37

Service Code	NDC 31722053201
Hospital Charge Code	60635309
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$10.19
Rate for Payer: Aetna Commercial	$7.74
Rate for Payer: Aetna Medicare Advantage	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.19
Rate for Payer: Cigna Commercial	$10.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.30
Rate for Payer: Oxford Commercial	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$3.06
Rate for Payer: UnitedHealthcare Commercial	$4.07
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

DEMECLOCYCLINE 150 MG TAB

Facility

$71.22

Service Code	NDC 62584015901
Hospital Charge Code	60627316
Hospital Revenue Code	251
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$10.68
Rate for Payer: Qualcare PPO/HMO/WC	$10.68

DEMECLOCYCLINE 150 MG TAB

Facility

$71.22

Service Code	NDC 62584015901
Hospital Charge Code	60627316
Hospital Revenue Code	251
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$35.61
Rate for Payer: Aetna Commercial	$27.06
Rate for Payer: Aetna Medicare Advantage	$21.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.16
Rate for Payer: Cigna Commercial	$35.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.52
Rate for Payer: Oxford Commercial	$14.24
Rate for Payer: Qualcare PPO/HMO/WC	$10.68
Rate for Payer: UnitedHealthcare Commercial	$14.24
Rate for Payer: UnitedHealthcare Community & State	$2.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.02

DEMEROL/100MG/1ML

Facility

$10.99

Service Code	HCPCS J2175
Hospital Charge Code	60632794
Hospital Revenue Code	636
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$2.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

DEMEROL/100MG/1ML

Facility

$10.99

Service Code	HCPCS J2175
Hospital Charge Code	60632794
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.80
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

DEMEROL/50MG/1ML

Facility

$10.05

Service Code	HCPCS J2175
Hospital Charge Code	60632792
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.03
Rate for Payer: Aetna Commercial	$3.82
Rate for Payer: Aetna Medicare Advantage	$3.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.56
Rate for Payer: Cigna Commercial	$5.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.51
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

DEMEROL/50MG/1ML

Facility

$10.05

Service Code	HCPCS J2175
Hospital Charge Code	60632792
Hospital Revenue Code	636
Min. Negotiated Rate	$1.51
Max. Negotiated Rate	$2.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.51

DEMINERALIZED FIBERS VESU 30CC

Facility

$13,759.95

Service Code	HCPCS C1713
Hospital Charge Code	270697909
Hospital Revenue Code	278
Min. Negotiated Rate	$390.78
Max. Negotiated Rate	$6,879.98
Rate for Payer: Aetna Commercial	$5,228.78
Rate for Payer: Aetna Medicare Advantage	$4,127.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,508.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,508.79
Rate for Payer: Cigna Commercial	$6,879.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.99
Rate for Payer: UnitedHealthcare Community & State	$434.81
Rate for Payer: Wellpoint Medicaid Managed Care	$390.78

DEMINERALIZED FIBERS VESU 30CC

Facility

$13,759.95

Service Code	HCPCS C1713
Hospital Charge Code	270697909
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.99
Max. Negotiated Rate	$3,329.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,751.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,329.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,063.99

DEMO EVAL INH DEVICE

Facility

$171.00

Service Code	HCPCS 94664
Hospital Charge Code	9500620
Hospital Revenue Code	410
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$1,440.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$943.69
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.46
Rate for Payer: Oxford Commercial	$1,367.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.65
Rate for Payer: UnitedHealthcare Commercial	$1,440.00
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$4.86

DEMO EVAL INH DEVICE

Facility

$171.00

Service Code	HCPCS 94664
Hospital Charge Code	9500620
Hospital Revenue Code	410
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$25.65
Rate for Payer: Qualcare PPO/HMO/WC	$25.65

DEMO/EVAL INH DEVICE

Facility

$58.41

Service Code	HCPCS 94664
Hospital Charge Code	87502735
Hospital Revenue Code	412
Min. Negotiated Rate	$8.76
Max. Negotiated Rate	$8.76
Rate for Payer: Qualcare PPO/HMO/WC	$8.76

DEMO/EVAL INH DEVICE

Facility

$58.41

Service Code	HCPCS 94664
Hospital Charge Code	87502735
Hospital Revenue Code	412
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$1,440.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$943.69
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.19
Rate for Payer: Oxford Commercial	$1,367.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.76
Rate for Payer: UnitedHealthcare Commercial	$1,440.00
Rate for Payer: UnitedHealthcare Community & State	$1.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1.66

DENGUE FEVER AB IGG, IGM, I

Facility

$390.00

Service Code	HCPCS 8679091
Hospital Charge Code	39990050A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DENGUE FEVER AB IGG, IGM, I

Facility

$390.00

Service Code	HCPCS 8679091
Hospital Charge Code	39990050A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DENGUE FEVER AB IGG, IGM, II

Facility

$390.00

Service Code	HCPCS 8679091
Hospital Charge Code	39990050B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DENGUE FEVER AB IGG, IGM, II

Facility

$390.00

Service Code	HCPCS 8679091
Hospital Charge Code	39990050B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DENOSUMAB 120 MG/1.7 ML ML

Facility

$14,728.07

Service Code	HCPCS J0897
Hospital Charge Code	6063943193
Hospital Revenue Code	636
Min. Negotiated Rate	$2,209.21
Max. Negotiated Rate	$3,564.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,564.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,209.21

DENOSUMAB 120 MG/1.7 ML ML

Facility

$14,728.07

Service Code	HCPCS J0897
Hospital Charge Code	6063943193
Hospital Revenue Code	636
Min. Negotiated Rate	$28.03
Max. Negotiated Rate	$3,564.19
Rate for Payer: Aetna Commercial	$80.27
Rate for Payer: Aetna Medicare Advantage	$95.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.05
Rate for Payer: Cigna Medicare Advantage	$29.51
Rate for Payer: Clover Medicare Advantage	$28.03
Rate for Payer: EmblemHealth Commercial	$88.53
Rate for Payer: Humana Medicare Advantage	$30.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,564.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,209.21
Rate for Payer: UnitedHealthcare Community & State	$465.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.51
Rate for Payer: Wellcare Medicare Advantage	$29.51
Rate for Payer: Wellpoint Medicaid Managed Care	$418.28

DENOSUMAB 60MG/ML SOL (PROLIA)

Facility

$6,635.68

Service Code	HCPCS J0897
Hospital Charge Code	60630053
Hospital Revenue Code	636
Min. Negotiated Rate	$28.03
Max. Negotiated Rate	$1,605.83
Rate for Payer: Aetna Commercial	$80.27
Rate for Payer: Aetna Medicare Advantage	$95.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$29.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.05
Rate for Payer: Cigna Medicare Advantage	$29.51
Rate for Payer: Clover Medicare Advantage	$28.03
Rate for Payer: EmblemHealth Commercial	$88.53
Rate for Payer: Humana Medicare Advantage	$30.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$29.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,605.83
Rate for Payer: Qualcare PPO/HMO/WC	$995.35
Rate for Payer: UnitedHealthcare Community & State	$209.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.51
Rate for Payer: Wellcare Medicare Advantage	$29.51
Rate for Payer: Wellpoint Medicaid Managed Care	$188.45

DENOSUMAB 60MG/ML SOL (PROLIA)

Facility

$6,635.68

Service Code	HCPCS J0897
Hospital Charge Code	60630053
Hospital Revenue Code	636
Min. Negotiated Rate	$995.35
Max. Negotiated Rate	$1,605.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,605.83
Rate for Payer: Qualcare PPO/HMO/WC	$995.35

Know your out-of-pocket cost for care.

All Charges