Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DENTAL AND ORAL DISEASES WITH CC

Facility

$48,208.43

Service Code	MSDRG 158
Min. Negotiated Rate	$14,678.85
Max. Negotiated Rate	$48,208.43
Rate for Payer: Aetna Commercial	$36,193.10
Rate for Payer: Aetna Medicare Advantage	$48,208.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26,042.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26,042.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,451.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26,042.70
Rate for Payer: Cigna Commercial	$20,282.17
Rate for Payer: Cigna Medicare Advantage	$15,451.42
Rate for Payer: Clover Medicare Advantage	$14,678.85
Rate for Payer: EmblemHealth Commercial	$46,354.26
Rate for Payer: Humana Medicare Advantage	$15,914.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,451.42
Rate for Payer: Oxford Commercial	$16,030.68
Rate for Payer: UnitedHealthcare Commercial	$21,457.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,451.42
Rate for Payer: Wellcare Medicare Advantage	$15,451.42

DENTAL AND ORAL DISEASES WITH MCC

Facility

$73,704.45

Service Code	MSDRG 157
Min. Negotiated Rate	$22,442.06
Max. Negotiated Rate	$73,704.45
Rate for Payer: Aetna Commercial	$54,351.66
Rate for Payer: Aetna Medicare Advantage	$73,704.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47,375.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47,375.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,623.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47,375.55
Rate for Payer: Cigna Commercial	$38,272.62
Rate for Payer: Cigna Medicare Advantage	$23,623.22
Rate for Payer: Clover Medicare Advantage	$22,442.06
Rate for Payer: EmblemHealth Commercial	$70,869.66
Rate for Payer: Humana Medicare Advantage	$24,331.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,623.22
Rate for Payer: Oxford Commercial	$30,250.02
Rate for Payer: UnitedHealthcare Commercial	$40,490.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,623.22
Rate for Payer: Wellcare Medicare Advantage	$23,623.22

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$41,848.68

Service Code	MSDRG 159
Min. Negotiated Rate	$12,483.77
Max. Negotiated Rate	$41,848.68
Rate for Payer: Aetna Commercial	$31,663.62
Rate for Payer: Aetna Medicare Advantage	$41,848.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,839.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,839.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,413.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,839.40
Rate for Payer: Cigna Commercial	$15,794.59
Rate for Payer: Cigna Medicare Advantage	$13,413.04
Rate for Payer: Clover Medicare Advantage	$12,742.39
Rate for Payer: EmblemHealth Commercial	$40,239.12
Rate for Payer: Humana Medicare Advantage	$13,815.43
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,413.04
Rate for Payer: Oxford Commercial	$12,483.77
Rate for Payer: UnitedHealthcare Commercial	$16,709.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,413.04
Rate for Payer: Wellcare Medicare Advantage	$13,413.04

DENTAL DISEASES AND DISORDERS

Facility

$11,023.00

Service Code	APR-DRG 1143
Min. Negotiated Rate	$10,806.86
Max. Negotiated Rate	$11,023.00
Rate for Payer: UnitedHealthcare Community & State	$10,806.86
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,023.00
Rate for Payer: Wellpoint Medicaid Managed Care	$10,806.86

DENTAL DISEASES AND DISORDERS

Facility

$21,310.10

Service Code	APR-DRG 1144
Min. Negotiated Rate	$20,892.25
Max. Negotiated Rate	$21,310.10
Rate for Payer: UnitedHealthcare Community & State	$20,892.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$21,310.10
Rate for Payer: Wellpoint Medicaid Managed Care	$20,892.25

DENTAL DISEASES AND DISORDERS

Facility

$5,333.84

Service Code	APR-DRG 1141
Min. Negotiated Rate	$5,229.25
Max. Negotiated Rate	$5,333.84
Rate for Payer: UnitedHealthcare Community & State	$5,229.25
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$5,333.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5,229.25

DENTAL DISEASES AND DISORDERS

Facility

$7,485.32

Service Code	APR-DRG 1142
Min. Negotiated Rate	$7,338.55
Max. Negotiated Rate	$7,485.32
Rate for Payer: UnitedHealthcare Community & State	$7,338.55
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,485.32
Rate for Payer: Wellpoint Medicaid Managed Care	$7,338.55

DENTAL SEALANT PER TOOTH

Facility

$5,110.00

Service Code	HCPCS D1351
Hospital Charge Code	1600000797
Hospital Revenue Code	360
Min. Negotiated Rate	$766.50
Max. Negotiated Rate	$766.50
Rate for Payer: Qualcare PPO/HMO/WC	$766.50

DENTAL SEALANT PER TOOTH

Facility

$5,110.00

Service Code	HCPCS D1351
Hospital Charge Code	1600000797
Hospital Revenue Code	360
Min. Negotiated Rate	$145.12
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,941.80
Rate for Payer: Aetna Medicare Advantage	$1,533.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,303.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,303.05
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	$1,303.05
Rate for Payer: Cigna Commercial	$2,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.60
Rate for Payer: Qualcare PPO/HMO/WC	$766.50
Rate for Payer: UnitedHealthcare Community & State	$161.48
Rate for Payer: Wellpoint Medicaid Managed Care	$145.12

DENVER ASCITES

Facility

$4,925.00

Hospital Charge Code	270621194
Hospital Revenue Code	272
Min. Negotiated Rate	$139.87
Max. Negotiated Rate	$2,462.50
Rate for Payer: Aetna Commercial	$1,871.50
Rate for Payer: Aetna Medicare Advantage	$1,477.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,255.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,255.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,255.88
Rate for Payer: Cigna Commercial	$2,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,280.50
Rate for Payer: Oxford Commercial	$985.00
Rate for Payer: Qualcare PPO/HMO/WC	$738.75
Rate for Payer: UnitedHealthcare Commercial	$985.00
Rate for Payer: UnitedHealthcare Community & State	$155.63
Rate for Payer: Wellpoint Medicaid Managed Care	$139.87

DENVER ASCITES

Facility

$4,925.00

Hospital Charge Code	270621194
Hospital Revenue Code	272
Min. Negotiated Rate	$738.75
Max. Negotiated Rate	$738.75
Rate for Payer: Qualcare PPO/HMO/WC	$738.75

DENVER NASAL SPLINT

Facility

$242.00

Hospital Charge Code	270331761
Hospital Revenue Code	272
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$36.30
Rate for Payer: Qualcare PPO/HMO/WC	$36.30

DENVER NASAL SPLINT

Facility

$242.00

Hospital Charge Code	270331761
Hospital Revenue Code	272
Min. Negotiated Rate	$6.87
Max. Negotiated Rate	$121.00
Rate for Payer: Aetna Commercial	$91.96
Rate for Payer: Aetna Medicare Advantage	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.71
Rate for Payer: Cigna Commercial	$121.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.92
Rate for Payer: Oxford Commercial	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$36.30
Rate for Payer: UnitedHealthcare Commercial	$48.40
Rate for Payer: UnitedHealthcare Community & State	$7.65
Rate for Payer: Wellpoint Medicaid Managed Care	$6.87

DENVER PERITONEAL VENOUS SHUNT

Facility

$5,407.50

Hospital Charge Code	270331636
Hospital Revenue Code	278
Min. Negotiated Rate	$811.12
Max. Negotiated Rate	$1,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,081.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,308.62
Rate for Payer: Qualcare PPO/HMO/WC	$811.12

DENVER PERITONEAL VENOUS SHUNT

Facility

$5,407.50

Hospital Charge Code	270331636
Hospital Revenue Code	278
Min. Negotiated Rate	$153.57
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Commercial	$2,054.85
Rate for Payer: Aetna Medicare Advantage	$1,622.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,378.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,378.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,081.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,378.91
Rate for Payer: Cigna Commercial	$2,703.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,308.62
Rate for Payer: Qualcare PPO/HMO/WC	$811.12
Rate for Payer: UnitedHealthcare Community & State	$170.88
Rate for Payer: Wellpoint Medicaid Managed Care	$153.57

DENVER SHUNT PERC

Facility

$11,250.00

Hospital Charge Code	270686042
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

DENVER SHUNT PERC

Facility

$11,250.00

Hospital Charge Code	270686042
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DEOXYCORTICOSTERONE

Facility

$211.30

Service Code	HCPCS 82633
Hospital Charge Code	39900502
Hospital Revenue Code	301
Min. Negotiated Rate	$31.70
Max. Negotiated Rate	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$31.70

DEOXYCORTICOSTERONE

Facility

$211.30

Service Code	HCPCS 82633
Hospital Charge Code	39900502
Hospital Revenue Code	301
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$84.27
Rate for Payer: Aetna Medicare Advantage	$100.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.38
Rate for Payer: Cigna Commercial	$105.65
Rate for Payer: Cigna Medicare Advantage	$30.98
Rate for Payer: Clover Medicare Advantage	$29.43
Rate for Payer: EmblemHealth Commercial	$92.94
Rate for Payer: Humana Medicare Advantage	$31.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$30.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$24.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.98
Rate for Payer: Wellcare Medicare Advantage	$30.98
Rate for Payer: Wellpoint Medicaid Managed Care	$6.00

DEPAKOTE DELAYED RELEASE 250 MG TB

Facility

$11.79

Service Code	NDC 93744001
Hospital Charge Code	606350965
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.89
Rate for Payer: Aetna Commercial	$4.48
Rate for Payer: Aetna Medicare Advantage	$3.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.01
Rate for Payer: Cigna Commercial	$5.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.07
Rate for Payer: Oxford Commercial	$2.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.77
Rate for Payer: UnitedHealthcare Commercial	$2.36
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

DEPAKOTE DELAYED RELEASE 250 MG TB

Facility

$11.79

Service Code	NDC 93744001
Hospital Charge Code	606350965
Hospital Revenue Code	250
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.77

DEPAKOTE DELAYED RELEASE 500 MG TB

Facility

$24.12

Service Code	NDC 51079047508
Hospital Charge Code	606350945
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$3.62
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

DEPAKOTE DELAYED RELEASE 500 MG TB

Facility

$24.12

Service Code	NDC 51079047508
Hospital Charge Code	606350945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$9.17
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.27
Rate for Payer: Oxford Commercial	$4.82
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Commercial	$4.82
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

DEPAKOTE TAB 125 MG

Facility

$6.03

Service Code	NDC 57237004601
Hospital Charge Code	60635342
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.90

DEPAKOTE TAB 125 MG

Facility

$6.03

Service Code	NDC 57237004601
Hospital Charge Code	60635342
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare Advantage	$1.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.54
Rate for Payer: Cigna Commercial	$3.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.57
Rate for Payer: Oxford Commercial	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.90
Rate for Payer: UnitedHealthcare Commercial	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

Know your out-of-pocket cost for care.

All Charges