Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DERML REP MATRIX 6x6CM/SQCMJW

Facility

$223.61

Hospital Charge Code	270674973W
Hospital Revenue Code	636
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$111.81
Rate for Payer: Aetna Commercial	$84.97
Rate for Payer: Aetna Medicare Advantage	$67.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.02
Rate for Payer: Cigna Commercial	$111.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.11
Rate for Payer: Qualcare PPO/HMO/WC	$33.54
Rate for Payer: UnitedHealthcare Community & State	$7.07
Rate for Payer: Wellpoint Medicaid Managed Care	$6.35

DERML REP MATRIX 6x6CM/SQCMJW

Facility

$223.61

Hospital Charge Code	270674973W
Hospital Revenue Code	636
Min. Negotiated Rate	$33.54
Max. Negotiated Rate	$54.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.11
Rate for Payer: Qualcare PPO/HMO/WC	$33.54

DERMOPLAST SPRAY

Facility

$32.50

Service Code	NDC 63029850401
Hospital Charge Code	60632355
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$12.35
Rate for Payer: Aetna Medicare Advantage	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.29
Rate for Payer: Cigna Commercial	$16.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.45
Rate for Payer: Oxford Commercial	$6.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Commercial	$6.50
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

DERMOPLAST SPRAY

Facility

$32.50

Service Code	NDC 63029850401
Hospital Charge Code	60632355
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$4.88
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

DESC HYPROCURE SZ 9

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270688253
Hospital Revenue Code	278
Min. Negotiated Rate	$282.58
Max. Negotiated Rate	$4,975.00
Rate for Payer: Aetna Commercial	$3,781.00
Rate for Payer: Aetna Medicare Advantage	$2,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,537.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,537.25
Rate for Payer: Cigna Commercial	$4,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50
Rate for Payer: UnitedHealthcare Community & State	$314.42
Rate for Payer: Wellpoint Medicaid Managed Care	$282.58

DESC HYPROCURE SZ 9

Facility

$9,950.00

Service Code	HCPCS C1776
Hospital Charge Code	270688253
Hospital Revenue Code	278
Min. Negotiated Rate	$1,492.50
Max. Negotiated Rate	$2,407.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,407.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,492.50

DESC LINER RETENTIVE 3R RSS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270692424
Hospital Revenue Code	278
Min. Negotiated Rate	$182.58
Max. Negotiated Rate	$3,214.35
Rate for Payer: Aetna Commercial	$2,442.91
Rate for Payer: Aetna Medicare Advantage	$1,928.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,639.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,639.32
Rate for Payer: Cigna Commercial	$3,214.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30
Rate for Payer: UnitedHealthcare Community & State	$203.15
Rate for Payer: Wellpoint Medicaid Managed Care	$182.58

DESC LINER RETENTIVE 3R RSS

Facility

$6,428.70

Service Code	HCPCS C1776
Hospital Charge Code	270692424
Hospital Revenue Code	278
Min. Negotiated Rate	$964.30
Max. Negotiated Rate	$1,555.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,285.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,555.75
Rate for Payer: Qualcare PPO/HMO/WC	$964.30

DESCOVY TABLET

Facility

$421.50

Service Code	NDC 61958200201
Hospital Charge Code	606390473
Hospital Revenue Code	250
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$210.75
Rate for Payer: Aetna Commercial	$160.17
Rate for Payer: Aetna Medicare Advantage	$126.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.48
Rate for Payer: Cigna Commercial	$210.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.59
Rate for Payer: Oxford Commercial	$84.30
Rate for Payer: Qualcare PPO/HMO/WC	$63.23
Rate for Payer: UnitedHealthcare Commercial	$84.30
Rate for Payer: UnitedHealthcare Community & State	$13.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.97

DESCOVY TABLET

Facility

$421.50

Service Code	NDC 61958200201
Hospital Charge Code	606390473
Hospital Revenue Code	250
Min. Negotiated Rate	$63.23
Max. Negotiated Rate	$63.23
Rate for Payer: Qualcare PPO/HMO/WC	$63.23

DESC PLATE SCREW PYENESS MONO

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692456
Hospital Revenue Code	278
Min. Negotiated Rate	$978.00
Max. Negotiated Rate	$1,577.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00

DESC PLATE SCREW PYENESS MONO

Facility

$6,520.00

Service Code	HCPCS C1713
Hospital Charge Code	270692456
Hospital Revenue Code	278
Min. Negotiated Rate	$185.17
Max. Negotiated Rate	$3,260.00
Rate for Payer: Aetna Commercial	$2,477.60
Rate for Payer: Aetna Medicare Advantage	$1,956.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,662.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,304.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,662.60
Rate for Payer: Cigna Commercial	$3,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,577.84
Rate for Payer: Qualcare PPO/HMO/WC	$978.00
Rate for Payer: UnitedHealthcare Community & State	$206.03
Rate for Payer: Wellpoint Medicaid Managed Care	$185.17

DESFLURANE 100% GAS

Facility

$1,288.14

Service Code	NDC 10019064134
Hospital Charge Code	60627666
Hospital Revenue Code	250
Min. Negotiated Rate	$36.58
Max. Negotiated Rate	$644.07
Rate for Payer: Aetna Commercial	$489.49
Rate for Payer: Aetna Medicare Advantage	$386.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.48
Rate for Payer: Cigna Commercial	$644.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$334.92
Rate for Payer: Oxford Commercial	$257.63
Rate for Payer: Qualcare PPO/HMO/WC	$193.22
Rate for Payer: UnitedHealthcare Commercial	$257.63
Rate for Payer: UnitedHealthcare Community & State	$40.71
Rate for Payer: Wellpoint Medicaid Managed Care	$36.58

DESFLURANE 100% GAS

Facility

$1,288.14

Service Code	NDC 10019064134
Hospital Charge Code	60627666
Hospital Revenue Code	250
Min. Negotiated Rate	$193.22
Max. Negotiated Rate	$193.22
Rate for Payer: Qualcare PPO/HMO/WC	$193.22

DESIGN MLC DEVICE FOR IMRT-GL

Facility

$1,887.22

Service Code	HCPCS 77338
Hospital Charge Code	85000645
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

DESIGN MLC DEVICE FOR IMRT-GL

Facility

$1,887.22

Service Code	HCPCS 77338
Hospital Charge Code	85000645
Hospital Revenue Code	333
Min. Negotiated Rate	$53.60
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,613.62
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.68
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$59.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellpoint Medicaid Managed Care	$53.60

DESIPRAMINE (NORPRAMINE)

Facility

$148.55

Service Code	HCPCS 80335
Hospital Charge Code	3007358
Hospital Revenue Code	301
Min. Negotiated Rate	$22.28
Max. Negotiated Rate	$22.28
Rate for Payer: Qualcare PPO/HMO/WC	$22.28

DESIPRAMINE (NORPRAMINE)

Facility

$148.55

Service Code	HCPCS 80335
Hospital Charge Code	3007358
Hospital Revenue Code	301
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$56.45
Rate for Payer: Aetna Medicare Advantage	$44.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.88
Rate for Payer: Cigna Commercial	$74.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.28
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.22

DESIPRAMINE SERUM

Facility

$370.00

Service Code	HCPCS 80335
Hospital Charge Code	38473106
Hospital Revenue Code	301
Min. Negotiated Rate	$10.51
Max. Negotiated Rate	$185.00
Rate for Payer: Aetna Commercial	$140.60
Rate for Payer: Aetna Medicare Advantage	$111.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$94.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$94.35
Rate for Payer: Cigna Commercial	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$10.51

DESIPRAMINE SERUM

Facility

$370.00

Service Code	HCPCS 80335
Hospital Charge Code	38473106
Hospital Revenue Code	301
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$55.50
Rate for Payer: Qualcare PPO/HMO/WC	$55.50

DESIPRANINE/25MG/U/D/TAB

Facility

$12.19

Service Code	NDC 781897201
Hospital Charge Code	60634717
Hospital Revenue Code	250
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$1.83
Rate for Payer: Qualcare PPO/HMO/WC	$1.83

DESIPRANINE/25MG/U/D/TAB

Facility

$12.19

Service Code	NDC 781897201
Hospital Charge Code	60634717
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.09
Rate for Payer: Aetna Commercial	$4.63
Rate for Payer: Aetna Medicare Advantage	$3.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.11
Rate for Payer: Cigna Commercial	$6.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.17
Rate for Payer: Oxford Commercial	$2.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.83
Rate for Payer: UnitedHealthcare Commercial	$2.44
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

DESITIN CREAM (60GM)

Facility

$22.78

Service Code	NDC 74300000300
Hospital Charge Code	606361039
Hospital Revenue Code	250
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$3.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.42

DESITIN CREAM (60GM)

Facility

$22.78

Service Code	NDC 74300000300
Hospital Charge Code	606361039
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.39
Rate for Payer: Aetna Commercial	$8.66
Rate for Payer: Aetna Medicare Advantage	$6.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.81
Rate for Payer: Cigna Commercial	$11.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.92
Rate for Payer: Oxford Commercial	$4.56
Rate for Payer: Qualcare PPO/HMO/WC	$3.42
Rate for Payer: UnitedHealthcare Commercial	$4.56
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

DESMOPRESSIN 0.01% NASAL SPRAY

Facility

$3,114.56

Service Code	NDC 75245201
Hospital Charge Code	6063943094
Hospital Revenue Code	250
Min. Negotiated Rate	$88.45
Max. Negotiated Rate	$1,557.28
Rate for Payer: Aetna Commercial	$1,183.53
Rate for Payer: Aetna Medicare Advantage	$934.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$794.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$794.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$794.21
Rate for Payer: Cigna Commercial	$1,557.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$809.79
Rate for Payer: Oxford Commercial	$622.91
Rate for Payer: Qualcare PPO/HMO/WC	$467.18
Rate for Payer: UnitedHealthcare Commercial	$622.91
Rate for Payer: UnitedHealthcare Community & State	$98.42
Rate for Payer: Wellpoint Medicaid Managed Care	$88.45

Know your out-of-pocket cost for care.

All Charges