Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DESMOPRESSIN 0.01% NASAL SPRAY

Facility

$3,114.56

Service Code	NDC 75245201
Hospital Charge Code	6063943094
Hospital Revenue Code	250
Min. Negotiated Rate	$467.18
Max. Negotiated Rate	$467.18
Rate for Payer: Qualcare PPO/HMO/WC	$467.18

DESMOPRESSIN 4MCG/ML INJ 10 ML

Facility

$4,778.71

Service Code	HCPCS J2597
Hospital Charge Code	6001648
Hospital Revenue Code	636
Min. Negotiated Rate	$135.72
Max. Negotiated Rate	$2,389.36
Rate for Payer: Aetna Commercial	$1,815.91
Rate for Payer: Aetna Medicare Advantage	$1,433.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.57
Rate for Payer: Cigna Commercial	$2,389.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.45
Rate for Payer: Qualcare PPO/HMO/WC	$716.81
Rate for Payer: UnitedHealthcare Community & State	$151.01
Rate for Payer: Wellpoint Medicaid Managed Care	$135.72

DESMOPRESSIN 4MCG/ML INJ 10 ML

Facility

$4,778.71

Service Code	HCPCS J2597
Hospital Charge Code	6001648
Hospital Revenue Code	636
Min. Negotiated Rate	$716.81
Max. Negotiated Rate	$1,156.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.45
Rate for Payer: Qualcare PPO/HMO/WC	$716.81

DESMOPRESSIN 4MCG/ML INJ 1 ML

Facility

$477.84

Service Code	HCPCS J2597
Hospital Charge Code	60632357
Hospital Revenue Code	636
Min. Negotiated Rate	$71.68
Max. Negotiated Rate	$115.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.64
Rate for Payer: Qualcare PPO/HMO/WC	$71.68

DESMOPRESSIN 4MCG/ML INJ 1 ML

Facility

$477.84

Service Code	HCPCS J2597
Hospital Charge Code	60632357
Hospital Revenue Code	636
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$238.92
Rate for Payer: Aetna Commercial	$181.58
Rate for Payer: Aetna Medicare Advantage	$143.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.85
Rate for Payer: Cigna Commercial	$238.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.64
Rate for Payer: Qualcare PPO/HMO/WC	$71.68
Rate for Payer: UnitedHealthcare Community & State	$15.10
Rate for Payer: Wellpoint Medicaid Managed Care	$13.57

DESOXIMETASONE 0.05% GEL 15 G

Facility

$586.72

Service Code	NDC 61748020515
Hospital Charge Code	606390044
Hospital Revenue Code	250
Min. Negotiated Rate	$88.01
Max. Negotiated Rate	$88.01
Rate for Payer: Qualcare PPO/HMO/WC	$88.01

DESOXIMETASONE 0.05% GEL 15 G

Facility

$586.72

Service Code	NDC 61748020515
Hospital Charge Code	606390044
Hospital Revenue Code	250
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$293.36
Rate for Payer: Aetna Commercial	$222.95
Rate for Payer: Aetna Medicare Advantage	$176.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.61
Rate for Payer: Cigna Commercial	$293.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.55
Rate for Payer: Oxford Commercial	$117.34
Rate for Payer: Qualcare PPO/HMO/WC	$88.01
Rate for Payer: UnitedHealthcare Commercial	$117.34
Rate for Payer: UnitedHealthcare Community & State	$18.54
Rate for Payer: Wellpoint Medicaid Managed Care	$16.66

DESOXIMETASONE 0.25 % CRE

Facility

$45.23

Service Code	NDC 51672127001
Hospital Charge Code	60628377
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$22.61
Rate for Payer: Aetna Commercial	$17.19
Rate for Payer: Aetna Medicare Advantage	$13.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.53
Rate for Payer: Cigna Commercial	$22.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.76
Rate for Payer: Oxford Commercial	$9.05
Rate for Payer: Qualcare PPO/HMO/WC	$6.78
Rate for Payer: UnitedHealthcare Commercial	$9.05
Rate for Payer: UnitedHealthcare Community & State	$1.43
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

DESOXIMETASONE 0.25 % CRE

Facility

$45.23

Service Code	NDC 51672127001
Hospital Charge Code	60628377
Hospital Revenue Code	250
Min. Negotiated Rate	$6.78
Max. Negotiated Rate	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$6.78

DESOXIMETASONE 0.25% OIN

Facility

$4.00

Service Code	NDC 168015160
Hospital Charge Code	60628375
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DESOXIMETASONE 0.25% OIN

Facility

$4.00

Service Code	NDC 168015160
Hospital Charge Code	60628375
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DESOXIMETASONE 15 GM

Facility

$261.05

Hospital Charge Code	60628376W
Hospital Revenue Code	250
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$130.53
Rate for Payer: Aetna Commercial	$99.20
Rate for Payer: Aetna Medicare Advantage	$78.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.57
Rate for Payer: Cigna Commercial	$130.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.87
Rate for Payer: Oxford Commercial	$52.21
Rate for Payer: Qualcare PPO/HMO/WC	$39.16
Rate for Payer: UnitedHealthcare Commercial	$52.21
Rate for Payer: UnitedHealthcare Community & State	$8.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.41

DESOXIMETASONE 15 GM

Facility

$261.05

Hospital Charge Code	60628376W
Hospital Revenue Code	250
Min. Negotiated Rate	$39.16
Max. Negotiated Rate	$39.16
Rate for Payer: Qualcare PPO/HMO/WC	$39.16

DESTROY ANAL LESN SMP,SURG EXC

Facility

$17,947.70

Service Code	HCPCS 46922
Hospital Charge Code	1600000537
Hospital Revenue Code	360
Min. Negotiated Rate	$2,692.16
Max. Negotiated Rate	$2,692.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,692.16

DESTROY ANAL LESN SMP,SURG EXC

Facility

$17,947.70

Service Code	HCPCS 46922
Hospital Charge Code	1600000537
Hospital Revenue Code	360
Min. Negotiated Rate	$509.71
Max. Negotiated Rate	$11,961.90
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,961.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,961.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
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	$11,961.90
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,666.40
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,692.16
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$567.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$509.71

DESTROY CERV/THOR FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64633
Hospital Charge Code	321564633
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

DESTROY CERV/THOR FACET JNT

Facility

$10,782.78

Service Code	HCPCS 64633
Hospital Charge Code	321564633
Hospital Revenue Code	361
Min. Negotiated Rate	$306.23
Max. Negotiated Rate	$8,415.40
Rate for Payer: Aetna Commercial	$6,310.10
Rate for Payer: Aetna Medicare Advantage	$7,516.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,415.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,319.89
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	$8,415.40
Rate for Payer: Cigna Commercial	$4,650.22
Rate for Payer: Cigna Medicare Advantage	$2,319.89
Rate for Payer: Clover Medicare Advantage	$2,203.90
Rate for Payer: EmblemHealth Commercial	$6,959.67
Rate for Payer: Humana Medicare Advantage	$2,389.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,319.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.52
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$340.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,319.89
Rate for Payer: Wellcare Medicare Advantage	$2,319.89
Rate for Payer: Wellpoint Medicaid Managed Care	$306.23

DESTROY C/TH FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64634
Hospital Charge Code	321564634
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

DESTROY C/TH FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64634
Hospital Charge Code	321564634
Hospital Revenue Code	361
Min. Negotiated Rate	$306.23
Max. Negotiated Rate	$5,391.39
Rate for Payer: Aetna Commercial	$4,097.46
Rate for Payer: Aetna Medicare Advantage	$3,234.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,749.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,749.61
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	$2,749.61
Rate for Payer: Cigna Commercial	$5,391.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.52
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$340.74
Rate for Payer: Wellpoint Medicaid Managed Care	$306.23

DESTROY C/TH FACET JNT ADDL

Facility

$18,351.40

Service Code	HCPCS 64634
Hospital Charge Code	160000250
Hospital Revenue Code	360
Min. Negotiated Rate	$521.18
Max. Negotiated Rate	$9,175.70
Rate for Payer: Aetna Commercial	$6,973.53
Rate for Payer: Aetna Medicare Advantage	$5,505.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,679.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,679.61
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	$4,679.61
Rate for Payer: Cigna Commercial	$9,175.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,771.36
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.71
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$579.90
Rate for Payer: Wellpoint Medicaid Managed Care	$521.18

DESTROY C/TH FACET JNT ADDL

Facility

$18,351.40

Service Code	HCPCS 64634
Hospital Charge Code	160000250
Hospital Revenue Code	360
Min. Negotiated Rate	$2,752.71
Max. Negotiated Rate	$2,752.71
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.71

DESTROY INTERNAL HEMORRHOID

Facility

$5,616.30

Service Code	HCPCS 46930
Hospital Charge Code	1600000264
Hospital Revenue Code	360
Min. Negotiated Rate	$159.50
Max. Negotiated Rate	$5,157.00
Rate for Payer: Aetna Commercial	$3,866.86
Rate for Payer: Aetna Medicare Advantage	$4,606.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,157.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,421.64
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	$5,157.00
Rate for Payer: Cigna Commercial	$2,849.67
Rate for Payer: Cigna Medicare Advantage	$1,421.64
Rate for Payer: Clover Medicare Advantage	$1,350.56
Rate for Payer: EmblemHealth Commercial	$4,264.92
Rate for Payer: Humana Medicare Advantage	$1,464.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,421.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,460.24
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$842.45
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$177.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.64
Rate for Payer: Wellcare Medicare Advantage	$1,421.64
Rate for Payer: Wellpoint Medicaid Managed Care	$159.50

DESTROY INTERNAL HEMORRHOID

Facility

$5,616.30

Service Code	HCPCS 46930
Hospital Charge Code	1600000264
Hospital Revenue Code	360
Min. Negotiated Rate	$842.45
Max. Negotiated Rate	$842.45
Rate for Payer: Qualcare PPO/HMO/WC	$842.45

DESTROY L/S FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64636
Hospital Charge Code	321564636
Hospital Revenue Code	361
Min. Negotiated Rate	$306.23
Max. Negotiated Rate	$5,391.39
Rate for Payer: Aetna Commercial	$4,097.46
Rate for Payer: Aetna Medicare Advantage	$3,234.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,749.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,749.61
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	$2,749.61
Rate for Payer: Cigna Commercial	$5,391.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,803.52
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$340.74
Rate for Payer: Wellpoint Medicaid Managed Care	$306.23

DESTROY L/S FACET JNT ADDL

Facility

$10,782.78

Service Code	HCPCS 64636
Hospital Charge Code	321564636
Hospital Revenue Code	361
Min. Negotiated Rate	$1,617.42
Max. Negotiated Rate	$1,617.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,617.42

Know your out-of-pocket cost for care.

All Charges