Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEXAMETHASONE 0.75 MG TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60628185
Hospital Revenue Code	636
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE 10 MG/ML INJ

Facility

$32.50

Service Code	HCPCS J1100
Hospital Charge Code	60639329
Hospital Revenue Code	636
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	$7.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.88
Rate for Payer: UnitedHealthcare Community & State	$1.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.92

DEXAMETHASONE 10 MG/ML INJ

Facility

$10.45

Service Code	HCPCS J1100
Hospital Charge Code	60628188
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.22
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare Advantage	$3.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.66
Rate for Payer: Cigna Commercial	$5.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

DEXAMETHASONE 10 MG/ML INJ

Facility

$10.45

Service Code	HCPCS J1100
Hospital Charge Code	60628188
Hospital Revenue Code	636
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$2.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

DEXAMETHASONE 10 MG/ML INJ

Facility

$32.50

Service Code	HCPCS J1100
Hospital Charge Code	60639329
Hospital Revenue Code	636
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$7.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.88

DEXAMETHASONE/1MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632806
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE/1MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632806
Hospital Revenue Code	636
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE/2MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632809
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE/2MG/TAB

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60632809
Hospital Revenue Code	636
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE 4 MG/1 ML

Facility

$7.30

Service Code	HCPCS J1100
Hospital Charge Code	60628190
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$2.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.86
Rate for Payer: Cigna Commercial	$3.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

DEXAMETHASONE 4 MG/1 ML

Facility

$7.30

Service Code	HCPCS J1100
Hospital Charge Code	60628190
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

DEXAMETHASONE 4 MG TAB

Facility

$8.04

Service Code	HCPCS J8540
Hospital Charge Code	60628187
Hospital Revenue Code	636
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

DEXAMETHASONE 4 MG TAB

Facility

$8.04

Service Code	HCPCS J8540
Hospital Charge Code	60628187
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

DEXAMETHASONE 6MG TAB

Facility

$11.93

Service Code	NDC 54418625
Hospital Charge Code	606390391
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.79

DEXAMETHASONE 6MG TAB

Facility

$11.93

Service Code	NDC 54418625
Hospital Charge Code	606390391
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$5.96
Rate for Payer: Aetna Commercial	$4.53
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.04
Rate for Payer: Cigna Commercial	$5.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.10
Rate for Payer: Oxford Commercial	$2.39
Rate for Payer: Qualcare PPO/HMO/WC	$1.79
Rate for Payer: UnitedHealthcare Commercial	$2.39
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DEXAMETHASONE ELX 0.5MG/5ML

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60628184
Hospital Revenue Code	636
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DEXAMETHASONE ELX 0.5MG/5ML

Facility

$4.00

Service Code	HCPCS J8540
Hospital Charge Code	60628184
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DEXAMETHASONE SUPPRESSION

Facility

$501.00

Service Code	HCPCS 80420
Hospital Charge Code	38472432
Hospital Revenue Code	301
Min. Negotiated Rate	$14.23
Max. Negotiated Rate	$587.22
Rate for Payer: Aetna Commercial	$440.31
Rate for Payer: Aetna Medicare Advantage	$524.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$587.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$587.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$161.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$66.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$587.22
Rate for Payer: Cigna Commercial	$250.50
Rate for Payer: Cigna Medicare Advantage	$161.88
Rate for Payer: Clover Medicare Advantage	$153.79
Rate for Payer: EmblemHealth Commercial	$485.64
Rate for Payer: Humana Medicare Advantage	$166.74
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$161.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.26
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$129.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.88
Rate for Payer: Wellcare Medicare Advantage	$161.88
Rate for Payer: Wellpoint Medicaid Managed Care	$14.23

DEXAMETHASONE SUPPRESSION

Facility

$501.00

Service Code	HCPCS 80420
Hospital Charge Code	38472432
Hospital Revenue Code	301
Min. Negotiated Rate	$75.15
Max. Negotiated Rate	$75.15
Rate for Payer: Qualcare PPO/HMO/WC	$75.15

DEXEMEDETOMIDEINE100MCG/ML 2ML

Facility

$253.65

Hospital Charge Code	6063943344
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$126.83
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna Medicare Advantage	$76.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$64.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$64.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$64.68
Rate for Payer: Cigna Commercial	$126.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.95
Rate for Payer: Oxford Commercial	$50.73
Rate for Payer: Qualcare PPO/HMO/WC	$38.05
Rate for Payer: UnitedHealthcare Commercial	$50.73
Rate for Payer: UnitedHealthcare Community & State	$8.02
Rate for Payer: Wellpoint Medicaid Managed Care	$7.20

DEXEMEDETOMIDEINE100MCG/ML 2ML

Facility

$253.65

Hospital Charge Code	6063943344
Hospital Revenue Code	250
Min. Negotiated Rate	$38.05
Max. Negotiated Rate	$38.05
Rate for Payer: Qualcare PPO/HMO/WC	$38.05

DEX FIBERTAK KIT

Facility

$1,375.00

Hospital Charge Code	270682059
Hospital Revenue Code	272
Min. Negotiated Rate	$206.25
Max. Negotiated Rate	$206.25
Rate for Payer: Qualcare PPO/HMO/WC	$206.25

DEX FIBERTAK KIT

Facility

$1,375.00

Hospital Charge Code	270682059
Hospital Revenue Code	272
Min. Negotiated Rate	$39.05
Max. Negotiated Rate	$687.50
Rate for Payer: Aetna Commercial	$522.50
Rate for Payer: Aetna Medicare Advantage	$412.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$350.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$350.62
Rate for Payer: Cigna Commercial	$687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$357.50
Rate for Payer: Oxford Commercial	$275.00
Rate for Payer: Qualcare PPO/HMO/WC	$206.25
Rate for Payer: UnitedHealthcare Commercial	$275.00
Rate for Payer: UnitedHealthcare Community & State	$43.45
Rate for Payer: Wellpoint Medicaid Managed Care	$39.05

DEXMEDETOMIDEINE HCL 100MCG/ML

Facility

$194.17

Service Code	NDC 409163802
Hospital Charge Code	6063943337
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$97.08
Rate for Payer: Aetna Commercial	$73.78
Rate for Payer: Aetna Medicare Advantage	$58.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.51
Rate for Payer: Cigna Commercial	$97.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.48
Rate for Payer: Oxford Commercial	$38.83
Rate for Payer: Qualcare PPO/HMO/WC	$29.13
Rate for Payer: UnitedHealthcare Commercial	$38.83
Rate for Payer: UnitedHealthcare Community & State	$6.14
Rate for Payer: Wellpoint Medicaid Managed Care	$5.51

DEXMEDETOMIDEINE HCL 100MCG/ML

Facility

$194.17

Service Code	NDC 409163802
Hospital Charge Code	6063943337
Hospital Revenue Code	250
Min. Negotiated Rate	$29.13
Max. Negotiated Rate	$29.13
Rate for Payer: Qualcare PPO/HMO/WC	$29.13

Know your out-of-pocket cost for care.

All Charges