Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEXMEDETOMIDINE 400 MCG/ML 100

Facility

$280.60

Service Code	NDC 409166020
Hospital Charge Code	60630214
Hospital Revenue Code	250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$140.30
Rate for Payer: Aetna Commercial	$106.63
Rate for Payer: Aetna Medicare Advantage	$84.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.55
Rate for Payer: Cigna Commercial	$140.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.96
Rate for Payer: Oxford Commercial	$56.12
Rate for Payer: Qualcare PPO/HMO/WC	$42.09
Rate for Payer: UnitedHealthcare Commercial	$56.12
Rate for Payer: UnitedHealthcare Community & State	$8.87
Rate for Payer: Wellpoint Medicaid Managed Care	$7.97

DEXMEDETOMIDINE 400 MCG/ML 100

Facility

$280.60

Service Code	NDC 409166020
Hospital Charge Code	60630214
Hospital Revenue Code	250
Min. Negotiated Rate	$42.09
Max. Negotiated Rate	$42.09
Rate for Payer: Qualcare PPO/HMO/WC	$42.09

DEXT 10% 500ML

Facility

$9.65

Hospital Charge Code	270040125
Hospital Revenue Code	258
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

DEXT 10% 500ML

Facility

$9.65

Hospital Charge Code	270040125
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DEXT 10% 500ML BAG

Facility

$13.74

Service Code	NDC 264752010
Hospital Charge Code	60627954
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.87
Rate for Payer: Aetna Commercial	$5.22
Rate for Payer: Aetna Medicare Advantage	$4.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.50
Rate for Payer: Cigna Commercial	$6.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.57
Rate for Payer: Oxford Commercial	$2.75
Rate for Payer: Qualcare PPO/HMO/WC	$2.06
Rate for Payer: UnitedHealthcare Commercial	$2.75
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

DEXT 10% 500ML BAG

Facility

$13.74

Service Code	NDC 264752010
Hospital Charge Code	60627954
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$2.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.06

DEXT 5%/0.45% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649414
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5%/0.45% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649414
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DEXT 5%/0.45% NACL 500ml

Facility

$22.50

Hospital Charge Code	270649415
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DEXT 5%/0.45% NACL 500ml

Facility

$22.50

Hospital Charge Code	270649415
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5%/0.9% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649417
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5%/0.9% NACL 1000ml

Facility

$22.50

Hospital Charge Code	270649417
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DEXT 5% 1000ML

Facility

$11.25

Hospital Charge Code	270040105
Hospital Revenue Code	258
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

DEXT 5% 1000ML

Facility

$11.25

Hospital Charge Code	270040105
Hospital Revenue Code	258
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

DEXT 5% 100ML

Facility

$8.00

Hospital Charge Code	270649138
Hospital Revenue Code	258
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

DEXT 5% 100ML

Facility

$8.00

Hospital Charge Code	270649138
Hospital Revenue Code	258
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare Advantage	$2.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.04
Rate for Payer: Cigna Commercial	$4.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.08
Rate for Payer: Oxford Commercial	$1.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

DEXT 5% 100ML ADD-LINE

Facility

$16.85

Hospital Charge Code	270040115
Hospital Revenue Code	258
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

DEXT 5% 100ML ADD-LINE

Facility

$16.85

Hospital Charge Code	270040115
Hospital Revenue Code	258
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DEXT 5% 250ML

Facility

$22.50

Hospital Charge Code	270649403
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DEXT 5% 250ML

Facility

$22.50

Hospital Charge Code	270649403
Hospital Revenue Code	258
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5% .45% 1000ML

Facility

$22.50

Hospital Charge Code	270649414S
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

DEXT 5% .45% 1000ML

Facility

$22.50

Hospital Charge Code	270649414S
Hospital Revenue Code	258
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DEXT 5% 500ML

Facility

$9.65

Hospital Charge Code	270040110
Hospital Revenue Code	258
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DEXT 5% 500ML

Facility

$9.65

Hospital Charge Code	270040110
Hospital Revenue Code	258
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

DEXT 5% 5OML ADD-LINE

Facility

$11.25

Hospital Charge Code	270040120
Hospital Revenue Code	258
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

Know your out-of-pocket cost for care.

All Charges