Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DEXTROSE 5% IN WATER 500ML

Facility

$13.20

Service Code	NDC 338001703
Hospital Charge Code	60627951
Hospital Revenue Code	258
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.60
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna Medicare Advantage	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.37
Rate for Payer: Cigna Commercial	$6.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.43
Rate for Payer: Oxford Commercial	$2.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.98
Rate for Payer: UnitedHealthcare Commercial	$2.64
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

DEXTROSE 5% IN WATER 50 ML

Facility

$12.93

Service Code	NDC 338001731
Hospital Charge Code	60627953
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.46
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: Aetna Medicare Advantage	$3.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.30
Rate for Payer: Cigna Commercial	$6.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.36
Rate for Payer: Oxford Commercial	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.94
Rate for Payer: UnitedHealthcare Commercial	$2.59
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

DEXTROSE 5% IN WATER 50 ML

Facility

$12.93

Service Code	NDC 338001731
Hospital Charge Code	60627953
Hospital Revenue Code	250
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.94

DEXTROSE 5% / LACTAID RINGERS

Facility

$17.49

Service Code	NDC 338012504
Hospital Charge Code	60628602
Hospital Revenue Code	258
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

DEXTROSE 5% / LACTAID RINGERS

Facility

$17.49

Service Code	NDC 338012504
Hospital Charge Code	60628602
Hospital Revenue Code	258
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.74
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare Advantage	$5.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.46
Rate for Payer: Cigna Commercial	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.62
Rate for Payer: UnitedHealthcare Commercial	$3.50
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

DEXTROSE 5% - NS 1000 ML

Facility

$16.42

Service Code	NDC 338008904
Hospital Charge Code	60627903
Hospital Revenue Code	258
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.46

DEXTROSE 5% - NS 1000 ML

Facility

$16.42

Service Code	NDC 338008904
Hospital Charge Code	60627903
Hospital Revenue Code	258
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.21
Rate for Payer: Aetna Commercial	$6.24
Rate for Payer: Aetna Medicare Advantage	$4.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.19
Rate for Payer: Cigna Commercial	$8.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.27
Rate for Payer: Oxford Commercial	$3.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.46
Rate for Payer: UnitedHealthcare Commercial	$3.28
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

DEXTROSE 5% W/0.45% NS 1000ML

Facility

$5.65

Hospital Charge Code	270653262
Hospital Revenue Code	258
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.47
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

DEXTROSE 5% W/0.45% NS 1000ML

Facility

$5.65

Hospital Charge Code	270653262
Hospital Revenue Code	258
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

DGTL ACU CMFLG TALRSPLNT 3.2MM

Facility

$365.00

Hospital Charge Code	270663151
Hospital Revenue Code	270
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$182.50
Rate for Payer: Aetna Commercial	$138.70
Rate for Payer: Aetna Medicare Advantage	$109.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.08
Rate for Payer: Cigna Commercial	$182.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.90
Rate for Payer: Oxford Commercial	$73.00
Rate for Payer: Qualcare PPO/HMO/WC	$54.75
Rate for Payer: UnitedHealthcare Commercial	$73.00
Rate for Payer: UnitedHealthcare Community & State	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$10.37

DGTL ACU CMFLG TALRSPLNT 3.2MM

Facility

$365.00

Hospital Charge Code	270663151
Hospital Revenue Code	270
Min. Negotiated Rate	$54.75
Max. Negotiated Rate	$54.75
Rate for Payer: Qualcare PPO/HMO/WC	$54.75

DHEA SULFATE

Facility

$390.00

Service Code	HCPCS 82627
Hospital Charge Code	39900071
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DHEA SULFATE

Facility

$390.00

Service Code	HCPCS 82627
Hospital Charge Code	39900071
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$60.47
Rate for Payer: Aetna Medicare Advantage	$72.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$22.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80.64
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$22.23
Rate for Payer: Clover Medicare Advantage	$21.12
Rate for Payer: EmblemHealth Commercial	$66.69
Rate for Payer: Humana Medicare Advantage	$22.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$22.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$17.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.23
Rate for Payer: Wellcare Medicare Advantage	$22.23
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

D-HELP DEFOGGER

Facility

$279.31

Hospital Charge Code	270664269
Hospital Revenue Code	272
Min. Negotiated Rate	$41.90
Max. Negotiated Rate	$41.90
Rate for Payer: Qualcare PPO/HMO/WC	$41.90

D-HELP DEFOGGER

Facility

$279.31

Hospital Charge Code	270664269
Hospital Revenue Code	272
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$139.66
Rate for Payer: Aetna Commercial	$106.14
Rate for Payer: Aetna Medicare Advantage	$83.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.22
Rate for Payer: Cigna Commercial	$139.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.62
Rate for Payer: Oxford Commercial	$55.86
Rate for Payer: Qualcare PPO/HMO/WC	$41.90
Rate for Payer: UnitedHealthcare Commercial	$55.86
Rate for Payer: UnitedHealthcare Community & State	$8.83
Rate for Payer: Wellpoint Medicaid Managed Care	$7.93

DHS COMPRESSION SCREW

Facility

$192.55

Service Code	HCPCS C1713
Hospital Charge Code	270682626
Hospital Revenue Code	278
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$96.28
Rate for Payer: Aetna Commercial	$73.17
Rate for Payer: Aetna Medicare Advantage	$57.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.10
Rate for Payer: Cigna Commercial	$96.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.60
Rate for Payer: Qualcare PPO/HMO/WC	$28.88
Rate for Payer: UnitedHealthcare Community & State	$6.08
Rate for Payer: Wellpoint Medicaid Managed Care	$5.47

DHS COMPRESSION SCREW

Facility

$192.55

Service Code	HCPCS C1713
Hospital Charge Code	270682626
Hospital Revenue Code	278
Min. Negotiated Rate	$28.88
Max. Negotiated Rate	$46.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$38.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.60
Rate for Payer: Qualcare PPO/HMO/WC	$28.88

DHS/DCS COUPLING SCREW LONG

Facility

$479.40

Service Code	HCPCS C1713
Hospital Charge Code	270687790
Hospital Revenue Code	278
Min. Negotiated Rate	$71.91
Max. Negotiated Rate	$116.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.01
Rate for Payer: Qualcare PPO/HMO/WC	$71.91

DHS/DCS COUPLING SCREW LONG

Facility

$479.40

Service Code	HCPCS C1713
Hospital Charge Code	270687790
Hospital Revenue Code	278
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$239.70
Rate for Payer: Aetna Commercial	$182.17
Rate for Payer: Aetna Medicare Advantage	$143.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.25
Rate for Payer: Cigna Commercial	$239.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.01
Rate for Payer: Qualcare PPO/HMO/WC	$71.91
Rate for Payer: UnitedHealthcare Community & State	$15.15
Rate for Payer: Wellpoint Medicaid Managed Care	$13.61

DHS/DCS LAG SCREW

Facility

$1,182.00

Hospital Charge Code	270335013
Hospital Revenue Code	278
Min. Negotiated Rate	$33.57
Max. Negotiated Rate	$591.00
Rate for Payer: Aetna Commercial	$449.16
Rate for Payer: Aetna Medicare Advantage	$354.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$301.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$301.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$236.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$301.41
Rate for Payer: Cigna Commercial	$591.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.04
Rate for Payer: Qualcare PPO/HMO/WC	$177.30
Rate for Payer: UnitedHealthcare Community & State	$37.35
Rate for Payer: Wellpoint Medicaid Managed Care	$33.57

DHS/DCS LAG SCREW

Facility

$1,182.00

Hospital Charge Code	270335013
Hospital Revenue Code	278
Min. Negotiated Rate	$177.30
Max. Negotiated Rate	$286.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$236.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.04
Rate for Payer: Qualcare PPO/HMO/WC	$177.30

DHS/DCS WRENCH

Facility

$695.60

Hospital Charge Code	270687789
Hospital Revenue Code	272
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$347.80
Rate for Payer: Aetna Commercial	$264.33
Rate for Payer: Aetna Medicare Advantage	$208.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$177.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$177.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$177.38
Rate for Payer: Cigna Commercial	$347.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.86
Rate for Payer: Oxford Commercial	$139.12
Rate for Payer: Qualcare PPO/HMO/WC	$104.34
Rate for Payer: UnitedHealthcare Commercial	$139.12
Rate for Payer: UnitedHealthcare Community & State	$21.98
Rate for Payer: Wellpoint Medicaid Managed Care	$19.76

DHS/DCS WRENCH

Facility

$695.60

Hospital Charge Code	270687789
Hospital Revenue Code	272
Min. Negotiated Rate	$104.34
Max. Negotiated Rate	$104.34
Rate for Payer: Qualcare PPO/HMO/WC	$104.34

DHS LAG SCREW-90MM

Facility

$1,495.85

Service Code	HCPCS C1713
Hospital Charge Code	270682627
Hospital Revenue Code	278
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$747.92
Rate for Payer: Aetna Commercial	$568.42
Rate for Payer: Aetna Medicare Advantage	$448.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$381.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$381.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$381.44
Rate for Payer: Cigna Commercial	$747.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.00
Rate for Payer: Qualcare PPO/HMO/WC	$224.38
Rate for Payer: UnitedHealthcare Community & State	$47.27
Rate for Payer: Wellpoint Medicaid Managed Care	$42.48

DHS LAG SCREW-90MM

Facility

$1,495.85

Service Code	HCPCS C1713
Hospital Charge Code	270682627
Hospital Revenue Code	278
Min. Negotiated Rate	$224.38
Max. Negotiated Rate	$362.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$299.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.00
Rate for Payer: Qualcare PPO/HMO/WC	$224.38

Know your out-of-pocket cost for care.

All Charges