Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DISTRACTION PIN 14MM DISP

Facility

$113.50

Hospital Charge Code	270699346
Hospital Revenue Code	272
Min. Negotiated Rate	$17.02
Max. Negotiated Rate	$17.02
Rate for Payer: Qualcare PPO/HMO/WC	$17.02

DISTRACTION PIN 14MM DISP

Facility

$113.50

Hospital Charge Code	270699346
Hospital Revenue Code	272
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$56.75
Rate for Payer: Aetna Commercial	$43.13
Rate for Payer: Aetna Medicare Advantage	$34.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.94
Rate for Payer: Cigna Commercial	$56.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.51
Rate for Payer: Oxford Commercial	$22.70
Rate for Payer: Qualcare PPO/HMO/WC	$17.02
Rate for Payer: UnitedHealthcare Commercial	$22.70
Rate for Payer: UnitedHealthcare Community & State	$3.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.22

DISTRACTION PINS

Facility

$347.00

Hospital Charge Code	270335905
Hospital Revenue Code	278
Min. Negotiated Rate	$52.05
Max. Negotiated Rate	$83.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.97
Rate for Payer: Qualcare PPO/HMO/WC	$52.05

DISTRACTION PINS

Facility

$347.00

Hospital Charge Code	270335905
Hospital Revenue Code	278
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$173.50
Rate for Payer: Aetna Commercial	$131.86
Rate for Payer: Aetna Medicare Advantage	$104.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.48
Rate for Payer: Cigna Commercial	$173.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.97
Rate for Payer: Qualcare PPO/HMO/WC	$52.05
Rate for Payer: UnitedHealthcare Community & State	$10.97
Rate for Payer: Wellpoint Medicaid Managed Care	$9.85

DISTRACTOR ANKLE UC GUHL

Facility

$1,975.00

Hospital Charge Code	270694961
Hospital Revenue Code	272
Min. Negotiated Rate	$56.09
Max. Negotiated Rate	$987.50
Rate for Payer: Aetna Commercial	$750.50
Rate for Payer: Aetna Medicare Advantage	$592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$503.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$503.62
Rate for Payer: Cigna Commercial	$987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$513.50
Rate for Payer: Oxford Commercial	$395.00
Rate for Payer: Qualcare PPO/HMO/WC	$296.25
Rate for Payer: UnitedHealthcare Commercial	$395.00
Rate for Payer: UnitedHealthcare Community & State	$62.41
Rate for Payer: Wellpoint Medicaid Managed Care	$56.09

DISTRACTOR ANKLE UC GUHL

Facility

$1,975.00

Hospital Charge Code	270694961
Hospital Revenue Code	272
Min. Negotiated Rate	$296.25
Max. Negotiated Rate	$296.25
Rate for Payer: Qualcare PPO/HMO/WC	$296.25

DISTRACTOR HINTERMANN

Facility

$5,505.00

Hospital Charge Code	270684913
Hospital Revenue Code	272
Min. Negotiated Rate	$825.75
Max. Negotiated Rate	$825.75
Rate for Payer: Qualcare PPO/HMO/WC	$825.75

DISTRACTOR HINTERMANN

Facility

$5,505.00

Hospital Charge Code	270684913
Hospital Revenue Code	272
Min. Negotiated Rate	$156.34
Max. Negotiated Rate	$2,752.50
Rate for Payer: Aetna Commercial	$2,091.90
Rate for Payer: Aetna Medicare Advantage	$1,651.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,403.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,403.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,403.78
Rate for Payer: Cigna Commercial	$2,752.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,431.30
Rate for Payer: Oxford Commercial	$1,101.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.75
Rate for Payer: UnitedHealthcare Commercial	$1,101.00
Rate for Payer: UnitedHealthcare Community & State	$173.96
Rate for Payer: Wellpoint Medicaid Managed Care	$156.34

DISTRACTOR HIP SUPINE

Facility

$5,500.00

Hospital Charge Code	270684947
Hospital Revenue Code	272
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$825.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

DISTRACTOR HIP SUPINE

Facility

$5,500.00

Hospital Charge Code	270684947
Hospital Revenue Code	272
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,430.00
Rate for Payer: Oxford Commercial	$1,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Commercial	$1,100.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

DITATION 10FN

Facility

$42.50

Hospital Charge Code	270663691
Hospital Revenue Code	270
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$21.25
Rate for Payer: Aetna Commercial	$16.15
Rate for Payer: Aetna Medicare Advantage	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.84
Rate for Payer: Cigna Commercial	$21.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.05
Rate for Payer: Oxford Commercial	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$6.38
Rate for Payer: UnitedHealthcare Commercial	$8.50
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

DITATION 10FN

Facility

$42.50

Hospital Charge Code	270663691
Hospital Revenue Code	270
Min. Negotiated Rate	$6.38
Max. Negotiated Rate	$6.38
Rate for Payer: Qualcare PPO/HMO/WC	$6.38

DITROPAN XL 10MG, TAB.

Facility

$46.57

Service Code	NDC 50458081001
Hospital Charge Code	60635438
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$23.29
Rate for Payer: Aetna Commercial	$17.70
Rate for Payer: Aetna Medicare Advantage	$13.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.88
Rate for Payer: Cigna Commercial	$23.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.11
Rate for Payer: Oxford Commercial	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.99
Rate for Payer: UnitedHealthcare Commercial	$9.31
Rate for Payer: UnitedHealthcare Community & State	$1.47
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

DITROPAN XL 10MG, TAB.

Facility

$46.57

Service Code	NDC 50458081001
Hospital Charge Code	60635438
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$6.99
Rate for Payer: Qualcare PPO/HMO/WC	$6.99

DIURETICS PNL(SERUM OR PLASMA)

Facility

$157.00

Service Code	HCPCS 80375
Hospital Charge Code	401180375
Hospital Revenue Code	306
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$59.66
Rate for Payer: Aetna Medicare Advantage	$47.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.03
Rate for Payer: Cigna Commercial	$78.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.82
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.46

DIURETICS PNL(SERUM OR PLASMA)

Facility

$157.00

Service Code	HCPCS 80375
Hospital Charge Code	401180375
Hospital Revenue Code	306
Min. Negotiated Rate	$23.55
Max. Negotiated Rate	$23.55
Rate for Payer: Qualcare PPO/HMO/WC	$23.55

DIVALPROEX CAP 125MG SPRINKLE

Facility

$12.06

Service Code	NDC 74611411
Hospital Charge Code	60627747
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna Commercial	$4.58
Rate for Payer: Aetna Medicare Advantage	$3.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.08
Rate for Payer: Cigna Commercial	$6.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.14
Rate for Payer: Oxford Commercial	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$2.41
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DIVALPROEX CAP 125MG SPRINKLE

Facility

$12.06

Service Code	NDC 74611411
Hospital Charge Code	60627747
Hospital Revenue Code	250
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

DIVALPROEX SODIUM 250 MG ER

Facility

$22.51

Service Code	NDC 74382611
Hospital Charge Code	60629950
Hospital Revenue Code	250
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.26
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	$11.26
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

DIVALPROEX SODIUM 250 MG ER

Facility

$22.51

Service Code	NDC 74382611
Hospital Charge Code	60629950
Hospital Revenue Code	250
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

DIVALPROEX SODIUM 500 MG ER

Facility

$39.53

Service Code	NDC 74712611
Hospital Charge Code	60629891
Hospital Revenue Code	250
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$5.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.93

DIVALPROEX SODIUM 500 MG ER

Facility

$39.53

Service Code	NDC 74712611
Hospital Charge Code	60629891
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$19.77
Rate for Payer: Aetna Commercial	$15.02
Rate for Payer: Aetna Medicare Advantage	$11.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.08
Rate for Payer: Cigna Commercial	$19.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.28
Rate for Payer: Oxford Commercial	$7.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.93
Rate for Payer: UnitedHealthcare Commercial	$7.91
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$24,726.92

Service Code	APR-DRG 2444
Min. Negotiated Rate	$24,242.08
Max. Negotiated Rate	$24,726.92
Rate for Payer: UnitedHealthcare Community & State	$24,242.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$24,726.92
Rate for Payer: Wellpoint Medicaid Managed Care	$24,242.08

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$7,120.18

Service Code	APR-DRG 2441
Min. Negotiated Rate	$6,980.57
Max. Negotiated Rate	$7,120.18
Rate for Payer: UnitedHealthcare Community & State	$6,980.57
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,120.18
Rate for Payer: Wellpoint Medicaid Managed Care	$6,980.57

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$14,101.40

Service Code	APR-DRG 2443
Min. Negotiated Rate	$13,824.90
Max. Negotiated Rate	$14,101.40
Rate for Payer: UnitedHealthcare Community & State	$13,824.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,101.40
Rate for Payer: Wellpoint Medicaid Managed Care	$13,824.90

Know your out-of-pocket cost for care.

All Charges