Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DNA ANTIBODIES, NATIVE

Facility

$390.00

Service Code	HCPCS 86225
Hospital Charge Code	39900200
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DNA ANTIBODIES, NATIVE

Facility

$390.00

Service Code	HCPCS 86225
Hospital Charge Code	39900200
Hospital Revenue Code	302
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.74
Rate for Payer: Clover Medicare Advantage	$13.05
Rate for Payer: EmblemHealth Commercial	$41.22
Rate for Payer: Humana Medicare Advantage	$14.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.74
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	$10.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.74
Rate for Payer: Wellcare Medicare Advantage	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DNA ANTIBODY NATIVE

Facility

$68.70

Service Code	HCPCS 86225
Hospital Charge Code	401386225C
Hospital Revenue Code	302
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.84
Rate for Payer: Cigna Commercial	$34.35
Rate for Payer: Cigna Medicare Advantage	$13.74
Rate for Payer: Clover Medicare Advantage	$13.05
Rate for Payer: EmblemHealth Commercial	$41.22
Rate for Payer: Humana Medicare Advantage	$14.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.74
Rate for Payer: Wellcare Medicare Advantage	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$1.95

DNA ANTIBODY NATIVE

Facility

$68.70

Service Code	HCPCS 86225
Hospital Charge Code	401386225C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$10.30
Rate for Payer: Qualcare PPO/HMO/WC	$10.30

DNA & PLODY ANALYSIS

Facility

$674.00

Service Code	HCPCS 88358
Hospital Charge Code	38474150
Hospital Revenue Code	310
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$101.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$111.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$19.14

DNA & PLODY ANALYSIS

Facility

$674.00

Service Code	HCPCS 88358
Hospital Charge Code	38474150
Hospital Revenue Code	310
Min. Negotiated Rate	$101.10
Max. Negotiated Rate	$101.10
Rate for Payer: Qualcare PPO/HMO/WC	$101.10

DNASE-B AB

Facility

$91.05

Service Code	HCPCS 86215
Hospital Charge Code	39900199
Hospital Revenue Code	302
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.06
Rate for Payer: Cigna Commercial	$45.52
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.67
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.66
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.59

DNASE-B AB

Facility

$91.05

Service Code	HCPCS 86215
Hospital Charge Code	39900199
Hospital Revenue Code	302
Min. Negotiated Rate	$13.66
Max. Negotiated Rate	$13.66
Rate for Payer: Qualcare PPO/HMO/WC	$13.66

DOBUTAMINE 250 MG/20ML INJ

Facility

$30.95

Service Code	HCPCS J1250
Hospital Charge Code	60627445
Hospital Revenue Code	636
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$15.47
Rate for Payer: Aetna Commercial	$11.76
Rate for Payer: Aetna Medicare Advantage	$9.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.89
Rate for Payer: Cigna Commercial	$15.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.64
Rate for Payer: UnitedHealthcare Community & State	$0.98
Rate for Payer: Wellpoint Medicaid Managed Care	$0.88

DOBUTAMINE 250 MG/20ML INJ

Facility

$30.95

Service Code	HCPCS J1250
Hospital Charge Code	60627445
Hospital Revenue Code	636
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$7.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.49
Rate for Payer: Qualcare PPO/HMO/WC	$4.64

DOBUTAMINE 250MG/250ML IVPB

Facility

$132.59

Service Code	HCPCS J1250
Hospital Charge Code	6063943099
Hospital Revenue Code	636
Min. Negotiated Rate	$3.77
Max. Negotiated Rate	$66.30
Rate for Payer: Aetna Commercial	$50.38
Rate for Payer: Aetna Medicare Advantage	$39.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.81
Rate for Payer: Cigna Commercial	$66.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.89
Rate for Payer: UnitedHealthcare Community & State	$4.19
Rate for Payer: Wellpoint Medicaid Managed Care	$3.77

DOBUTAMINE 250MG/250ML IVPB

Facility

$132.59

Service Code	HCPCS J1250
Hospital Charge Code	6063943099
Hospital Revenue Code	636
Min. Negotiated Rate	$19.89
Max. Negotiated Rate	$32.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.09
Rate for Payer: Qualcare PPO/HMO/WC	$19.89

DOBUTAMINE 500MG/250ML D5W

Facility

$233.03

Service Code	HCPCS J1250
Hospital Charge Code	60629346
Hospital Revenue Code	636
Min. Negotiated Rate	$34.95
Max. Negotiated Rate	$56.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.39
Rate for Payer: Qualcare PPO/HMO/WC	$34.95

DOBUTAMINE 500MG/250ML D5W

Facility

$233.03

Service Code	HCPCS J1250
Hospital Charge Code	60629346
Hospital Revenue Code	636
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$116.52
Rate for Payer: Aetna Commercial	$88.55
Rate for Payer: Aetna Medicare Advantage	$69.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$59.42
Rate for Payer: Cigna Commercial	$116.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.39
Rate for Payer: Qualcare PPO/HMO/WC	$34.95
Rate for Payer: UnitedHealthcare Community & State	$7.36
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

DOCETAXEL 20MG

Facility

$2,987.73

Service Code	HCPCS J9171
Hospital Charge Code	60627377
Hospital Revenue Code	636
Min. Negotiated Rate	$84.85
Max. Negotiated Rate	$1,493.87
Rate for Payer: Aetna Commercial	$1,135.34
Rate for Payer: Aetna Medicare Advantage	$896.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$761.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$761.87
Rate for Payer: Cigna Commercial	$1,493.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$723.03
Rate for Payer: Qualcare PPO/HMO/WC	$448.16
Rate for Payer: UnitedHealthcare Community & State	$94.41
Rate for Payer: Wellpoint Medicaid Managed Care	$84.85

DOCETAXEL 20MG

Facility

$2,987.73

Service Code	HCPCS J9171
Hospital Charge Code	60627377
Hospital Revenue Code	636
Min. Negotiated Rate	$448.16
Max. Negotiated Rate	$723.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$723.03
Rate for Payer: Qualcare PPO/HMO/WC	$448.16

DOCETAXEL 80MG

Facility

$11,948.98

Service Code	HCPCS J9171
Hospital Charge Code	60627378
Hospital Revenue Code	636
Min. Negotiated Rate	$339.35
Max. Negotiated Rate	$5,974.49
Rate for Payer: Aetna Commercial	$4,540.61
Rate for Payer: Aetna Medicare Advantage	$3,584.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,046.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,046.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,046.99
Rate for Payer: Cigna Commercial	$5,974.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.35
Rate for Payer: UnitedHealthcare Community & State	$377.59
Rate for Payer: Wellpoint Medicaid Managed Care	$339.35

DOCETAXEL 80MG

Facility

$11,948.98

Service Code	HCPCS J9171
Hospital Charge Code	60627378
Hospital Revenue Code	636
Min. Negotiated Rate	$1,792.35
Max. Negotiated Rate	$2,891.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.65
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.35

DOCUSATE SODIUM 100MG/10ML LIQ

Facility

$14.87

Service Code	NDC 67618010110
Hospital Charge Code	60628126
Hospital Revenue Code	250
Min. Negotiated Rate	$2.23
Max. Negotiated Rate	$2.23
Rate for Payer: Qualcare PPO/HMO/WC	$2.23

DOCUSATE SODIUM 100MG/10ML LIQ

Facility

$14.87

Service Code	NDC 67618010110
Hospital Charge Code	60628126
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna Commercial	$5.65
Rate for Payer: Aetna Medicare Advantage	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.79
Rate for Payer: Cigna Commercial	$7.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Oxford Commercial	$2.97
Rate for Payer: Qualcare PPO/HMO/WC	$2.23
Rate for Payer: UnitedHealthcare Commercial	$2.97
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.42

DOCUSATE SOD SENNA TAB

Facility

$4.00

Service Code	NDC 904633961
Hospital Charge Code	60628128
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DOCUSATE SOD SENNA TAB

Facility

$4.00

Service Code	NDC 904633961
Hospital Charge Code	60628128
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

DOG BONE BUTTON

Facility

$1,750.00

Hospital Charge Code	270675092
Hospital Revenue Code	272
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

DOG BONE BUTTON

Facility

$1,750.00

Hospital Charge Code	270675092
Hospital Revenue Code	272
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$455.00
Rate for Payer: Oxford Commercial	$350.00
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Commercial	$350.00
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

DOLUTEGRAVIR 50MG (TIVICAY)

Facility

$353.22

Service Code	NDC 49702022813
Hospital Charge Code	606380001
Hospital Revenue Code	250
Min. Negotiated Rate	$10.03
Max. Negotiated Rate	$176.61
Rate for Payer: Aetna Commercial	$134.22
Rate for Payer: Aetna Medicare Advantage	$105.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.07
Rate for Payer: Cigna Commercial	$176.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.84
Rate for Payer: Oxford Commercial	$70.64
Rate for Payer: Qualcare PPO/HMO/WC	$52.98
Rate for Payer: UnitedHealthcare Commercial	$70.64
Rate for Payer: UnitedHealthcare Community & State	$11.16
Rate for Payer: Wellpoint Medicaid Managed Care	$10.03

Know your out-of-pocket cost for care.

All Charges