Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DONEPEZIL HYDROCHLORIDE 10 MG

Facility

$58.02

Service Code	NDC 68382034706
Hospital Charge Code	6063943262
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$29.01
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare Advantage	$17.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.80
Rate for Payer: Cigna Commercial	$29.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.09
Rate for Payer: Oxford Commercial	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$11.60
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

DONEPEZIL HYDROCHLORIDE 10 MG

Facility

$58.02

Service Code	NDC 68382034706
Hospital Charge Code	6063943262
Hospital Revenue Code	250
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

DONEPEZIL HYDROCHLORIDE 5 MG O

Facility

$58.02

Service Code	NDC 68382034606
Hospital Charge Code	6063943263
Hospital Revenue Code	250
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

DONEPEZIL HYDROCHLORIDE 5 MG O

Facility

$58.02

Service Code	NDC 68382034606
Hospital Charge Code	6063943263
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$29.01
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare Advantage	$17.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.80
Rate for Payer: Cigna Commercial	$29.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.09
Rate for Payer: Oxford Commercial	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$11.60
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

DOPAMINE 200MG/250ML IVPB

Facility

$311.55

Hospital Charge Code	6063943100
Hospital Revenue Code	250
Min. Negotiated Rate	$46.73
Max. Negotiated Rate	$46.73
Rate for Payer: Qualcare PPO/HMO/WC	$46.73

DOPAMINE 200MG/250ML IVPB

Facility

$311.55

Hospital Charge Code	6063943100
Hospital Revenue Code	250
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$155.78
Rate for Payer: Aetna Commercial	$118.39
Rate for Payer: Aetna Medicare Advantage	$93.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.45
Rate for Payer: Cigna Commercial	$155.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.00
Rate for Payer: Oxford Commercial	$62.31
Rate for Payer: Qualcare PPO/HMO/WC	$46.73
Rate for Payer: UnitedHealthcare Commercial	$62.31
Rate for Payer: UnitedHealthcare Community & State	$9.84
Rate for Payer: Wellpoint Medicaid Managed Care	$8.85

DOPAMINE 400MG/250ML D5W

Facility

$104.12

Service Code	HCPCS J1265
Hospital Charge Code	60629345
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$52.06
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna Medicare Advantage	$31.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.55
Rate for Payer: Cigna Commercial	$52.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.62
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

DOPAMINE 400MG/250ML D5W

Facility

$104.12

Service Code	HCPCS J1265
Hospital Charge Code	60629345
Hospital Revenue Code	636
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$25.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.62

DOPAMINE, PLASMA

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	38479450
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna Medicare Advantage	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.39
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$24.09
Rate for Payer: Clover Medicare Advantage	$22.89
Rate for Payer: EmblemHealth Commercial	$72.27
Rate for Payer: Humana Medicare Advantage	$24.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.09
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	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.09
Rate for Payer: Wellcare Medicare Advantage	$24.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DOPAMINE, PLASMA

Facility

$390.00

Service Code	HCPCS 82542
Hospital Charge Code	38479450
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DOPPLER COLOR FLOW LTD

Facility

$1,615.00

Service Code	HCPCS 93307
Hospital Charge Code	36540013
Hospital Revenue Code	483
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$242.25
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

DOPPLER COLOR FLOW LTD

Facility

$1,615.00

Service Code	HCPCS 93307
Hospital Charge Code	36540013
Hospital Revenue Code	483
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$358.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.90
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$51.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$45.87

DOPPLER MIDDLE CEREBRAL ARTERY

Facility

$721.00

Service Code	HCPCS 76821
Hospital Charge Code	83653100
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

DOPPLER MIDDLE CEREBRAL ARTERY

Facility

$721.00

Service Code	HCPCS 76821
Hospital Charge Code	83653100
Hospital Revenue Code	402
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$92.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.46
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$22.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.48

DOPPLER UMBILICAL CORD

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	83653095
Hospital Revenue Code	402
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$108.15
Rate for Payer: Qualcare PPO/HMO/WC	$108.15

DOPPLER UMBILICAL CORD

Facility

$721.00

Service Code	HCPCS 76820
Hospital Charge Code	83653095
Hospital Revenue Code	402
Min. Negotiated Rate	$20.48
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$42.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.46
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.15
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$22.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$20.48

DORNASE ALFA 1MG/2.5ML

Facility

$754.62

Service Code	HCPCS J7639
Hospital Charge Code	606390339
Hospital Revenue Code	636
Min. Negotiated Rate	$113.19
Max. Negotiated Rate	$182.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.62
Rate for Payer: Qualcare PPO/HMO/WC	$113.19

DORNASE ALFA 1MG/2.5ML

Facility

$754.62

Service Code	HCPCS J7639
Hospital Charge Code	606390339
Hospital Revenue Code	636
Min. Negotiated Rate	$21.43
Max. Negotiated Rate	$377.31
Rate for Payer: Aetna Commercial	$286.76
Rate for Payer: Aetna Medicare Advantage	$226.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.43
Rate for Payer: Cigna Commercial	$377.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.62
Rate for Payer: Qualcare PPO/HMO/WC	$113.19
Rate for Payer: UnitedHealthcare Community & State	$23.85
Rate for Payer: Wellpoint Medicaid Managed Care	$21.43

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$96,482.42

Service Code	APR-DRG 3044
Min. Negotiated Rate	$94,590.61
Max. Negotiated Rate	$96,482.42
Rate for Payer: UnitedHealthcare Community & State	$94,590.61
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$96,482.42
Rate for Payer: Wellpoint Medicaid Managed Care	$94,590.61

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$38,152.85

Service Code	APR-DRG 3041
Min. Negotiated Rate	$37,404.75
Max. Negotiated Rate	$38,152.85
Rate for Payer: UnitedHealthcare Community & State	$37,404.75
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$38,152.85
Rate for Payer: Wellpoint Medicaid Managed Care	$37,404.75

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$45,142.43

Service Code	APR-DRG 3042
Min. Negotiated Rate	$44,257.28
Max. Negotiated Rate	$45,142.43
Rate for Payer: UnitedHealthcare Community & State	$44,257.28
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$45,142.43
Rate for Payer: Wellpoint Medicaid Managed Care	$44,257.28

DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK

Facility

$62,774.43

Service Code	APR-DRG 3043
Min. Negotiated Rate	$61,543.56
Max. Negotiated Rate	$62,774.43
Rate for Payer: UnitedHealthcare Community & State	$61,543.56
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$62,774.43
Rate for Payer: Wellpoint Medicaid Managed Care	$61,543.56

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$132,833.41

Service Code	APR-DRG 3034
Min. Negotiated Rate	$130,228.83
Max. Negotiated Rate	$132,833.41
Rate for Payer: UnitedHealthcare Community & State	$130,228.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$132,833.41
Rate for Payer: Wellpoint Medicaid Managed Care	$130,228.83

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$55,370.57

Service Code	APR-DRG 3031
Min. Negotiated Rate	$54,284.87
Max. Negotiated Rate	$55,370.57
Rate for Payer: UnitedHealthcare Community & State	$54,284.87
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$55,370.57
Rate for Payer: Wellpoint Medicaid Managed Care	$54,284.87

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$90,817.14

Service Code	APR-DRG 3033
Min. Negotiated Rate	$89,036.41
Max. Negotiated Rate	$90,817.14
Rate for Payer: UnitedHealthcare Community & State	$89,036.41
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$90,817.14
Rate for Payer: Wellpoint Medicaid Managed Care	$89,036.41

Know your out-of-pocket cost for care.

All Charges