Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DOXEPIN 50 MG CAP

Facility

$6.23

Service Code	NDC 51079043801
Hospital Charge Code	60627764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Qualcare PPO/HMO/WC	$0.93

DOXEPIN 50 MG CAP

Facility

$6.23

Service Code	NDC 51079043801
Hospital Charge Code	60627764
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$3.12
Rate for Payer: Aetna Commercial	$2.37
Rate for Payer: Aetna Medicare Advantage	$1.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.59
Rate for Payer: Cigna Commercial	$3.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.62
Rate for Payer: Oxford Commercial	$1.25
Rate for Payer: Qualcare PPO/HMO/WC	$0.93
Rate for Payer: UnitedHealthcare Commercial	$1.25
Rate for Payer: UnitedHealthcare Community & State	$0.20
Rate for Payer: Wellpoint Medicaid Managed Care	$0.18

DOXEPIN, SERUM 1-2

Facility

$153.65

Service Code	HCPCS 80335
Hospital Charge Code	3001112
Hospital Revenue Code	301
Min. Negotiated Rate	$23.05
Max. Negotiated Rate	$23.05
Rate for Payer: Qualcare PPO/HMO/WC	$23.05

DOXEPIN, SERUM 1-2

Facility

$153.65

Service Code	HCPCS 80335
Hospital Charge Code	3001112
Hospital Revenue Code	301
Min. Negotiated Rate	$4.36
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$58.39
Rate for Payer: Aetna Medicare Advantage	$46.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.18
Rate for Payer: Cigna Commercial	$76.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.95
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$4.36

DOXEPIN,URINE

Facility

$277.00

Service Code	HCPCS 80335
Hospital Charge Code	38473092
Hospital Revenue Code	301
Min. Negotiated Rate	$41.55
Max. Negotiated Rate	$41.55
Rate for Payer: Qualcare PPO/HMO/WC	$41.55

DOXEPIN,URINE

Facility

$277.00

Service Code	HCPCS 80335
Hospital Charge Code	38473092
Hospital Revenue Code	301
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$105.26
Rate for Payer: Aetna Medicare Advantage	$83.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.64
Rate for Payer: Cigna Commercial	$138.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$7.87

DOXERCALCIFEROL 0.5 MCG CAP

Facility

$116.85

Service Code	NDC 58468012001
Hospital Charge Code	60629911
Hospital Revenue Code	250
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$58.42
Rate for Payer: Aetna Commercial	$44.40
Rate for Payer: Aetna Medicare Advantage	$35.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.80
Rate for Payer: Cigna Commercial	$58.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.38
Rate for Payer: Oxford Commercial	$23.37
Rate for Payer: Qualcare PPO/HMO/WC	$17.53
Rate for Payer: UnitedHealthcare Commercial	$23.37
Rate for Payer: UnitedHealthcare Community & State	$3.69
Rate for Payer: Wellpoint Medicaid Managed Care	$3.32

DOXERCALCIFEROL 0.5 MCG CAP

Facility

$116.85

Service Code	NDC 58468012001
Hospital Charge Code	60629911
Hospital Revenue Code	250
Min. Negotiated Rate	$17.53
Max. Negotiated Rate	$17.53
Rate for Payer: Qualcare PPO/HMO/WC	$17.53

DOXERCALCIFEROL 2.5 MCG CAP

Facility

$270.75

Service Code	NDC 58468012101
Hospital Charge Code	60635492
Hospital Revenue Code	250
Min. Negotiated Rate	$40.61
Max. Negotiated Rate	$40.61
Rate for Payer: Qualcare PPO/HMO/WC	$40.61

DOXERCALCIFEROL 2.5 MCG CAP

Facility

$270.75

Service Code	NDC 58468012101
Hospital Charge Code	60635492
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$135.38
Rate for Payer: Aetna Commercial	$102.89
Rate for Payer: Aetna Medicare Advantage	$81.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.04
Rate for Payer: Cigna Commercial	$135.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.39
Rate for Payer: Oxford Commercial	$54.15
Rate for Payer: Qualcare PPO/HMO/WC	$40.61
Rate for Payer: UnitedHealthcare Commercial	$54.15
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$7.69

DOXERCALCIFEROL 4 MCG/2ML INJ

Facility

$185.59

Service Code	HCPCS J1270
Hospital Charge Code	60629353
Hospital Revenue Code	636
Min. Negotiated Rate	$5.27
Max. Negotiated Rate	$92.80
Rate for Payer: Aetna Commercial	$70.52
Rate for Payer: Aetna Medicare Advantage	$55.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.33
Rate for Payer: Cigna Commercial	$92.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.91
Rate for Payer: Qualcare PPO/HMO/WC	$27.84
Rate for Payer: UnitedHealthcare Community & State	$5.86
Rate for Payer: Wellpoint Medicaid Managed Care	$5.27

DOXERCALCIFEROL 4 MCG/2ML INJ

Facility

$185.59

Service Code	HCPCS J1270
Hospital Charge Code	60629353
Hospital Revenue Code	636
Min. Negotiated Rate	$27.84
Max. Negotiated Rate	$44.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.91
Rate for Payer: Qualcare PPO/HMO/WC	$27.84

DOXORUBICIN 50 MG/25ML INJ

Facility

$446.22

Service Code	HCPCS J9000
Hospital Charge Code	60627379
Hospital Revenue Code	636
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$223.11
Rate for Payer: Aetna Commercial	$169.56
Rate for Payer: Aetna Medicare Advantage	$133.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.79
Rate for Payer: Cigna Commercial	$223.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.99
Rate for Payer: Qualcare PPO/HMO/WC	$66.93
Rate for Payer: UnitedHealthcare Community & State	$14.10
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

DOXORUBICIN 50 MG/25ML INJ

Facility

$446.22

Service Code	HCPCS J9000
Hospital Charge Code	60627379
Hospital Revenue Code	636
Min. Negotiated Rate	$66.93
Max. Negotiated Rate	$107.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$107.99
Rate for Payer: Qualcare PPO/HMO/WC	$66.93

DOXORUBICIN LIPOSOMAL 2 MG/ML

Facility

$83,869.80

Hospital Charge Code	6063943102
Hospital Revenue Code	636
Min. Negotiated Rate	$12,580.47
Max. Negotiated Rate	$20,296.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,296.49
Rate for Payer: Qualcare PPO/HMO/WC	$12,580.47

DOXORUBICIN LIPOSOMAL 2 MG/ML

Facility

$83,869.80

Hospital Charge Code	6063943102
Hospital Revenue Code	636
Min. Negotiated Rate	$2,381.90
Max. Negotiated Rate	$41,934.90
Rate for Payer: Aetna Commercial	$31,870.52
Rate for Payer: Aetna Medicare Advantage	$25,160.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,386.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,386.80
Rate for Payer: Cigna Commercial	$41,934.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,296.49
Rate for Payer: Qualcare PPO/HMO/WC	$12,580.47
Rate for Payer: UnitedHealthcare Community & State	$2,650.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2,381.90

DOXORUBICIN LIPOSOME 20MG/10ML

Facility

$8,666.32

Service Code	HCPCS Q2050
Hospital Charge Code	60628766
Hospital Revenue Code	636
Min. Negotiated Rate	$68.27
Max. Negotiated Rate	$2,097.25
Rate for Payer: Aetna Commercial	$195.46
Rate for Payer: Aetna Medicare Advantage	$232.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$71.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.67
Rate for Payer: Cigna Medicare Advantage	$71.86
Rate for Payer: Clover Medicare Advantage	$68.27
Rate for Payer: EmblemHealth Commercial	$215.58
Rate for Payer: Humana Medicare Advantage	$74.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$71.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,097.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.95
Rate for Payer: UnitedHealthcare Community & State	$273.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.86
Rate for Payer: Wellcare Medicare Advantage	$71.86
Rate for Payer: Wellpoint Medicaid Managed Care	$246.12

DOXORUBICIN LIPOSOME 20MG/10ML

Facility

$8,666.32

Service Code	HCPCS Q2050
Hospital Charge Code	60628766
Hospital Revenue Code	636
Min. Negotiated Rate	$1,299.95
Max. Negotiated Rate	$2,097.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,097.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,299.95

DOXYCYCLINE 100 MG INJ

Facility

$97.28

Service Code	NDC 63323013013
Hospital Charge Code	6002091
Hospital Revenue Code	250
Min. Negotiated Rate	$14.59
Max. Negotiated Rate	$14.59
Rate for Payer: Qualcare PPO/HMO/WC	$14.59

DOXYCYCLINE 100 MG INJ

Facility

$97.28

Service Code	NDC 63323013013
Hospital Charge Code	6002091
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$48.64
Rate for Payer: Aetna Commercial	$36.97
Rate for Payer: Aetna Medicare Advantage	$29.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.81
Rate for Payer: Cigna Commercial	$48.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.29
Rate for Payer: Oxford Commercial	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.59
Rate for Payer: UnitedHealthcare Commercial	$19.46
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

Doxycycline 50mg/5ml oral

Facility

$4.08

Hospital Charge Code	6063943274
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

Doxycycline 50mg/5ml oral

Facility

$4.08

Hospital Charge Code	6063943274
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.04
Rate for Payer: Aetna Commercial	$1.55
Rate for Payer: Aetna Medicare Advantage	$1.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.04
Rate for Payer: Cigna Commercial	$2.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.06
Rate for Payer: Oxford Commercial	$0.82
Rate for Payer: Qualcare PPO/HMO/WC	$0.61
Rate for Payer: UnitedHealthcare Commercial	$0.82
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

DOXYCYCLINE HYCLATE 100 MG TAB

Facility

$9.45

Service Code	NDC 69095050
Hospital Charge Code	6002083
Hospital Revenue Code	251
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$1.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.42

DOXYCYCLINE HYCLATE 100 MG TAB

Facility

$9.45

Service Code	NDC 69095050
Hospital Charge Code	6002083
Hospital Revenue Code	251
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Commercial	$3.59
Rate for Payer: Aetna Medicare Advantage	$2.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.41
Rate for Payer: Cigna Commercial	$4.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.46
Rate for Payer: Oxford Commercial	$1.89
Rate for Payer: Qualcare PPO/HMO/WC	$1.42
Rate for Payer: UnitedHealthcare Commercial	$1.89
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DOXYCYCLINE HYCLATE 100MG TAB

Facility

$19.78

Hospital Charge Code	60630236
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$9.89
Rate for Payer: Aetna Commercial	$7.52
Rate for Payer: Aetna Medicare Advantage	$5.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.04
Rate for Payer: Cigna Commercial	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.14
Rate for Payer: Oxford Commercial	$3.96
Rate for Payer: Qualcare PPO/HMO/WC	$2.97
Rate for Payer: UnitedHealthcare Commercial	$3.96
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

Know your out-of-pocket cost for care.

All Charges