Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ISOPTO CARPINE 4% OPHTH/1

Facility

$679.78

Service Code	NDC 998020615
Hospital Charge Code	60633211
Hospital Revenue Code	250
Min. Negotiated Rate	$19.31
Max. Negotiated Rate	$339.89
Rate for Payer: Aetna Commercial	$258.32
Rate for Payer: Aetna Medicare Advantage	$203.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.34
Rate for Payer: Cigna Commercial	$339.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$176.74
Rate for Payer: Oxford Commercial	$135.96
Rate for Payer: Qualcare PPO/HMO/WC	$101.97
Rate for Payer: UnitedHealthcare Commercial	$135.96
Rate for Payer: UnitedHealthcare Community & State	$21.48
Rate for Payer: Wellpoint Medicaid Managed Care	$19.31

ISOPTO CARPINE 4% OPHTH/1

Facility

$679.78

Service Code	NDC 998020615
Hospital Charge Code	60633211
Hospital Revenue Code	250
Min. Negotiated Rate	$101.97
Max. Negotiated Rate	$101.97
Rate for Payer: Qualcare PPO/HMO/WC	$101.97

ISOPTO HOMATROPINE 5% OPH

Facility

$383.51

Service Code	NDC 59390019205
Hospital Charge Code	60633213
Hospital Revenue Code	250
Min. Negotiated Rate	$57.53
Max. Negotiated Rate	$57.53
Rate for Payer: Qualcare PPO/HMO/WC	$57.53

ISOPTO HOMATROPINE 5% OPH

Facility

$383.51

Service Code	NDC 59390019205
Hospital Charge Code	60633213
Hospital Revenue Code	250
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$191.75
Rate for Payer: Aetna Commercial	$145.73
Rate for Payer: Aetna Medicare Advantage	$115.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.80
Rate for Payer: Cigna Commercial	$191.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.71
Rate for Payer: Oxford Commercial	$76.70
Rate for Payer: Qualcare PPO/HMO/WC	$57.53
Rate for Payer: UnitedHealthcare Commercial	$76.70
Rate for Payer: UnitedHealthcare Community & State	$12.12
Rate for Payer: Wellpoint Medicaid Managed Care	$10.89

ISOSORBIDE DINITRATE 10 MG TAB

Facility

$7.24

Service Code	NDC 781155601
Hospital Charge Code	60627648
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.62
Rate for Payer: Aetna Commercial	$2.75
Rate for Payer: Aetna Medicare Advantage	$2.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.88
Rate for Payer: Oxford Commercial	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Commercial	$1.45
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

ISOSORBIDE DINITRATE 10 MG TAB

Facility

$7.24

Service Code	NDC 781155601
Hospital Charge Code	60627648
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

ISOSORBIDE DINITRATE 20 MG TAB

Facility

$7.97

Service Code	NDC 781169513
Hospital Charge Code	60627649
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

ISOSORBIDE DINITRATE 20 MG TAB

Facility

$7.97

Service Code	NDC 781169513
Hospital Charge Code	60627649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.07
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

ISOSORBIDE DINITRATE 30MG

Facility

$8.78

Service Code	NDC 49884000901
Hospital Charge Code	606390328
Hospital Revenue Code	250
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.32
Rate for Payer: Qualcare PPO/HMO/WC	$1.32

ISOSORBIDE DINITRATE 30MG

Facility

$8.78

Service Code	NDC 49884000901
Hospital Charge Code	606390328
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.39
Rate for Payer: Aetna Commercial	$3.34
Rate for Payer: Aetna Medicare Advantage	$2.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.24
Rate for Payer: Cigna Commercial	$4.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.28
Rate for Payer: Oxford Commercial	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.32
Rate for Payer: UnitedHealthcare Commercial	$1.76
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

ISOSORBIDE DINITRATE 5 MG TAB

Facility

$6.63

Service Code	NDC 68001022300
Hospital Charge Code	6022594
Hospital Revenue Code	251
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$0.99
Rate for Payer: Qualcare PPO/HMO/WC	$0.99

ISOSORBIDE DINITRATE 5 MG TAB

Facility

$6.63

Service Code	NDC 68001022300
Hospital Charge Code	6022594
Hospital Revenue Code	251
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$2.52
Rate for Payer: Aetna Medicare Advantage	$1.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.69
Rate for Payer: Cigna Commercial	$3.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.72
Rate for Payer: Oxford Commercial	$1.33
Rate for Payer: Qualcare PPO/HMO/WC	$0.99
Rate for Payer: UnitedHealthcare Commercial	$1.33
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

ISOSORBIDE MONONIT TAB 10MG

Facility

$4.09

Service Code	NDC 62175010601
Hospital Charge Code	60628630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$0.61
Rate for Payer: Qualcare PPO/HMO/WC	$0.61

ISOSORBIDE MONONIT TAB 10MG

Facility

$4.09

Service Code	NDC 62175010601
Hospital Charge Code	60628630
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	$1.23
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

ISOSORBIDE MONONIT TAB SR 30MG

Facility

$11.12

Service Code	NDC 904644961
Hospital Charge Code	60627652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.56
Rate for Payer: Aetna Commercial	$4.23
Rate for Payer: Aetna Medicare Advantage	$3.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.84
Rate for Payer: Cigna Commercial	$5.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.89
Rate for Payer: Oxford Commercial	$2.22
Rate for Payer: Qualcare PPO/HMO/WC	$1.67
Rate for Payer: UnitedHealthcare Commercial	$2.22
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

ISOSORBIDE MONONIT TAB SR 30MG

Facility

$11.12

Service Code	NDC 904644961
Hospital Charge Code	60627652
Hospital Revenue Code	250
Min. Negotiated Rate	$1.67
Max. Negotiated Rate	$1.67
Rate for Payer: Qualcare PPO/HMO/WC	$1.67

ISOSORBIDE MONONIT TAB SR 60MG

Facility

$9.05

Service Code	NDC 603411128
Hospital Charge Code	60627653
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$1.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.36

ISOSORBIDE MONONIT TAB SR 60MG

Facility

$9.05

Service Code	NDC 603411128
Hospital Charge Code	60627653
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$4.53
Rate for Payer: Aetna Commercial	$3.44
Rate for Payer: Aetna Medicare Advantage	$2.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.31
Rate for Payer: Cigna Commercial	$4.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.35
Rate for Payer: Oxford Commercial	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.36
Rate for Payer: UnitedHealthcare Commercial	$1.81
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

ISOSPORA BELLI

Facility

$169.00

Service Code	HCPCS 87015
Hospital Charge Code	38475106
Hospital Revenue Code	309
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$84.50
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

ISOSPORA BELLI

Facility

$169.00

Service Code	HCPCS 87015
Hospital Charge Code	38475106
Hospital Revenue Code	309
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Qualcare PPO/HMO/WC	$25.35

ISOSULFAN BLUE 10 MG/ML ML

Facility

$1,422.14

Service Code	NDC 67457022005
Hospital Charge Code	60630098
Hospital Revenue Code	254
Min. Negotiated Rate	$213.32
Max. Negotiated Rate	$213.32
Rate for Payer: Qualcare PPO/HMO/WC	$213.32

ISOSULFAN BLUE 10 MG/ML ML

Facility

$1,422.14

Service Code	NDC 67457022005
Hospital Charge Code	60630098
Hospital Revenue Code	254
Min. Negotiated Rate	$40.39
Max. Negotiated Rate	$711.07
Rate for Payer: Aetna Commercial	$540.41
Rate for Payer: Aetna Medicare Advantage	$426.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.65
Rate for Payer: Cigna Commercial	$711.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.76
Rate for Payer: Oxford Commercial	$284.43
Rate for Payer: Qualcare PPO/HMO/WC	$213.32
Rate for Payer: UnitedHealthcare Commercial	$284.43
Rate for Payer: UnitedHealthcare Community & State	$44.94
Rate for Payer: Wellpoint Medicaid Managed Care	$40.39

ISOVUE 61% 300MG/ML 30ML

Facility

$362.34

Service Code	NDC 270131525
Hospital Charge Code	60390543
Hospital Revenue Code	255
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$181.17
Rate for Payer: Aetna Commercial	$137.69
Rate for Payer: Aetna Medicare Advantage	$108.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.40
Rate for Payer: Cigna Commercial	$181.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$94.21
Rate for Payer: Oxford Commercial	$72.47
Rate for Payer: Qualcare PPO/HMO/WC	$54.35
Rate for Payer: UnitedHealthcare Commercial	$72.47
Rate for Payer: UnitedHealthcare Community & State	$11.45
Rate for Payer: Wellpoint Medicaid Managed Care	$10.29

ISOVUE 61% 300MG/ML 30ML

Facility

$362.34

Service Code	NDC 270131525
Hospital Charge Code	60390543
Hospital Revenue Code	255
Min. Negotiated Rate	$54.35
Max. Negotiated Rate	$54.35
Rate for Payer: Qualcare PPO/HMO/WC	$54.35

ISOVUE M200 10ML

Facility

$90.34

Hospital Charge Code	270653684
Hospital Revenue Code	270
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$13.55
Rate for Payer: Qualcare PPO/HMO/WC	$13.55

Know your out-of-pocket cost for care.

All Charges