Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MIDAZOLAM 100MG/100ML NACL

Facility

$225.12

Service Code	HCPCS J2250
Hospital Charge Code	60630239
Hospital Revenue Code	636
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$112.56
Rate for Payer: Aetna Commercial	$85.55
Rate for Payer: Aetna Medicare Advantage	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.41
Rate for Payer: Cigna Commercial	$112.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.48
Rate for Payer: Qualcare PPO/HMO/WC	$33.77
Rate for Payer: UnitedHealthcare Community & State	$7.11
Rate for Payer: Wellpoint Medicaid Managed Care	$6.39

MIDAZOLAM 10MG/2ML INJ

Facility

$4.00

Service Code	HCPCS J2250
Hospital Charge Code	6063943137
Hospital Revenue Code	636
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	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

MIDAZOLAM 10MG/2ML INJ

Facility

$4.00

Service Code	HCPCS J2250
Hospital Charge Code	6063943137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MIDAZOLAM 2 MG / 2 ML INJ

Facility

$23.72

Service Code	HCPCS J2250
Hospital Charge Code	6008734
Hospital Revenue Code	636
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$11.86
Rate for Payer: Aetna Commercial	$9.01
Rate for Payer: Aetna Medicare Advantage	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.05
Rate for Payer: Cigna Commercial	$11.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.56
Rate for Payer: UnitedHealthcare Community & State	$0.75
Rate for Payer: Wellpoint Medicaid Managed Care	$0.67

MIDAZOLAM 2 MG / 2 ML INJ

Facility

$23.72

Service Code	HCPCS J2250
Hospital Charge Code	6008734
Hospital Revenue Code	636
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.56

MIDAZOLAM 2 MG/ML SYRUP

Facility

$14.47

Service Code	NDC 52959091501
Hospital Charge Code	60628903
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

MIDAZOLAM 2 MG/ML SYRUP

Facility

$14.47

Service Code	NDC 52959091501
Hospital Charge Code	60628903
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$5.50
Rate for Payer: Aetna Medicare Advantage	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.69
Rate for Payer: Cigna Commercial	$7.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.76
Rate for Payer: Oxford Commercial	$2.89
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$2.89
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

MIDAZOLAM 50 MG / 10 ML INJ

Facility

$102.91

Service Code	HCPCS J2250
Hospital Charge Code	60629282
Hospital Revenue Code	636
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$51.45
Rate for Payer: Aetna Commercial	$39.11
Rate for Payer: Aetna Medicare Advantage	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Commercial	$51.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.44
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

MIDAZOLAM 50 MG / 10 ML INJ

Facility

$102.91

Service Code	HCPCS J2250
Hospital Charge Code	60629282
Hospital Revenue Code	636
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$24.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.44

MIDAZOLAM 50MG/50ML

Facility

$176.81

Service Code	NDC 44567061010
Hospital Charge Code	6063943396
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$88.41
Rate for Payer: Aetna Commercial	$67.19
Rate for Payer: Aetna Medicare Advantage	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.09
Rate for Payer: Cigna Commercial	$88.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.97
Rate for Payer: Oxford Commercial	$35.36
Rate for Payer: Qualcare PPO/HMO/WC	$26.52
Rate for Payer: UnitedHealthcare Commercial	$35.36
Rate for Payer: UnitedHealthcare Community & State	$5.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.02

MIDAZOLAM 50MG/50ML

Facility

$176.81

Service Code	NDC 44567061010
Hospital Charge Code	6063943396
Hospital Revenue Code	250
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$26.52
Rate for Payer: Qualcare PPO/HMO/WC	$26.52

MIDAZOLAM 50MG/50ML NS

Facility

$131.90

Hospital Charge Code	606390576
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$65.95
Rate for Payer: Aetna Commercial	$50.12
Rate for Payer: Aetna Medicare Advantage	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.63
Rate for Payer: Cigna Commercial	$65.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.29
Rate for Payer: Oxford Commercial	$26.38
Rate for Payer: Qualcare PPO/HMO/WC	$19.79
Rate for Payer: UnitedHealthcare Commercial	$26.38
Rate for Payer: UnitedHealthcare Community & State	$4.17
Rate for Payer: Wellpoint Medicaid Managed Care	$3.75

MIDAZOLAM 50MG/50ML NS

Facility

$131.90

Hospital Charge Code	606390576
Hospital Revenue Code	250
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$19.79
Rate for Payer: Qualcare PPO/HMO/WC	$19.79

MIDAZOLAM 5MG/2.5ML DOSE CUPS

Facility

$42.41

Service Code	NDC 68094076259
Hospital Charge Code	6063943399
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$21.20
Rate for Payer: Aetna Commercial	$16.12
Rate for Payer: Aetna Medicare Advantage	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.81
Rate for Payer: Cigna Commercial	$21.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.03
Rate for Payer: Oxford Commercial	$8.48
Rate for Payer: Qualcare PPO/HMO/WC	$6.36
Rate for Payer: UnitedHealthcare Commercial	$8.48
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

MIDAZOLAM 5MG/2.5ML DOSE CUPS

Facility

$42.41

Service Code	NDC 68094076259
Hospital Charge Code	6063943399
Hospital Revenue Code	250
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$6.36
Rate for Payer: Qualcare PPO/HMO/WC	$6.36

MIDAZOLAM 5 MG/5 ML VIAL

Facility

$12.06

Service Code	HCPCS J2250
Hospital Charge Code	6008726
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

MIDAZOLAM 5 MG/5 ML VIAL

Facility

$12.06

Service Code	HCPCS J2250
Hospital Charge Code	6008726
Hospital Revenue Code	636
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	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

MIDAZOLAM 5 MG/ML VIAL

Facility

$44.62

Service Code	HCPCS J2250
Hospital Charge Code	60627849
Hospital Revenue Code	636
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.69

MIDAZOLAM 5 MG/ML VIAL

Facility

$44.62

Service Code	HCPCS J2250
Hospital Charge Code	60627849
Hospital Revenue Code	636
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$22.31
Rate for Payer: Aetna Commercial	$16.96
Rate for Payer: Aetna Medicare Advantage	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.38
Rate for Payer: Cigna Commercial	$22.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.69
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

MIDAZOLAM HCL 25MG/5ML VIAL

Facility

$7.27

Hospital Charge Code	6063943265
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$3.63
Rate for Payer: Aetna Commercial	$2.76
Rate for Payer: Aetna Medicare Advantage	$2.18
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	$3.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.09
Rate for Payer: UnitedHealthcare Community & State	$0.23
Rate for Payer: Wellpoint Medicaid Managed Care	$0.21

MIDAZOLAM HCL 25MG/5ML VIAL

Facility

$7.27

Hospital Charge Code	6063943265
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

MIDAZOLAM INJ 5MG/1ML

Facility

$69.01

Service Code	HCPCS J2250
Hospital Charge Code	60627850
Hospital Revenue Code	636
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$16.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

MIDAZOLAM INJ 5MG/1ML

Facility

$69.01

Service Code	HCPCS J2250
Hospital Charge Code	60627850
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$34.51
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.60
Rate for Payer: Cigna Commercial	$34.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35
Rate for Payer: UnitedHealthcare Community & State	$2.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.96

MIDAZOLOAM 5MG/1ML INJ (5ML)

Facility

$181.75

Hospital Charge Code	6063943138
Hospital Revenue Code	636
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$43.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Qualcare PPO/HMO/WC	$27.26

MIDAZOLOAM 5MG/1ML INJ (5ML)

Facility

$181.75

Hospital Charge Code	6063943138
Hospital Revenue Code	636
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$90.88
Rate for Payer: Aetna Commercial	$69.06
Rate for Payer: Aetna Medicare Advantage	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.35
Rate for Payer: Cigna Commercial	$90.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Qualcare PPO/HMO/WC	$27.26
Rate for Payer: UnitedHealthcare Community & State	$5.74
Rate for Payer: Wellpoint Medicaid Managed Care	$5.16

Know your out-of-pocket cost for care.

All Charges