Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 50MG/10ML INJ

Facility

$108.88

Service Code	NDC 517481025
Hospital Charge Code	6003958
Hospital Revenue Code	250
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$16.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.33

NITROGLYCERIN IN D5W 50MG/250M

Facility

$51.26

Service Code	NDC 409148202
Hospital Charge Code	60630162
Hospital Revenue Code	250
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$25.63
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.33
Rate for Payer: Oxford Commercial	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$10.25
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

NITROGLYCERIN IN D5W 50MG/250M

Facility

$51.26

Service Code	NDC 409148202
Hospital Charge Code	60630162
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

NITROGLYCERIN PATCH 0.1MG/HR

Facility

$12.46

Service Code	NDC 378910293
Hospital Charge Code	60627660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.23
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare Advantage	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.18
Rate for Payer: Cigna Commercial	$6.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.24
Rate for Payer: Oxford Commercial	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$2.49
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

NITROGLYCERIN PATCH 0.1MG/HR

Facility

$12.46

Service Code	NDC 378910293
Hospital Charge Code	60627660
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

NITROGLYCERIN PATCH 0.3MG/HR

Facility

$36.58

Service Code	NDC 85331530
Hospital Charge Code	60627654
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.29
Rate for Payer: Aetna Commercial	$13.90
Rate for Payer: Aetna Medicare Advantage	$10.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.33
Rate for Payer: Cigna Commercial	$18.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.51
Rate for Payer: Oxford Commercial	$7.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.49
Rate for Payer: UnitedHealthcare Commercial	$7.32
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

NITROGLYCERIN PATCH 0.3MG/HR

Facility

$36.58

Service Code	NDC 85331530
Hospital Charge Code	60627654
Hospital Revenue Code	250
Min. Negotiated Rate	$5.49
Max. Negotiated Rate	$5.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.49

NITROGLYCERIN PATCH 0.4MG/HR

Facility

$12.46

Service Code	NDC 85332030
Hospital Charge Code	60627655
Hospital Revenue Code	250
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

NITROGLYCERIN PATCH 0.4MG/HR

Facility

$12.46

Service Code	NDC 85332030
Hospital Charge Code	60627655
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.23
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare Advantage	$3.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.18
Rate for Payer: Cigna Commercial	$6.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.24
Rate for Payer: Oxford Commercial	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$2.49
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

NITROGLYCERIN PATCH 0.6MG/HR

Facility

$16.08

Service Code	NDC 378911693
Hospital Charge Code	60627656
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$8.04
Rate for Payer: Aetna Commercial	$6.11
Rate for Payer: Aetna Medicare Advantage	$4.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.10
Rate for Payer: Cigna Commercial	$8.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.18
Rate for Payer: Oxford Commercial	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$2.41
Rate for Payer: UnitedHealthcare Commercial	$3.22
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

NITROGLYCERIN PATCH 0.6MG/HR

Facility

$16.08

Service Code	NDC 378911693
Hospital Charge Code	60627656
Hospital Revenue Code	250
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$2.41
Rate for Payer: Qualcare PPO/HMO/WC	$2.41

NITROPRUSSIDE 50MG/2ML VIAL

Facility

$1,727.26

Service Code	NDC 187430202
Hospital Charge Code	60630163
Hospital Revenue Code	250
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$863.63
Rate for Payer: Aetna Commercial	$656.36
Rate for Payer: Aetna Medicare Advantage	$518.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$440.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$440.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$440.45
Rate for Payer: Cigna Commercial	$863.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.09
Rate for Payer: Oxford Commercial	$345.45
Rate for Payer: Qualcare PPO/HMO/WC	$259.09
Rate for Payer: UnitedHealthcare Commercial	$345.45
Rate for Payer: UnitedHealthcare Community & State	$54.58
Rate for Payer: Wellpoint Medicaid Managed Care	$49.05

NITROPRUSSIDE 50MG/2ML VIAL

Facility

$1,727.26

Service Code	NDC 187430202
Hospital Charge Code	60630163
Hospital Revenue Code	250
Min. Negotiated Rate	$259.09
Max. Negotiated Rate	$259.09
Rate for Payer: Qualcare PPO/HMO/WC	$259.09

NITROUS OXIDE ANALGESIA SUPPLY

Facility

$15.29

Hospital Charge Code	270999015
Hospital Revenue Code	270
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Qualcare PPO/HMO/WC	$2.29

NITROUS OXIDE ANALGESIA SUPPLY

Facility

$15.29

Hospital Charge Code	270999015
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.64
Rate for Payer: Aetna Commercial	$5.81
Rate for Payer: Aetna Medicare Advantage	$4.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.90
Rate for Payer: Cigna Commercial	$7.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.98
Rate for Payer: Oxford Commercial	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.29
Rate for Payer: UnitedHealthcare Commercial	$3.06
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

NIVESTYM 480MCG/.8ML PER MCG

Facility

$1,599.22

Service Code	HCPCS Q5110
Hospital Charge Code	606390440
Hospital Revenue Code	636
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$387.01
Rate for Payer: Aetna Commercial	$0.76
Rate for Payer: Aetna Medicare Advantage	$0.91
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) Medicare Advantage	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Medicare Advantage	$0.28
Rate for Payer: Clover Medicare Advantage	$0.27
Rate for Payer: EmblemHealth Commercial	$0.84
Rate for Payer: Humana Medicare Advantage	$0.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$0.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.01
Rate for Payer: Qualcare PPO/HMO/WC	$239.88
Rate for Payer: UnitedHealthcare Community & State	$50.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.28
Rate for Payer: Wellcare Medicare Advantage	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$45.42

NIVESTYM 480MCG/.8ML PER MCG

Facility

$1,599.22

Service Code	HCPCS Q5110
Hospital Charge Code	606390440
Hospital Revenue Code	636
Min. Negotiated Rate	$239.88
Max. Negotiated Rate	$387.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.01
Rate for Payer: Qualcare PPO/HMO/WC	$239.88

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$3,865.20

Service Code	HCPCS 64454
Hospital Charge Code	321564454
Hospital Revenue Code	361
Min. Negotiated Rate	$109.77
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,042.06
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,004.95
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$579.78
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$122.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$109.77

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$2,930.12

Service Code	HCPCS 64454
Hospital Charge Code	1600000661
Hospital Revenue Code	360
Min. Negotiated Rate	$439.52
Max. Negotiated Rate	$439.52
Rate for Payer: Qualcare PPO/HMO/WC	$439.52

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$2,930.12

Service Code	HCPCS 64454
Hospital Charge Code	1600000661
Hospital Revenue Code	360
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,042.06
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$761.83
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$439.52
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$92.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$83.22

NJX AA&/STRD GNCLR NRV BRNCH

Facility

$3,865.20

Service Code	HCPCS 64454
Hospital Charge Code	321564454
Hospital Revenue Code	361
Min. Negotiated Rate	$579.78
Max. Negotiated Rate	$579.78
Rate for Payer: Qualcare PPO/HMO/WC	$579.78

NJX AA&/STRD GR OCPL NRV

Facility

$1,630.99

Service Code	HCPCS 64405
Hospital Charge Code	321564405
Hospital Revenue Code	361
Min. Negotiated Rate	$244.65
Max. Negotiated Rate	$244.65
Rate for Payer: Qualcare PPO/HMO/WC	$244.65

NJX AA&/STRD GR OCPL NRV

Facility

$1,630.99

Service Code	HCPCS 64405
Hospital Charge Code	321564405
Hospital Revenue Code	361
Min. Negotiated Rate	$46.32
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.06
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$244.65
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$51.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$46.32

NJX AA&/STRD NRV NRVTG SI JT

Facility

$2,930.12

Service Code	HCPCS 64451
Hospital Charge Code	16000653
Hospital Revenue Code	360
Min. Negotiated Rate	$439.52
Max. Negotiated Rate	$439.52
Rate for Payer: Qualcare PPO/HMO/WC	$439.52

NJX AA&/STRD NRV NRVTG SI JT

Facility

$2,930.12

Service Code	HCPCS 64451
Hospital Charge Code	16000653
Hospital Revenue Code	360
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,281.02
Rate for Payer: Aetna Medicare Advantage	$2,717.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,042.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$838.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,042.06
Rate for Payer: Cigna Commercial	$1,680.99
Rate for Payer: Cigna Medicare Advantage	$838.61
Rate for Payer: Clover Medicare Advantage	$796.68
Rate for Payer: EmblemHealth Commercial	$2,515.83
Rate for Payer: Humana Medicare Advantage	$863.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$838.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$761.83
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$439.52
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$92.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.61
Rate for Payer: Wellcare Medicare Advantage	$838.61
Rate for Payer: Wellpoint Medicaid Managed Care	$83.22

Know your out-of-pocket cost for care.

All Charges