Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DIAPER BRIEF ADULT XL

Facility

$29.76

Hospital Charge Code	270649678
Hospital Revenue Code	270
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$14.88
Rate for Payer: Aetna Commercial	$11.31
Rate for Payer: Aetna Medicare Advantage	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.59
Rate for Payer: Cigna Commercial	$14.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.74
Rate for Payer: Oxford Commercial	$5.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.46
Rate for Payer: UnitedHealthcare Commercial	$5.95
Rate for Payer: UnitedHealthcare Community & State	$0.94
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

DIAPER BRIEF ADULT XL

Facility

$29.76

Hospital Charge Code	270649678
Hospital Revenue Code	270
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$4.46
Rate for Payer: Qualcare PPO/HMO/WC	$4.46

DIAPER PAMPERS SZ-6

Facility

$1.10

Hospital Charge Code	270633895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.17

DIAPER PAMPERS SZ-6

Facility

$1.10

Hospital Charge Code	270633895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.55
Rate for Payer: Aetna Commercial	$0.42
Rate for Payer: Aetna Medicare Advantage	$0.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.28
Rate for Payer: Cigna Commercial	$0.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.29
Rate for Payer: Oxford Commercial	$0.22
Rate for Payer: Qualcare PPO/HMO/WC	$0.17
Rate for Payer: UnitedHealthcare Commercial	$0.22
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

DIAPERS ADULT

Facility

$16.35

Hospital Charge Code	270300850
Hospital Revenue Code	270
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$2.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.45

DIAPERS ADULT

Facility

$16.35

Hospital Charge Code	270300850
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$8.18
Rate for Payer: Aetna Commercial	$6.21
Rate for Payer: Aetna Medicare Advantage	$4.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.17
Rate for Payer: Cigna Commercial	$8.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.25
Rate for Payer: Oxford Commercial	$3.27
Rate for Payer: Qualcare PPO/HMO/WC	$2.45
Rate for Payer: UnitedHealthcare Commercial	$3.27
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

DIAPERS PHASES NEWBORN

Facility

$0.32

Hospital Charge Code	270649470
Hospital Revenue Code	270
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.16
Rate for Payer: Aetna Commercial	$0.12
Rate for Payer: Aetna Medicare Advantage	$0.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.08
Rate for Payer: Cigna Commercial	$0.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.08
Rate for Payer: Oxford Commercial	$0.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.05
Rate for Payer: UnitedHealthcare Commercial	$0.06
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

DIAPERS PHASES NEWBORN

Facility

$0.32

Hospital Charge Code	270649470
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Qualcare PPO/HMO/WC	$0.05

DIAPHYSIS SH HUMER CEMENTLS 12

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699210
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

DIAPHYSIS SH HUMER CEMENTLS 12

Facility

$17,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270699210
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

DIAZEPAM

Facility

$180.00

Service Code	HCPCS 80346
Hospital Charge Code	38473087
Hospital Revenue Code	301
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

DIAZEPAM

Facility

$180.00

Service Code	HCPCS 80346
Hospital Charge Code	38473087
Hospital Revenue Code	301
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

DIAZEPAM 10 MG/2 ML INJ

Facility

$16.95

Service Code	HCPCS J3360
Hospital Charge Code	60627842
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.47
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna Medicare Advantage	$5.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.32
Rate for Payer: Cigna Commercial	$8.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.54
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

DIAZEPAM 10 MG/2 ML INJ

Facility

$16.95

Service Code	HCPCS J3360
Hospital Charge Code	60627842
Hospital Revenue Code	636
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$4.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.54

DIAZEPAM 2 MG TAB

Facility

$4.00

Service Code	NDC 51079028420
Hospital Charge Code	60627843
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIAZEPAM 2 MG TAB

Facility

$4.00

Service Code	NDC 51079028420
Hospital Charge Code	60627843
Hospital Revenue Code	250
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DIAZEPAM 50MG/10ML VIAL

Facility

$168.84

Service Code	HCPCS J3360
Hospital Charge Code	60635784
Hospital Revenue Code	636
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$84.42
Rate for Payer: Aetna Commercial	$64.16
Rate for Payer: Aetna Medicare Advantage	$50.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.05
Rate for Payer: Cigna Commercial	$84.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.86
Rate for Payer: Qualcare PPO/HMO/WC	$25.33
Rate for Payer: UnitedHealthcare Community & State	$5.34
Rate for Payer: Wellpoint Medicaid Managed Care	$4.80

DIAZEPAM 50MG/10ML VIAL

Facility

$168.84

Service Code	HCPCS J3360
Hospital Charge Code	60635784
Hospital Revenue Code	636
Min. Negotiated Rate	$25.33
Max. Negotiated Rate	$40.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.86
Rate for Payer: Qualcare PPO/HMO/WC	$25.33

DIAZEPAM 5 MG TAB

Facility

$4.00

Service Code	NDC 51079028520
Hospital Charge Code	6021000
Hospital Revenue Code	251
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	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

DIAZEPAM 5 MG TAB

Facility

$4.00

Service Code	NDC 51079028520
Hospital Charge Code	6021000
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIAZEPAM & NORDIAZEPAM,SER

Facility

$127.15

Service Code	HCPCS 80346
Hospital Charge Code	39900513
Hospital Revenue Code	301
Min. Negotiated Rate	$19.07
Max. Negotiated Rate	$19.07
Rate for Payer: Qualcare PPO/HMO/WC	$19.07

DIAZEPAM & NORDIAZEPAM,SER

Facility

$127.15

Service Code	HCPCS 80346
Hospital Charge Code	39900513
Hospital Revenue Code	301
Min. Negotiated Rate	$3.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.32
Rate for Payer: Aetna Medicare Advantage	$38.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.42
Rate for Payer: Cigna Commercial	$63.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.06
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$19.07
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$3.61

DIAZEPAM (NORDIAZEPAM) UR SCRN

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007366
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

DIAZEPAM (NORDIAZEPAM) UR SCRN

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3007366
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.03
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.23
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.16

DIAZEPAM, SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3038093
Hospital Revenue Code	301
Min. Negotiated Rate	$5.16
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.03
Rate for Payer: Aetna Medicare Advantage	$54.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.32
Rate for Payer: Cigna Commercial	$90.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.23
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.96
Rate for Payer: Wellpoint Medicaid Managed Care	$5.16

Know your out-of-pocket cost for care.

All Charges