Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DIAZEPAM, SERUM

Facility

$181.65

Service Code	HCPCS 80346
Hospital Charge Code	3038093
Hospital Revenue Code	301
Min. Negotiated Rate	$27.25
Max. Negotiated Rate	$27.25
Rate for Payer: Qualcare PPO/HMO/WC	$27.25

DIAZEPAM (VALIUM) 10MG TAB

Facility

$4.00

Service Code	NDC 51079028620
Hospital Charge Code	60630184
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIAZEPAM (VALIUM) 10MG TAB

Facility

$4.00

Service Code	NDC 51079028620
Hospital Charge Code	60630184
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

DIBUCAINE 1 % OIN

Facility

$4.00

Service Code	NDC 45802005003
Hospital Charge Code	60628412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIBUCAINE 1 % OIN

Facility

$4.00

Service Code	NDC 45802005003
Hospital Charge Code	60628412
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

DICYCLOMINE/10MG/5ML

Facility

$4.00

Service Code	NDC 68012516
Hospital Charge Code	60632832
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

DICYCLOMINE/10MG/5ML

Facility

$4.00

Service Code	NDC 68012516
Hospital Charge Code	60632832
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DICYCLOMINE 10 MG CAP

Facility

$4.02

Service Code	NDC 51079011820
Hospital Charge Code	60627429
Hospital Revenue Code	251
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.01
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare Advantage	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.03
Rate for Payer: Cigna Commercial	$2.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.05
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

DICYCLOMINE 10 MG CAP

Facility

$4.02

Service Code	NDC 51079011820
Hospital Charge Code	60627429
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DICYCLOMINE 20 MG/2ML INJ

Facility

$152.36

Service Code	HCPCS J0500
Hospital Charge Code	60627430
Hospital Revenue Code	636
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$76.18
Rate for Payer: Aetna Commercial	$57.90
Rate for Payer: Aetna Medicare Advantage	$45.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.85
Rate for Payer: Cigna Commercial	$76.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$22.85
Rate for Payer: UnitedHealthcare Community & State	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$4.33

DICYCLOMINE 20 MG/2ML INJ

Facility

$152.36

Service Code	HCPCS J0500
Hospital Charge Code	60627430
Hospital Revenue Code	636
Min. Negotiated Rate	$22.85
Max. Negotiated Rate	$36.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.87
Rate for Payer: Qualcare PPO/HMO/WC	$22.85

DICYCLOMINE 20MG TABLET

Facility

$4.02

Service Code	NDC 51079011920
Hospital Charge Code	60632354
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DICYCLOMINE 20MG TABLET

Facility

$4.02

Service Code	NDC 51079011920
Hospital Charge Code	60632354
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.01
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare Advantage	$1.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.03
Rate for Payer: Cigna Commercial	$2.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.05
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

DIFF/AUTO ADS OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86978
Hospital Charge Code	3100182
Hospital Revenue Code	300
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$254.22
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$35.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DIFF/AUTO ADS OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86978
Hospital Charge Code	3100182
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DIFFERENTIAL

Facility

$70.00

Service Code	HCPCS 85007
Hospital Charge Code	38473006
Hospital Revenue Code	305
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$10.34
Rate for Payer: Aetna Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.78
Rate for Payer: Cigna Commercial	$35.00
Rate for Payer: Cigna Medicare Advantage	$3.80
Rate for Payer: Clover Medicare Advantage	$3.61
Rate for Payer: EmblemHealth Commercial	$11.40
Rate for Payer: Humana Medicare Advantage	$3.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.80
Rate for Payer: Wellcare Medicare Advantage	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

DIFFERENTIAL

Facility

$70.00

Service Code	HCPCS 85007
Hospital Charge Code	38473006
Hospital Revenue Code	305
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

DIFFERENTIAL, MANUAL

Facility

$390.00

Service Code	HCPCS 85007
Hospital Charge Code	3005428
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DIFFERENTIAL, MANUAL

Facility

$390.00

Service Code	HCPCS 85007
Hospital Charge Code	3005428
Hospital Revenue Code	305
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$10.34
Rate for Payer: Aetna Medicare Advantage	$12.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.78
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.80
Rate for Payer: Clover Medicare Advantage	$3.61
Rate for Payer: EmblemHealth Commercial	$11.40
Rate for Payer: Humana Medicare Advantage	$3.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.80
Rate for Payer: Wellcare Medicare Advantage	$3.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DIFFUSER MAESTRO

Facility

$62.10

Hospital Charge Code	270672675
Hospital Revenue Code	272
Min. Negotiated Rate	$9.31
Max. Negotiated Rate	$9.31
Rate for Payer: Qualcare PPO/HMO/WC	$9.31

DIFFUSER MAESTRO

Facility

$62.10

Hospital Charge Code	270672675
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$31.05
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare Advantage	$18.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.84
Rate for Payer: Cigna Commercial	$31.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.15
Rate for Payer: Oxford Commercial	$12.42
Rate for Payer: Qualcare PPO/HMO/WC	$9.31
Rate for Payer: UnitedHealthcare Commercial	$12.42
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

DIFLUCAN IV 100 MG IN NS

Facility

$80.40

Service Code	HCPCS J1450
Hospital Charge Code	606351000
Hospital Revenue Code	636
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$40.20
Rate for Payer: Aetna Commercial	$30.55
Rate for Payer: Aetna Medicare Advantage	$24.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.50
Rate for Payer: Cigna Commercial	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$12.06
Rate for Payer: UnitedHealthcare Community & State	$2.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

DIFLUCAN IV 100 MG IN NS

Facility

$80.40

Service Code	HCPCS J1450
Hospital Charge Code	606351000
Hospital Revenue Code	636
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$19.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.46
Rate for Payer: Qualcare PPO/HMO/WC	$12.06

DIGESTIVE MALIGNANCY

Facility

$25,294.30

Service Code	APR-DRG 2404
Min. Negotiated Rate	$24,798.33
Max. Negotiated Rate	$25,294.30
Rate for Payer: UnitedHealthcare Community & State	$24,798.33
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25,294.30
Rate for Payer: Wellpoint Medicaid Managed Care	$24,798.33

DIGESTIVE MALIGNANCY

Facility

$15,460.86

Service Code	APR-DRG 2403
Min. Negotiated Rate	$15,157.71
Max. Negotiated Rate	$15,460.86
Rate for Payer: UnitedHealthcare Community & State	$15,157.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$15,460.86
Rate for Payer: Wellpoint Medicaid Managed Care	$15,157.71

Know your out-of-pocket cost for care.

All Charges