Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DIGITOXIN

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39900481
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DIGITOXIN

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	39900481
Hospital Revenue Code	301
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DIGOXIN

Facility

$146.00

Service Code	HCPCS 80162
Hospital Charge Code	38472275
Hospital Revenue Code	301
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$21.90
Rate for Payer: Qualcare PPO/HMO/WC	$21.90

DIGOXIN

Facility

$146.00

Service Code	HCPCS 80162
Hospital Charge Code	38472275
Hospital Revenue Code	301
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.12
Rate for Payer: Aetna Medicare Advantage	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.17
Rate for Payer: Cigna Commercial	$73.00
Rate for Payer: Cigna Medicare Advantage	$13.28
Rate for Payer: Clover Medicare Advantage	$12.62
Rate for Payer: EmblemHealth Commercial	$39.84
Rate for Payer: Humana Medicare Advantage	$13.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.28
Rate for Payer: Wellcare Medicare Advantage	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$4.15

DIGOXIN 0.25MG/5ML ORAL SOLUTI

Facility

$93.80

Service Code	NDC 54005746
Hospital Charge Code	60630171
Hospital Revenue Code	250
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$46.90
Rate for Payer: Aetna Commercial	$35.64
Rate for Payer: Aetna Medicare Advantage	$28.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.92
Rate for Payer: Cigna Commercial	$46.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.39
Rate for Payer: Oxford Commercial	$18.76
Rate for Payer: Qualcare PPO/HMO/WC	$14.07
Rate for Payer: UnitedHealthcare Commercial	$18.76
Rate for Payer: UnitedHealthcare Community & State	$2.96
Rate for Payer: Wellpoint Medicaid Managed Care	$2.66

DIGOXIN 0.25MG/5ML ORAL SOLUTI

Facility

$93.80

Service Code	NDC 54005746
Hospital Charge Code	60630171
Hospital Revenue Code	250
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$14.07

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$14.40

Hospital Charge Code	6023097R
Hospital Revenue Code	251
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$2.16
Rate for Payer: Qualcare PPO/HMO/WC	$2.16

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$19.30

Service Code	NDC 59212024256
Hospital Charge Code	6023097
Hospital Revenue Code	251
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$14.40

Hospital Charge Code	6023097R
Hospital Revenue Code	251
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna Commercial	$5.47
Rate for Payer: Aetna Medicare Advantage	$4.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.67
Rate for Payer: Cigna Commercial	$7.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.74
Rate for Payer: Oxford Commercial	$2.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.16
Rate for Payer: UnitedHealthcare Commercial	$2.88
Rate for Payer: UnitedHealthcare Community & State	$0.46
Rate for Payer: Wellpoint Medicaid Managed Care	$0.41

DIGOXIN 125 MCG (0.125 MG) TAB

Facility

$19.30

Service Code	NDC 59212024256
Hospital Charge Code	6023097
Hospital Revenue Code	251
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

DIGOXIN 250 MCG (0.25 MG) TAB

Facility

$19.30

Service Code	NDC 24987024956
Hospital Charge Code	6022404
Hospital Revenue Code	251
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$9.65
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.92
Rate for Payer: Cigna Commercial	$9.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.02
Rate for Payer: Oxford Commercial	$3.86
Rate for Payer: Qualcare PPO/HMO/WC	$2.90
Rate for Payer: UnitedHealthcare Commercial	$3.86
Rate for Payer: UnitedHealthcare Community & State	$0.61
Rate for Payer: Wellpoint Medicaid Managed Care	$0.55

DIGOXIN 250 MCG (0.25 MG) TAB

Facility

$19.30

Service Code	NDC 24987024956
Hospital Charge Code	6022404
Hospital Revenue Code	251
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$2.90
Rate for Payer: Qualcare PPO/HMO/WC	$2.90

DIGOXIN IMMUNE FAB 40 MG INJ

Facility

$18,258.84

Service Code	HCPCS J1162
Hospital Charge Code	60628285
Hospital Revenue Code	636
Min. Negotiated Rate	$2,738.83
Max. Negotiated Rate	$4,418.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,418.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,738.83

DIGOXIN IMMUNE FAB 40 MG INJ

Facility

$18,258.84

Service Code	HCPCS J1162
Hospital Charge Code	60628285
Hospital Revenue Code	636
Min. Negotiated Rate	$518.55
Max. Negotiated Rate	$18,743.26
Rate for Payer: Aetna Commercial	$14,054.21
Rate for Payer: Aetna Medicare Advantage	$16,741.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,743.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,743.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5,166.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,477.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,743.26
Rate for Payer: Cigna Medicare Advantage	$5,166.99
Rate for Payer: Clover Medicare Advantage	$4,908.64
Rate for Payer: EmblemHealth Commercial	$15,500.97
Rate for Payer: Humana Medicare Advantage	$5,322.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5,166.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,418.64
Rate for Payer: Qualcare PPO/HMO/WC	$2,738.83
Rate for Payer: UnitedHealthcare Community & State	$576.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,166.99
Rate for Payer: Wellcare Medicare Advantage	$5,166.99
Rate for Payer: Wellpoint Medicaid Managed Care	$518.55

DIGOXIN INJ 0.5MG/2ML

Facility

$34.71

Service Code	HCPCS J1160
Hospital Charge Code	60627552
Hospital Revenue Code	636
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.36
Rate for Payer: Aetna Commercial	$13.19
Rate for Payer: Aetna Medicare Advantage	$10.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.85
Rate for Payer: Cigna Commercial	$17.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.21
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

DIGOXIN INJ 0.5MG/2ML

Facility

$34.71

Service Code	HCPCS J1160
Hospital Charge Code	60627552
Hospital Revenue Code	636
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$8.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.21

DIGOXIN LEVEL

Facility

$667.59

Service Code	HCPCS 80162
Hospital Charge Code	3001096
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

DIGOXIN LEVEL

Facility

$667.59

Service Code	HCPCS 80162
Hospital Charge Code	3001096
Hospital Revenue Code	301
Min. Negotiated Rate	$10.62
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$36.12
Rate for Payer: Aetna Medicare Advantage	$43.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.17
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.28
Rate for Payer: Clover Medicare Advantage	$12.62
Rate for Payer: EmblemHealth Commercial	$39.84
Rate for Payer: Humana Medicare Advantage	$13.68
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.28
Rate for Payer: Wellcare Medicare Advantage	$13.28
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

DIHYDROTERTOSTERONE 1-2

Facility

$179.00

Service Code	HCPCS 80327
Hospital Charge Code	3000602
Hospital Revenue Code	301
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

DIHYDROTERTOSTERONE 1-2

Facility

$179.00

Service Code	HCPCS 80327
Hospital Charge Code	3000602
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$68.02
Rate for Payer: Aetna Medicare Advantage	$53.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.65
Rate for Payer: Cigna Commercial	$89.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.08

DIHYDROTESTOSTERONE

Facility

$182.00

Service Code	HCPCS 80327
Hospital Charge Code	38472937
Hospital Revenue Code	301
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.16
Rate for Payer: Aetna Medicare Advantage	$54.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.41
Rate for Payer: Cigna Commercial	$91.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.32
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.17

DIHYDROTESTOSTERONE

Facility

$182.00

Service Code	HCPCS 80327
Hospital Charge Code	38472937
Hospital Revenue Code	301
Min. Negotiated Rate	$27.30
Max. Negotiated Rate	$27.30
Rate for Payer: Qualcare PPO/HMO/WC	$27.30

DIHYDROTESTOSTERONE,LC/MS

Facility

$390.00

Service Code	HCPCS 80327
Hospital Charge Code	39900072
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DIHYDROTESTOSTERONE,LC/MS

Facility

$390.00

Service Code	HCPCS 80327
Hospital Charge Code	39900072
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DILANTIN (PHENYTOIN)

Facility

$303.00

Service Code	HCPCS 80185
Hospital Charge Code	38472536
Hospital Revenue Code	301
Min. Negotiated Rate	$8.61
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.06
Rate for Payer: Cigna Commercial	$151.50
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.78
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.45
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

Know your out-of-pocket cost for care.

All Charges