Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DILATOR VESSEL 6FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624073
Hospital Revenue Code	278
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DILATOR VESSEL 7FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270605470
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL 7FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270605470
Hospital Revenue Code	278
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DILATOR VESSEL 7FR .038 20CM

Facility

$45.45

Service Code	HCPCS C1725
Hospital Charge Code	270605470S
Hospital Revenue Code	278
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$11.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.82

DILATOR VESSEL 7FR .038 20CM

Facility

$45.45

Service Code	HCPCS C1725
Hospital Charge Code	270605470S
Hospital Revenue Code	278
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$22.73
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.59
Rate for Payer: Cigna Commercial	$22.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.82
Rate for Payer: UnitedHealthcare Community & State	$1.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

DILATOR VESSEL 8FR .038 20cm

Facility

$42.45

Hospital Charge Code	270624074
Hospital Revenue Code	278
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$21.23
Rate for Payer: Aetna Commercial	$16.13
Rate for Payer: Aetna Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.82
Rate for Payer: Cigna Commercial	$21.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.27
Rate for Payer: Qualcare PPO/HMO/WC	$6.37
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

DILATOR VESSEL 8FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624074S
Hospital Revenue Code	278
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DILATOR VESSEL 8FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270624074S
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL 8FR .038 20cm

Facility

$42.45

Hospital Charge Code	270624074
Hospital Revenue Code	278
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$10.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.27
Rate for Payer: Qualcare PPO/HMO/WC	$6.37

DILATOR VESSEL 8FR.038 20CM

Facility

$45.45

Service Code	HCPCS C1725
Hospital Charge Code	270624074N
Hospital Revenue Code	278
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$22.73
Rate for Payer: Aetna Commercial	$17.27
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.59
Rate for Payer: Cigna Commercial	$22.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.82
Rate for Payer: UnitedHealthcare Community & State	$1.44
Rate for Payer: Wellpoint Medicaid Managed Care	$1.29

DILATOR VESSEL 8FR.038 20CM

Facility

$36.70

Hospital Charge Code	270624074C
Hospital Revenue Code	272
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILATOR VESSEL 8FR.038 20CM

Facility

$45.45

Service Code	HCPCS C1725
Hospital Charge Code	270624074N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$11.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.82

DILATOR VESSEL 8FR.038 20CM

Facility

$36.70

Hospital Charge Code	270624074C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.54
Rate for Payer: Oxford Commercial	$7.34
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DILATOR VESSEL 9FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270601482
Hospital Revenue Code	278
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$18.35
Rate for Payer: Aetna Commercial	$13.95
Rate for Payer: Aetna Medicare Advantage	$11.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.36
Rate for Payer: Cigna Commercial	$18.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.50
Rate for Payer: UnitedHealthcare Community & State	$1.16
Rate for Payer: Wellpoint Medicaid Managed Care	$1.04

DILATOR VESSEL 9FR .038 20cm

Facility

$36.70

Service Code	HCPCS C1725
Hospital Charge Code	270601482
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$8.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.50

DILAT XST TRC NDURLGC PX

Facility

$18,928.50

Service Code	HCPCS 50436
Hospital Charge Code	411050436
Hospital Revenue Code	361
Min. Negotiated Rate	$537.57
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,921.41
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$598.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$537.57

DILAT XST TRC NDURLGC PX

Facility

$18,928.50

Service Code	HCPCS 50436
Hospital Charge Code	411050436
Hospital Revenue Code	361
Min. Negotiated Rate	$2,839.28
Max. Negotiated Rate	$2,839.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28

DILAT XST TRC NEW ACCESS RCS

Facility

$18,928.50

Service Code	HCPCS 50437
Hospital Charge Code	411050437
Hospital Revenue Code	361
Min. Negotiated Rate	$2,839.28
Max. Negotiated Rate	$2,839.28
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28

DILAT XST TRC NEW ACCESS RCS

Facility

$18,928.50

Service Code	HCPCS 50437
Hospital Charge Code	411050437
Hospital Revenue Code	361
Min. Negotiated Rate	$537.57
Max. Negotiated Rate	$15,191.14
Rate for Payer: Aetna Commercial	$11,390.73
Rate for Payer: Aetna Medicare Advantage	$13,568.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,191.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,187.77
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	$15,191.14
Rate for Payer: Cigna Commercial	$8,394.37
Rate for Payer: Cigna Medicare Advantage	$4,187.77
Rate for Payer: Clover Medicare Advantage	$3,978.38
Rate for Payer: EmblemHealth Commercial	$12,563.31
Rate for Payer: Humana Medicare Advantage	$4,313.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,187.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,921.41
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,839.28
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$598.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,187.77
Rate for Payer: Wellcare Medicare Advantage	$4,187.77
Rate for Payer: Wellpoint Medicaid Managed Care	$537.57

DILTIAZEM 100 MG INJ (ADD-VAN)

Facility

$166.43

Service Code	NDC 409435003
Hospital Charge Code	60630102
Hospital Revenue Code	250
Min. Negotiated Rate	$24.96
Max. Negotiated Rate	$24.96
Rate for Payer: Qualcare PPO/HMO/WC	$24.96

DILTIAZEM 100 MG INJ (ADD-VAN)

Facility

$166.43

Service Code	NDC 409435003
Hospital Charge Code	60630102
Hospital Revenue Code	250
Min. Negotiated Rate	$4.73
Max. Negotiated Rate	$83.22
Rate for Payer: Aetna Commercial	$63.24
Rate for Payer: Aetna Medicare Advantage	$49.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.44
Rate for Payer: Cigna Commercial	$83.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.27
Rate for Payer: Oxford Commercial	$33.29
Rate for Payer: Qualcare PPO/HMO/WC	$24.96
Rate for Payer: UnitedHealthcare Commercial	$33.29
Rate for Payer: UnitedHealthcare Community & State	$5.26
Rate for Payer: Wellpoint Medicaid Managed Care	$4.73

DILTIAZEM 125 MG/25ML INJ

Facility

$72.36

Service Code	NDC 55390056530
Hospital Charge Code	60629215
Hospital Revenue Code	250
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

DILTIAZEM 125 MG/25ML INJ

Facility

$72.36

Service Code	NDC 55390056530
Hospital Charge Code	60629215
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$36.18
Rate for Payer: Aetna Commercial	$27.50
Rate for Payer: Aetna Medicare Advantage	$21.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.45
Rate for Payer: Cigna Commercial	$36.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.81
Rate for Payer: Oxford Commercial	$14.47
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Commercial	$14.47
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

DILTIAZEM 25 MG/5ML INJ

Facility

$17.69

Service Code	NDC 55390056505
Hospital Charge Code	60627553
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$6.72
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Oxford Commercial	$3.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$3.54
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

DILTIAZEM 25 MG/5ML INJ

Facility

$17.69

Service Code	NDC 55390056505
Hospital Charge Code	60627553
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

Know your out-of-pocket cost for care.

All Charges