Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DILTIAZEM 30 MG TAB

Facility

$4.00

Service Code	NDC 51079074520
Hospital Charge Code	60627554
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

DILTIAZEM 30 MG TAB

Facility

$4.00

Service Code	NDC 51079074520
Hospital Charge Code	60627554
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DILTIAZEM 50 MG/10ML INJ

Facility

$35.44

Service Code	NDC 55390056510
Hospital Charge Code	6016414
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$17.72
Rate for Payer: Aetna Commercial	$13.47
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.04
Rate for Payer: Cigna Commercial	$17.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.21
Rate for Payer: Oxford Commercial	$7.09
Rate for Payer: Qualcare PPO/HMO/WC	$5.32
Rate for Payer: UnitedHealthcare Commercial	$7.09
Rate for Payer: UnitedHealthcare Community & State	$1.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

DILTIAZEM 50 MG/10ML INJ

Facility

$35.44

Service Code	NDC 55390056510
Hospital Charge Code	6016414
Hospital Revenue Code	250
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$5.32

DILTIAZEM 60 MG TAB

Facility

$4.69

Service Code	NDC 51079074620
Hospital Charge Code	60627555
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Qualcare PPO/HMO/WC	$0.70

DILTIAZEM 60 MG TAB

Facility

$4.69

Service Code	NDC 51079074620
Hospital Charge Code	60627555
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.35
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare Advantage	$1.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.20
Rate for Payer: Cigna Commercial	$2.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.22
Rate for Payer: Oxford Commercial	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.70
Rate for Payer: UnitedHealthcare Commercial	$0.94
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

DILTIAZEM CAP CD 180MG

Facility

$12.13

Service Code	NDC 63739028410
Hospital Charge Code	6009591
Hospital Revenue Code	251
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$1.82
Rate for Payer: Qualcare PPO/HMO/WC	$1.82

DILTIAZEM CAP CD 180MG

Facility

$12.13

Service Code	NDC 63739028410
Hospital Charge Code	6009591
Hospital Revenue Code	251
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.07
Rate for Payer: Aetna Commercial	$4.61
Rate for Payer: Aetna Medicare Advantage	$3.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.09
Rate for Payer: Cigna Commercial	$6.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.15
Rate for Payer: Oxford Commercial	$2.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.82
Rate for Payer: UnitedHealthcare Commercial	$2.43
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

DILTIAZEM CAP CD 240MG

Facility

$5.36

Service Code	NDC 68084005401
Hospital Charge Code	6009492
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

DILTIAZEM CAP CD 240MG

Facility

$5.36

Service Code	NDC 68084005401
Hospital Charge Code	6009492
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

DILTIAZEM CAP CD 300MG

Facility

$17.82

Service Code	NDC 62037060090
Hospital Charge Code	60627556
Hospital Revenue Code	250
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.67

DILTIAZEM CAP CD 300MG

Facility

$17.82

Service Code	NDC 62037060090
Hospital Charge Code	60627556
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$8.91
Rate for Payer: Aetna Commercial	$6.77
Rate for Payer: Aetna Medicare Advantage	$5.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.54
Rate for Payer: Cigna Commercial	$8.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.63
Rate for Payer: Oxford Commercial	$3.56
Rate for Payer: Qualcare PPO/HMO/WC	$2.67
Rate for Payer: UnitedHealthcare Commercial	$3.56
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

DILTIAZEM CAP SR 120MG

Facility

$4.00

Service Code	NDC 68084005201
Hospital Charge Code	6009575
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

DILTIAZEM CAP SR 120MG

Facility

$4.00

Service Code	NDC 68084005201
Hospital Charge Code	6009575
Hospital Revenue Code	251
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

DIL URETH STRICT SND,MALE INIT

Facility

$1,368.65

Service Code	HCPCS 53600
Hospital Charge Code	1600000664
Hospital Revenue Code	360
Min. Negotiated Rate	$38.87
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$807.38
Rate for Payer: Aetna Medicare Advantage	$961.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$296.83
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	$1,076.75
Rate for Payer: Cigna Commercial	$594.98
Rate for Payer: Cigna Medicare Advantage	$296.83
Rate for Payer: Clover Medicare Advantage	$281.99
Rate for Payer: EmblemHealth Commercial	$890.49
Rate for Payer: Humana Medicare Advantage	$305.73
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$296.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.85
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$205.30
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$43.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$296.83
Rate for Payer: Wellcare Medicare Advantage	$296.83
Rate for Payer: Wellpoint Medicaid Managed Care	$38.87

DIL URETH STRICT SND,MALE INIT

Facility

$1,368.65

Service Code	HCPCS 53600
Hospital Charge Code	1600000664
Hospital Revenue Code	360
Min. Negotiated Rate	$205.30
Max. Negotiated Rate	$205.30
Rate for Payer: Qualcare PPO/HMO/WC	$205.30

DILUTION OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86976
Hospital Charge Code	3100185
Hospital Revenue Code	300
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

DILUTION OF SERUM EACH

Facility

$390.00

Service Code	HCPCS 86976
Hospital Charge Code	3100185
Hospital Revenue Code	300
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
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	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
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	$25.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

DINOPROSTONE 10MG VAGINAL INST

Facility

$2,462.38

Service Code	NDC 55566280001
Hospital Charge Code	60632287
Hospital Revenue Code	250
Min. Negotiated Rate	$369.36
Max. Negotiated Rate	$369.36
Rate for Payer: Qualcare PPO/HMO/WC	$369.36

DINOPROSTONE 10MG VAGINAL INST

Facility

$2,462.38

Service Code	NDC 55566280001
Hospital Charge Code	60632287
Hospital Revenue Code	250
Min. Negotiated Rate	$69.93
Max. Negotiated Rate	$1,231.19
Rate for Payer: Aetna Commercial	$935.70
Rate for Payer: Aetna Medicare Advantage	$738.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$627.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$627.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$627.91
Rate for Payer: Cigna Commercial	$1,231.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$640.22
Rate for Payer: Oxford Commercial	$492.48
Rate for Payer: Qualcare PPO/HMO/WC	$369.36
Rate for Payer: UnitedHealthcare Commercial	$492.48
Rate for Payer: UnitedHealthcare Community & State	$77.81
Rate for Payer: Wellpoint Medicaid Managed Care	$69.93

DIOVAN 160MG TAB

Facility

$34.91

Service Code	NDC 93743398
Hospital Charge Code	6063943096
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.45
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare Advantage	$10.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.90
Rate for Payer: Cigna Commercial	$17.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.08
Rate for Payer: Oxford Commercial	$6.98
Rate for Payer: Qualcare PPO/HMO/WC	$5.24
Rate for Payer: UnitedHealthcare Commercial	$6.98
Rate for Payer: UnitedHealthcare Community & State	$1.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

DIOVAN 160MG TAB

Facility

$34.91

Service Code	NDC 93743398
Hospital Charge Code	6063943096
Hospital Revenue Code	250
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$5.24
Rate for Payer: Qualcare PPO/HMO/WC	$5.24

DIOVAN 40MG TAB

Facility

$27.20

Service Code	NDC 93743156
Hospital Charge Code	6063943097
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna Commercial	$10.34
Rate for Payer: Aetna Medicare Advantage	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.94
Rate for Payer: Cigna Commercial	$13.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.07
Rate for Payer: Oxford Commercial	$5.44
Rate for Payer: Qualcare PPO/HMO/WC	$4.08
Rate for Payer: UnitedHealthcare Commercial	$5.44
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

DIOVAN 40MG TAB

Facility

$27.20

Service Code	NDC 93743156
Hospital Charge Code	6063943097
Hospital Revenue Code	250
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$4.08
Rate for Payer: Qualcare PPO/HMO/WC	$4.08

DIOVAN 80MG TAB

Facility

$60.03

Service Code	NDC 78035834
Hospital Charge Code	6063943098
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.00

Know your out-of-pocket cost for care.

All Charges