Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FI LAS 365 MIC HOL DHBFSF365DO

Facility

$1,050.00

Hospital Charge Code	270639739
Hospital Revenue Code	272
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.00
Rate for Payer: Oxford Commercial	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$210.00
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

FI LAS 365 MIC HOL DHBFSF365DO

Facility

$1,050.00

Hospital Charge Code	270639739
Hospital Revenue Code	272
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

FILGRASTIM 300 MCG INJ

Facility

$2,423.59

Service Code	HCPCS J1442
Hospital Charge Code	60627535
Hospital Revenue Code	636
Min. Negotiated Rate	$363.54
Max. Negotiated Rate	$586.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.51
Rate for Payer: Qualcare PPO/HMO/WC	$363.54

FILGRASTIM 300 MCG INJ

Facility

$3,859.20

Service Code	HCPCS J1442
Hospital Charge Code	60630226
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$933.93
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.70
Rate for Payer: Cigna Medicare Advantage	$1.02
Rate for Payer: Clover Medicare Advantage	$0.97
Rate for Payer: EmblemHealth Commercial	$3.06
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$933.93
Rate for Payer: Qualcare PPO/HMO/WC	$578.88
Rate for Payer: UnitedHealthcare Community & State	$121.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.02
Rate for Payer: Wellcare Medicare Advantage	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$109.60

FILGRASTIM 300 MCG INJ

Facility

$3,859.20

Service Code	HCPCS J1442
Hospital Charge Code	60630226
Hospital Revenue Code	636
Min. Negotiated Rate	$578.88
Max. Negotiated Rate	$933.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$933.93
Rate for Payer: Qualcare PPO/HMO/WC	$578.88

FILGRASTIM 300 MCG INJ

Facility

$2,423.59

Service Code	HCPCS J1442
Hospital Charge Code	60627535
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$586.51
Rate for Payer: Aetna Commercial	$2.77
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.70
Rate for Payer: Cigna Medicare Advantage	$1.02
Rate for Payer: Clover Medicare Advantage	$0.97
Rate for Payer: EmblemHealth Commercial	$3.06
Rate for Payer: Humana Medicare Advantage	$1.05
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$586.51
Rate for Payer: Qualcare PPO/HMO/WC	$363.54
Rate for Payer: UnitedHealthcare Community & State	$76.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.02
Rate for Payer: Wellcare Medicare Advantage	$1.02
Rate for Payer: Wellpoint Medicaid Managed Care	$68.83

FILIFORM LONG 5FR

Facility

$613.30

Hospital Charge Code	270600278
Hospital Revenue Code	272
Min. Negotiated Rate	$92.00
Max. Negotiated Rate	$92.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.00

FILIFORM LONG 5FR

Facility

$613.30

Hospital Charge Code	270600278
Hospital Revenue Code	272
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$306.65
Rate for Payer: Aetna Commercial	$233.05
Rate for Payer: Aetna Medicare Advantage	$183.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.39
Rate for Payer: Cigna Commercial	$306.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.46
Rate for Payer: Oxford Commercial	$122.66
Rate for Payer: Qualcare PPO/HMO/WC	$92.00
Rate for Payer: UnitedHealthcare Commercial	$122.66
Rate for Payer: UnitedHealthcare Community & State	$19.38
Rate for Payer: Wellpoint Medicaid Managed Care	$17.42

FILIFORM SPIRAL TIP 5FR

Facility

$135.05

Hospital Charge Code	270659715
Hospital Revenue Code	272
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$67.53
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare Advantage	$40.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.44
Rate for Payer: Cigna Commercial	$67.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.11
Rate for Payer: Oxford Commercial	$27.01
Rate for Payer: Qualcare PPO/HMO/WC	$20.26
Rate for Payer: UnitedHealthcare Commercial	$27.01
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

FILIFORM SPIRAL TIP 5FR

Facility

$135.05

Hospital Charge Code	270659715
Hospital Revenue Code	272
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$20.26
Rate for Payer: Qualcare PPO/HMO/WC	$20.26

FILIFORM SPRL TIP 6FR

Facility

$135.05

Hospital Charge Code	270651860
Hospital Revenue Code	272
Min. Negotiated Rate	$20.26
Max. Negotiated Rate	$20.26
Rate for Payer: Qualcare PPO/HMO/WC	$20.26

FILIFORM SPRL TIP 6FR

Facility

$135.05

Hospital Charge Code	270651860
Hospital Revenue Code	272
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$67.53
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare Advantage	$40.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.44
Rate for Payer: Cigna Commercial	$67.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.11
Rate for Payer: Oxford Commercial	$27.01
Rate for Payer: Qualcare PPO/HMO/WC	$20.26
Rate for Payer: UnitedHealthcare Commercial	$27.01
Rate for Payer: UnitedHealthcare Community & State	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$3.84

FILIFORM ST TIP 12 5 3F 021903

Facility

$652.50

Hospital Charge Code	270619884
Hospital Revenue Code	272
Min. Negotiated Rate	$18.53
Max. Negotiated Rate	$326.25
Rate for Payer: Aetna Commercial	$247.95
Rate for Payer: Aetna Medicare Advantage	$195.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.39
Rate for Payer: Cigna Commercial	$326.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.65
Rate for Payer: Oxford Commercial	$130.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.88
Rate for Payer: UnitedHealthcare Commercial	$130.50
Rate for Payer: UnitedHealthcare Community & State	$20.62
Rate for Payer: Wellpoint Medicaid Managed Care	$18.53

FILIFORM ST TIP 12 5 3F 021903

Facility

$652.50

Hospital Charge Code	270619884
Hospital Revenue Code	272
Min. Negotiated Rate	$97.88
Max. Negotiated Rate	$97.88
Rate for Payer: Qualcare PPO/HMO/WC	$97.88

FILLER KEY

Facility

$560.00

Hospital Charge Code	270657136
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$212.80
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.60
Rate for Payer: Oxford Commercial	$112.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Commercial	$112.00
Rate for Payer: UnitedHealthcare Community & State	$17.70
Rate for Payer: Wellpoint Medicaid Managed Care	$15.90

FILLER KEY

Facility

$560.00

Hospital Charge Code	270657136
Hospital Revenue Code	272
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270297
Hospital Revenue Code	278
Min. Negotiated Rate	$328.02
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$364.98
Rate for Payer: Wellpoint Medicaid Managed Care	$328.02

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701297
Hospital Revenue Code	278
Min. Negotiated Rate	$328.02
Max. Negotiated Rate	$5,775.00
Rate for Payer: Aetna Commercial	$4,389.00
Rate for Payer: Aetna Medicare Advantage	$3,465.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,945.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,945.25
Rate for Payer: Cigna Commercial	$5,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50
Rate for Payer: UnitedHealthcare Community & State	$364.98
Rate for Payer: Wellpoint Medicaid Managed Care	$328.02

FILLER MAGNESIUM 5 CC

Facility

$11,550.00

Service Code	HCPCS C1713
Hospital Charge Code	270701297
Hospital Revenue Code	278
Min. Negotiated Rate	$1,732.50
Max. Negotiated Rate	$2,795.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,310.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,795.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,732.50

FILL POLY KIT OPRIME PMA, 14ML

Facility

$3,750.00

Hospital Charge Code	270679785
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILL POLY KIT OPRIME PMA, 14ML

Facility

$3,750.00

Hospital Charge Code	270679785
Hospital Revenue Code	272
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

FILL POLYMER

Facility

$3,750.00

Hospital Charge Code	270683413
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

FILL POLYMER

Facility

$3,750.00

Hospital Charge Code	270683413
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

FILL POLYMER KIT

Facility

$3,750.00

Hospital Charge Code	270678257
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Know your out-of-pocket cost for care.

All Charges