Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FLUENT DISPOSABLE PACK

Facility

$1,625.00

Hospital Charge Code	270693690
Hospital Revenue Code	272
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Qualcare PPO/HMO/WC	$243.75

FLUID AMNIOTIC GRAFT 1.0CC

Facility

$6,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270695085
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

FLUID AMNIOTIC GRAFT 1.0CC

Facility

$6,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270695085
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

FLUID COLLECTION SYSTEM

Facility

$58.00

Hospital Charge Code	2008160
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$29.00
Rate for Payer: Aetna Commercial	$22.04
Rate for Payer: Aetna Medicare Advantage	$17.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.79
Rate for Payer: Cigna Commercial	$29.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.08
Rate for Payer: Oxford Commercial	$11.60
Rate for Payer: Qualcare PPO/HMO/WC	$8.70
Rate for Payer: UnitedHealthcare Commercial	$11.60
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

FLUID COLLECTION SYSTEM

Facility

$58.00

Hospital Charge Code	2008160
Hospital Revenue Code	272
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Qualcare PPO/HMO/WC	$8.70

FLUID GF AMNIOT ALLOGRAFT 2CC

Facility

$12,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270694914
Hospital Revenue Code	278
Min. Negotiated Rate	$340.80
Max. Negotiated Rate	$6,000.00
Rate for Payer: Aetna Commercial	$4,560.00
Rate for Payer: Aetna Medicare Advantage	$3,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,060.00
Rate for Payer: Cigna Commercial	$6,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00
Rate for Payer: UnitedHealthcare Community & State	$379.20
Rate for Payer: Wellpoint Medicaid Managed Care	$340.80

FLUID GF AMNIOT ALLOGRAFT 2CC

Facility

$12,000.00

Service Code	HCPCS Q4206
Hospital Charge Code	270694914
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$2,904.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,904.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,800.00

FLUIDOTHERAPY CQ

Facility

$77.65

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022F
Hospital Revenue Code	420
Min. Negotiated Rate	$2.21
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$29.51
Rate for Payer: Aetna Medicare Advantage	$23.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.80
Rate for Payer: Cigna Commercial	$38.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.19
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.65
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$2.45
Rate for Payer: Wellpoint Medicaid Managed Care	$2.21

FLUIDOTHERAPY CQ

Facility

$77.65

Service Code	HCPCS 97022GP
Hospital Charge Code	904197022F
Hospital Revenue Code	420
Min. Negotiated Rate	$11.65
Max. Negotiated Rate	$11.65
Rate for Payer: Qualcare PPO/HMO/WC	$11.65

FLU INTRADERMAL >18 YR

Facility

$99.36

Service Code	HCPCS 90654
Hospital Charge Code	83652309
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$24.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90

FLU INTRADERMAL >18 YR

Facility

$99.36

Service Code	HCPCS 90654
Hospital Charge Code	83652309
Hospital Revenue Code	636
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$49.68
Rate for Payer: Aetna Commercial	$37.76
Rate for Payer: Aetna Medicare Advantage	$29.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.34
Rate for Payer: Cigna Commercial	$49.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.05
Rate for Payer: Qualcare PPO/HMO/WC	$14.90
Rate for Payer: UnitedHealthcare Community & State	$3.14
Rate for Payer: Wellpoint Medicaid Managed Care	$2.82

FLUMAZENIL 0.1 MG/ML LNJ

Facility

$1,090.43

Service Code	NDC 63323042405
Hospital Charge Code	6007520
Hospital Revenue Code	250
Min. Negotiated Rate	$30.97
Max. Negotiated Rate	$545.22
Rate for Payer: Aetna Commercial	$414.36
Rate for Payer: Aetna Medicare Advantage	$327.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.06
Rate for Payer: Cigna Commercial	$545.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$283.51
Rate for Payer: Oxford Commercial	$218.09
Rate for Payer: Qualcare PPO/HMO/WC	$163.56
Rate for Payer: UnitedHealthcare Commercial	$218.09
Rate for Payer: UnitedHealthcare Community & State	$34.46
Rate for Payer: Wellpoint Medicaid Managed Care	$30.97

FLUMAZENIL 0.1 MG/ML LNJ

Facility

$1,090.43

Service Code	NDC 63323042405
Hospital Charge Code	6007520
Hospital Revenue Code	250
Min. Negotiated Rate	$163.56
Max. Negotiated Rate	$163.56
Rate for Payer: Qualcare PPO/HMO/WC	$163.56

FLUOCINOLONE ACETONIDE 0.

Facility

$226.26

Service Code	NDC 168006015
Hospital Charge Code	60632999
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$113.13
Rate for Payer: Aetna Commercial	$85.98
Rate for Payer: Aetna Medicare Advantage	$67.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.70
Rate for Payer: Cigna Commercial	$113.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.83
Rate for Payer: Oxford Commercial	$45.25
Rate for Payer: Qualcare PPO/HMO/WC	$33.94
Rate for Payer: UnitedHealthcare Commercial	$45.25
Rate for Payer: UnitedHealthcare Community & State	$7.15
Rate for Payer: Wellpoint Medicaid Managed Care	$6.43

FLUOCINOLONE ACETONIDE 0.

Facility

$226.26

Service Code	NDC 168006015
Hospital Charge Code	60632999
Hospital Revenue Code	250
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$33.94
Rate for Payer: Qualcare PPO/HMO/WC	$33.94

fLUOCINONIDE 0.05% CREAM 15G

Facility

$305.19

Service Code	NDC 51672125301
Hospital Charge Code	60630178
Hospital Revenue Code	250
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$152.59
Rate for Payer: Aetna Commercial	$115.97
Rate for Payer: Aetna Medicare Advantage	$91.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.82
Rate for Payer: Cigna Commercial	$152.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.35
Rate for Payer: Oxford Commercial	$61.04
Rate for Payer: Qualcare PPO/HMO/WC	$45.78
Rate for Payer: UnitedHealthcare Commercial	$61.04
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: Wellpoint Medicaid Managed Care	$8.67

fLUOCINONIDE 0.05% CREAM 15G

Facility

$305.19

Service Code	NDC 51672125301
Hospital Charge Code	60630178
Hospital Revenue Code	250
Min. Negotiated Rate	$45.78
Max. Negotiated Rate	$45.78
Rate for Payer: Qualcare PPO/HMO/WC	$45.78

FLUOCINONIDE 0.05% OINTMENT 15

Facility

$191.15

Service Code	NDC 168014015
Hospital Charge Code	60630177
Hospital Revenue Code	250
Min. Negotiated Rate	$28.67
Max. Negotiated Rate	$28.67
Rate for Payer: Qualcare PPO/HMO/WC	$28.67

FLUOCINONIDE 0.05% OINTMENT 15

Facility

$191.15

Service Code	NDC 168014015
Hospital Charge Code	60630177
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$95.58
Rate for Payer: Aetna Commercial	$72.64
Rate for Payer: Aetna Medicare Advantage	$57.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.74
Rate for Payer: Cigna Commercial	$95.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.70
Rate for Payer: Oxford Commercial	$38.23
Rate for Payer: Qualcare PPO/HMO/WC	$28.67
Rate for Payer: UnitedHealthcare Commercial	$38.23
Rate for Payer: UnitedHealthcare Community & State	$6.04
Rate for Payer: Wellpoint Medicaid Managed Care	$5.43

FLUOCINONIDE/0.05% SOL

Facility

$385.72

Service Code	NDC 51672127302
Hospital Charge Code	60634870
Hospital Revenue Code	250
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$192.86
Rate for Payer: Aetna Commercial	$146.57
Rate for Payer: Aetna Medicare Advantage	$115.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.36
Rate for Payer: Cigna Commercial	$192.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.29
Rate for Payer: Oxford Commercial	$77.14
Rate for Payer: Qualcare PPO/HMO/WC	$57.86
Rate for Payer: UnitedHealthcare Commercial	$77.14
Rate for Payer: UnitedHealthcare Community & State	$12.19
Rate for Payer: Wellpoint Medicaid Managed Care	$10.95

FLUOCINONIDE/0.05% SOL

Facility

$385.72

Service Code	NDC 51672127302
Hospital Charge Code	60634870
Hospital Revenue Code	250
Min. Negotiated Rate	$57.86
Max. Negotiated Rate	$57.86
Rate for Payer: Qualcare PPO/HMO/WC	$57.86

FLUORESCEIN OPTHALM STRIP

Facility

$11.40

Hospital Charge Code	270658298
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.70
Rate for Payer: Aetna Commercial	$4.33
Rate for Payer: Aetna Medicare Advantage	$3.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.91
Rate for Payer: Cigna Commercial	$5.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.96
Rate for Payer: Oxford Commercial	$2.28
Rate for Payer: Qualcare PPO/HMO/WC	$1.71
Rate for Payer: UnitedHealthcare Commercial	$2.28
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

FLUORESCEIN OPTHALM STRIP

Facility

$11.40

Hospital Charge Code	270658298
Hospital Revenue Code	250
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$1.71
Rate for Payer: Qualcare PPO/HMO/WC	$1.71

FLUORESCEIN OPTH SOL/ML

Facility

$296.14

Service Code	NDC 54799050721
Hospital Charge Code	606390178
Hospital Revenue Code	250
Min. Negotiated Rate	$44.42
Max. Negotiated Rate	$44.42
Rate for Payer: Qualcare PPO/HMO/WC	$44.42

FLUORESCEIN OPTH SOL/ML

Facility

$296.14

Service Code	NDC 54799050721
Hospital Charge Code	606390178
Hospital Revenue Code	250
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$148.07
Rate for Payer: Aetna Commercial	$112.53
Rate for Payer: Aetna Medicare Advantage	$88.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.52
Rate for Payer: Cigna Commercial	$148.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.00
Rate for Payer: Oxford Commercial	$59.23
Rate for Payer: Qualcare PPO/HMO/WC	$44.42
Rate for Payer: UnitedHealthcare Commercial	$59.23
Rate for Payer: UnitedHealthcare Community & State	$9.36
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

Know your out-of-pocket cost for care.

All Charges