Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FLUORESCEIN SODIUM STRIP

Facility

$4.00

Service Code	NDC 17238090011
Hospital Charge Code	6022453
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FLUORESCEIN SODIUM STRIP

Facility

$4.00

Service Code	NDC 17238090011
Hospital Charge Code	6022453
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

FLUORESCENCE IMAGING PACK

Facility

$975.00

Hospital Charge Code	270663998
Hospital Revenue Code	270
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$30.81
Rate for Payer: Wellpoint Medicaid Managed Care	$27.69

FLUORESCENCE IMAGING PACK

Facility

$975.00

Hospital Charge Code	270663998
Hospital Revenue Code	270
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

FLUORESCITE 10% 5ML

Facility

$387.66

Service Code	NDC 65009265
Hospital Charge Code	606390412
Hospital Revenue Code	250
Min. Negotiated Rate	$58.15
Max. Negotiated Rate	$58.15
Rate for Payer: Qualcare PPO/HMO/WC	$58.15

FLUORESCITE 10% 5ML

Facility

$387.66

Service Code	NDC 65009265
Hospital Charge Code	606390412
Hospital Revenue Code	250
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$193.83
Rate for Payer: Aetna Commercial	$147.31
Rate for Payer: Aetna Medicare Advantage	$116.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.85
Rate for Payer: Cigna Commercial	$193.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.79
Rate for Payer: Oxford Commercial	$77.53
Rate for Payer: Qualcare PPO/HMO/WC	$58.15
Rate for Payer: UnitedHealthcare Commercial	$77.53
Rate for Payer: UnitedHealthcare Community & State	$12.25
Rate for Payer: Wellpoint Medicaid Managed Care	$11.01

FLUOR NON-INFECT ANTIBODY

Facility

$314.00

Service Code	HCPCS 86255
Hospital Charge Code	38479407
Hospital Revenue Code	302
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

FLUOR NON-INFECT ANTIBODY

Facility

$314.00

Service Code	HCPCS 86255
Hospital Charge Code	38479407
Hospital Revenue Code	302
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$157.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.64
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$8.92

FLUORO EXAM OF G/COLON TUBE

Facility

$929.24

Service Code	HCPCS 49465
Hospital Charge Code	16000752
Hospital Revenue Code	360
Min. Negotiated Rate	$26.39
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
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	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$241.60
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$139.39
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$29.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$26.39

FLUORO EXAM OF G/COLON TUBE

Facility

$929.24

Service Code	HCPCS 49465
Hospital Charge Code	16000752
Hospital Revenue Code	360
Min. Negotiated Rate	$139.39
Max. Negotiated Rate	$139.39
Rate for Payer: Qualcare PPO/HMO/WC	$139.39

FLUORO GUIDED NEEDLE PLCMT

Facility

$5,100.00

Service Code	HCPCS 77002
Hospital Charge Code	5100827
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUORO GUIDED NEEDLE PLCMT

Facility

$5,100.00

Service Code	HCPCS 77002
Hospital Charge Code	5100827
Hospital Revenue Code	320
Min. Negotiated Rate	$47.26
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$47.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

FLUOROGUIDE FOR SPINE INJ

Facility

$457.84

Service Code	HCPCS 77001
Hospital Charge Code	1600000590
Hospital Revenue Code	360
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$173.98
Rate for Payer: Aetna Medicare Advantage	$137.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.75
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	$116.75
Rate for Payer: Cigna Commercial	$228.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.04
Rate for Payer: Qualcare PPO/HMO/WC	$68.68
Rate for Payer: UnitedHealthcare Community & State	$14.47
Rate for Payer: Wellpoint Medicaid Managed Care	$13.00

FLUOROGUIDE FOR SPINE INJ

Facility

$457.84

Service Code	HCPCS 77001
Hospital Charge Code	1600000590
Hospital Revenue Code	360
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$68.68
Rate for Payer: Qualcare PPO/HMO/WC	$68.68

FLUOROSCOPE EXAM EXTENSIVE

Facility

$1,005.00

Service Code	HCPCS 76001
Hospital Charge Code	366876001
Hospital Revenue Code	320
Min. Negotiated Rate	$150.75
Max. Negotiated Rate	$150.75
Rate for Payer: Qualcare PPO/HMO/WC	$150.75

FLUOROSCOPE EXAM EXTENSIVE

Facility

$1,005.00

Service Code	HCPCS 76001
Hospital Charge Code	366876001
Hospital Revenue Code	320
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$381.90
Rate for Payer: Aetna Medicare Advantage	$301.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.27
Rate for Payer: Cigna Commercial	$502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.30
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.75
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$31.76
Rate for Payer: Wellpoint Medicaid Managed Care	$28.54

FLUOROSCOPE EXAM EXTENSIVE

Facility

$1,005.00

Service Code	HCPCS 76001
Hospital Charge Code	411076001
Hospital Revenue Code	320
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$381.90
Rate for Payer: Aetna Medicare Advantage	$301.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$256.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$256.27
Rate for Payer: Cigna Commercial	$502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$261.30
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.75
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$31.76
Rate for Payer: Wellpoint Medicaid Managed Care	$28.54

FLUOROSCOPE EXAM EXTENSIVE

Facility

$1,005.00

Service Code	HCPCS 76001
Hospital Charge Code	411076001
Hospital Revenue Code	320
Min. Negotiated Rate	$150.75
Max. Negotiated Rate	$150.75
Rate for Payer: Qualcare PPO/HMO/WC	$150.75

FLUOROSCOPIC PROCEDURE

Facility

$5,100.00

Service Code	HCPCS 76946
Hospital Charge Code	366876496
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUOROSCOPIC PROCEDURE

Facility

$5,100.00

Service Code	HCPCS 76946
Hospital Charge Code	366876946
Hospital Revenue Code	320
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

FLUOROSCOPIC PROCEDURE

Facility

$5,100.00

Service Code	HCPCS 76946
Hospital Charge Code	366876946
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUOROSCOPIC PROCEDURE

Facility

$5,100.00

Service Code	HCPCS 76946
Hospital Charge Code	366876496
Hospital Revenue Code	320
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

FLUOROSCOPIC PROCEDURE

Facility

$5,100.00

Service Code	HCPCS 76946
Hospital Charge Code	411076496
Hospital Revenue Code	320
Min. Negotiated Rate	$51.15
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

FLUOROSCOPIC PROCEDURE

Facility

$5,100.00

Service Code	HCPCS 76946
Hospital Charge Code	411076496
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUOROSCOPY

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	7411167
Hospital Revenue Code	320
Min. Negotiated Rate	$81.67
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$198.43
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

Know your out-of-pocket cost for care.

All Charges