Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FLUOROSCOPY

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	7411167
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	366876000
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

FLUOROSCOPY

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	366876000
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUOROSCOPY UP TO 1 HR

Facility

$6,601.19

Service Code	HCPCS 76000
Hospital Charge Code	2000636
Hospital Revenue Code	320
Min. Negotiated Rate	$990.18
Max. Negotiated Rate	$990.18
Rate for Payer: Qualcare PPO/HMO/WC	$990.18

FLUOROSCOPY UP TO 1 HR

Facility

$6,601.19

Service Code	HCPCS 76000
Hospital Charge Code	2000636
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	$1,716.31
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$990.18
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$208.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$187.47

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2690260
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	2690260
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

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	321076000
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

FLUORO UP TO 1 HR MD TIME

Facility

$5,100.00

Service Code	HCPCS 76000
Hospital Charge Code	321076000
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

FLUOROURACIL 500 MG/10 ML INJ

Facility

$24.12

Service Code	HCPCS J9190
Hospital Charge Code	60627383
Hospital Revenue Code	636
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$5.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.62

FLUOROURACIL 500 MG/10 ML INJ

Facility

$24.12

Service Code	HCPCS J9190
Hospital Charge Code	60627383
Hospital Revenue Code	636
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$12.06
Rate for Payer: Aetna Commercial	$9.17
Rate for Payer: Aetna Medicare Advantage	$7.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.15
Rate for Payer: Cigna Commercial	$12.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.62
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.69

FLUOXETINE 10 MG CAP

Facility

$70.02

Service Code	NDC 777310402
Hospital Charge Code	60627765
Hospital Revenue Code	250
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$10.50
Rate for Payer: Qualcare PPO/HMO/WC	$10.50

FLUOXETINE 10 MG CAP

Facility

$70.02

Service Code	NDC 777310402
Hospital Charge Code	60627765
Hospital Revenue Code	250
Min. Negotiated Rate	$1.99
Max. Negotiated Rate	$35.01
Rate for Payer: Aetna Commercial	$26.61
Rate for Payer: Aetna Medicare Advantage	$21.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.86
Rate for Payer: Cigna Commercial	$35.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.21
Rate for Payer: Oxford Commercial	$14.00
Rate for Payer: Qualcare PPO/HMO/WC	$10.50
Rate for Payer: UnitedHealthcare Commercial	$14.00
Rate for Payer: UnitedHealthcare Community & State	$2.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1.99

FLUOXETINE 20 MG/5 ML ELIX

Facility

$32.83

Service Code	NDC 121072104
Hospital Charge Code	60628620
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$4.92
Rate for Payer: Qualcare PPO/HMO/WC	$4.92

FLUOXETINE 20 MG/5 ML ELIX

Facility

$32.83

Service Code	NDC 121072104
Hospital Charge Code	60628620
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$16.41
Rate for Payer: Aetna Commercial	$12.48
Rate for Payer: Aetna Medicare Advantage	$9.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.37
Rate for Payer: Cigna Commercial	$16.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.54
Rate for Payer: Oxford Commercial	$6.57
Rate for Payer: Qualcare PPO/HMO/WC	$4.92
Rate for Payer: UnitedHealthcare Commercial	$6.57
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

FLUOXETINE 20 MG CAP

Facility

$17.89

Service Code	NDC 777310502
Hospital Charge Code	6010383
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.65
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$3.58
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

FLUOXETINE 20 MG CAP

Facility

$17.89

Service Code	NDC 777310502
Hospital Charge Code	6010383
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

FLUOXETINE,SERUM (PROZAC)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473104
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

FLUOXETINE,SERUM (PROZAC)

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38473104
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

FLUPHENAZIN DEC25MG/ML INJ 5ML

Facility

$160.80

Service Code	HCPCS J2680
Hospital Charge Code	60627795
Hospital Revenue Code	636
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$80.40
Rate for Payer: Aetna Commercial	$61.10
Rate for Payer: Aetna Medicare Advantage	$48.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.00
Rate for Payer: Cigna Commercial	$80.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12
Rate for Payer: UnitedHealthcare Community & State	$5.08
Rate for Payer: Wellpoint Medicaid Managed Care	$4.57

FLUPHENAZIN DEC25MG/ML INJ 5ML

Facility

$160.80

Service Code	HCPCS J2680
Hospital Charge Code	60627795
Hospital Revenue Code	636
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$38.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.91
Rate for Payer: Qualcare PPO/HMO/WC	$24.12

FLUPHENAZINE 10 MG TAB

Facility

$11.19

Service Code	NDC 378609701
Hospital Charge Code	60628980
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.59
Rate for Payer: Aetna Commercial	$4.25
Rate for Payer: Aetna Medicare Advantage	$3.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.85
Rate for Payer: Cigna Commercial	$5.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.91
Rate for Payer: Oxford Commercial	$2.24
Rate for Payer: Qualcare PPO/HMO/WC	$1.68
Rate for Payer: UnitedHealthcare Commercial	$2.24
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

FLUPHENAZINE 10 MG TAB

Facility

$11.19

Service Code	NDC 378609701
Hospital Charge Code	60628980
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Qualcare PPO/HMO/WC	$1.68

FLUPHENAZINE 1 MG TAB

Facility

$4.22

Service Code	NDC 378600401
Hospital Charge Code	60627796
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.63

FLUPHENAZINE 1 MG TAB

Facility

$4.22

Service Code	NDC 378600401
Hospital Charge Code	60627796
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.11
Rate for Payer: Aetna Commercial	$1.60
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.10
Rate for Payer: Oxford Commercial	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.63
Rate for Payer: UnitedHealthcare Commercial	$0.84
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

Know your out-of-pocket cost for care.

All Charges