Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$107.20

Service Code	HCPCS 90658
Hospital Charge Code	83652313
Hospital Revenue Code	636
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$25.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.94
Rate for Payer: Qualcare PPO/HMO/WC	$16.08

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$76.92

Service Code	HCPCS 90657
Hospital Charge Code	83652605
Hospital Revenue Code	636
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$18.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54

FLU VAC PRESERVATIVE FREE >3 Y

Facility

$76.92

Service Code	HCPCS 90657
Hospital Charge Code	83652605
Hospital Revenue Code	636
Min. Negotiated Rate	$2.18
Max. Negotiated Rate	$38.46
Rate for Payer: Aetna Commercial	$29.23
Rate for Payer: Aetna Medicare Advantage	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.61
Rate for Payer: Cigna Commercial	$38.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.61
Rate for Payer: Qualcare PPO/HMO/WC	$11.54
Rate for Payer: UnitedHealthcare Community & State	$2.43
Rate for Payer: Wellpoint Medicaid Managed Care	$2.18

FLUVOXAMINE 100 MG TAB

Facility

$17.69

Service Code	NDC 51079099320
Hospital Charge Code	60628831
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$2.65
Rate for Payer: Qualcare PPO/HMO/WC	$2.65

FLUVOXAMINE 100 MG TAB

Facility

$17.69

Service Code	NDC 51079099320
Hospital Charge Code	60628831
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.85
Rate for Payer: Aetna Commercial	$6.72
Rate for Payer: Aetna Medicare Advantage	$5.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.51
Rate for Payer: Cigna Commercial	$8.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.60
Rate for Payer: Oxford Commercial	$3.54
Rate for Payer: Qualcare PPO/HMO/WC	$2.65
Rate for Payer: UnitedHealthcare Commercial	$3.54
Rate for Payer: UnitedHealthcare Community & State	$0.56
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

FLUVOXAMINE 25 MG TAB

Facility

$15.41

Service Code	NDC 62559015801
Hospital Charge Code	606390053
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

FLUVOXAMINE 25 MG TAB

Facility

$15.41

Service Code	NDC 62559015801
Hospital Charge Code	606390053
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.71
Rate for Payer: Aetna Commercial	$5.86
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.01
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

FLUVOXAMINE 50 MG TAB

Facility

$17.22

Service Code	NDC 51079099220
Hospital Charge Code	60627766
Hospital Revenue Code	250
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.58

FLUVOXAMINE 50 MG TAB

Facility

$17.22

Service Code	NDC 51079099220
Hospital Charge Code	60627766
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$8.61
Rate for Payer: Aetna Commercial	$6.54
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.39
Rate for Payer: Cigna Commercial	$8.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.48
Rate for Payer: Oxford Commercial	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$2.58
Rate for Payer: UnitedHealthcare Commercial	$3.44
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

FLUZONE P 0.5ML

Facility

$104.39

Service Code	HCPCS 90655
Hospital Charge Code	606350927
Hospital Revenue Code	636
Min. Negotiated Rate	$15.66
Max. Negotiated Rate	$25.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.66

FLUZONE P 0.5ML

Facility

$104.39

Service Code	HCPCS 90655
Hospital Charge Code	606350927
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$52.20
Rate for Payer: Aetna Commercial	$39.67
Rate for Payer: Aetna Medicare Advantage	$31.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.62
Rate for Payer: Cigna Commercial	$52.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.26
Rate for Payer: Qualcare PPO/HMO/WC	$15.66
Rate for Payer: UnitedHealthcare Community & State	$3.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2.96

FLUZONE TRIVALANT HD 0.5 ML

Facility

$442.20

Service Code	NDC 49281012488
Hospital Charge Code	6063943392
Hospital Revenue Code	250
Min. Negotiated Rate	$66.33
Max. Negotiated Rate	$66.33
Rate for Payer: Qualcare PPO/HMO/WC	$66.33

FLUZONE TRIVALANT HD 0.5 ML

Facility

$442.20

Service Code	NDC 49281012488
Hospital Charge Code	6063943392
Hospital Revenue Code	250
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$221.10
Rate for Payer: Aetna Commercial	$168.04
Rate for Payer: Aetna Medicare Advantage	$132.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.76
Rate for Payer: Cigna Commercial	$221.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.97
Rate for Payer: Oxford Commercial	$88.44
Rate for Payer: Qualcare PPO/HMO/WC	$66.33
Rate for Payer: UnitedHealthcare Commercial	$88.44
Rate for Payer: UnitedHealthcare Community & State	$13.97
Rate for Payer: Wellpoint Medicaid Managed Care	$12.56

FLZONE INFLUNZA .25ML PED

Facility

$104.79

Service Code	HCPCS 90655
Hospital Charge Code	60635785
Hospital Revenue Code	636
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$52.40
Rate for Payer: Aetna Commercial	$39.82
Rate for Payer: Aetna Medicare Advantage	$31.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.72
Rate for Payer: Cigna Commercial	$52.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.72
Rate for Payer: UnitedHealthcare Community & State	$3.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

FLZONE INFLUNZA .25ML PED

Facility

$104.79

Service Code	HCPCS 90655
Hospital Charge Code	60635785
Hospital Revenue Code	636
Min. Negotiated Rate	$15.72
Max. Negotiated Rate	$25.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.36
Rate for Payer: Qualcare PPO/HMO/WC	$15.72

FML LIQUIFILM 0.1% OPHTH

Facility

$434.16

Service Code	NDC 71776010005
Hospital Charge Code	60633008
Hospital Revenue Code	250
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$65.12
Rate for Payer: Qualcare PPO/HMO/WC	$65.12

FML LIQUIFILM 0.1% OPHTH

Facility

$434.16

Service Code	NDC 71776010005
Hospital Charge Code	60633008
Hospital Revenue Code	250
Min. Negotiated Rate	$12.33
Max. Negotiated Rate	$217.08
Rate for Payer: Aetna Commercial	$164.98
Rate for Payer: Aetna Medicare Advantage	$130.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.71
Rate for Payer: Cigna Commercial	$217.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.88
Rate for Payer: Oxford Commercial	$86.83
Rate for Payer: Qualcare PPO/HMO/WC	$65.12
Rate for Payer: UnitedHealthcare Commercial	$86.83
Rate for Payer: UnitedHealthcare Community & State	$13.72
Rate for Payer: Wellpoint Medicaid Managed Care	$12.33

FMRL SEG OSS RS RIGHT

Facility

$61,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270691621
Hospital Revenue Code	278
Min. Negotiated Rate	$1,744.33
Max. Negotiated Rate	$30,710.00
Rate for Payer: Aetna Commercial	$23,339.60
Rate for Payer: Aetna Medicare Advantage	$18,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,662.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,662.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,284.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,662.10
Rate for Payer: Cigna Commercial	$30,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,863.64
Rate for Payer: Qualcare PPO/HMO/WC	$9,213.00
Rate for Payer: UnitedHealthcare Community & State	$1,940.87
Rate for Payer: Wellpoint Medicaid Managed Care	$1,744.33

FMRL SEG OSS RS RIGHT

Facility

$61,420.00

Service Code	HCPCS C1776
Hospital Charge Code	270691621
Hospital Revenue Code	278
Min. Negotiated Rate	$9,213.00
Max. Negotiated Rate	$14,863.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,863.64
Rate for Payer: Qualcare PPO/HMO/WC	$9,213.00

FNA BIOPSY/CT 1ST LESION

Facility

$9,500.00

Service Code	HCPCS 10009
Hospital Charge Code	404310009
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

FNA BIOPSY/CT 1ST LESION

Facility

$9,500.00

Service Code	HCPCS 10009
Hospital Charge Code	404310009
Hospital Revenue Code	361
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

FNA BIOPSY/CT EA ADD LESION

Facility

$9,500.00

Service Code	HCPCS 10010
Hospital Charge Code	404310010
Hospital Revenue Code	361
Min. Negotiated Rate	$269.80
Max. Negotiated Rate	$4,750.00
Rate for Payer: Aetna Commercial	$3,610.00
Rate for Payer: Aetna Medicare Advantage	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,422.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,422.50
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	$2,422.50
Rate for Payer: Cigna Commercial	$4,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,470.00
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$300.20
Rate for Payer: Wellpoint Medicaid Managed Care	$269.80

FNA BIOPSY/CT EA ADD LESION

Facility

$9,500.00

Service Code	HCPCS 10010
Hospital Charge Code	404310010
Hospital Revenue Code	361
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$1,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,425.00

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	404610007
Hospital Revenue Code	361
Min. Negotiated Rate	$96.46
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.10
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$107.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$96.46

FNA BIOPSY/FLUORO 1ST LESION

Facility

$3,396.55

Service Code	HCPCS 10007
Hospital Charge Code	411010007
Hospital Revenue Code	361
Min. Negotiated Rate	$96.46
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$883.10
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$509.48
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$107.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$96.46

Know your out-of-pocket cost for care.

All Charges