Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FOLEY CATH INSERTION

Facility

$499.90

Service Code	HCPCS 51702
Hospital Charge Code	1001196
Hospital Revenue Code	361
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.97
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.98
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

FOLEY CATH INSERTION

Facility

$159.00

Service Code	HCPCS 51702
Hospital Charge Code	366851702
Hospital Revenue Code	361
Min. Negotiated Rate	$23.85
Max. Negotiated Rate	$23.85
Rate for Payer: Qualcare PPO/HMO/WC	$23.85

FOLEY CATH INSERTION

Facility

$159.00

Service Code	HCPCS 51702
Hospital Charge Code	366851702
Hospital Revenue Code	361
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.34
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.85
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$5.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.52

FOLEY CONE TIP URETERAL 8FR

Facility

$631.00

Hospital Charge Code	270331018
Hospital Revenue Code	272
Min. Negotiated Rate	$17.92
Max. Negotiated Rate	$315.50
Rate for Payer: Aetna Commercial	$239.78
Rate for Payer: Aetna Medicare Advantage	$189.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.91
Rate for Payer: Cigna Commercial	$315.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.06
Rate for Payer: Oxford Commercial	$126.20
Rate for Payer: Qualcare PPO/HMO/WC	$94.65
Rate for Payer: UnitedHealthcare Commercial	$126.20
Rate for Payer: UnitedHealthcare Community & State	$19.94
Rate for Payer: Wellpoint Medicaid Managed Care	$17.92

FOLEY CONE TIP URETERAL 8FR

Facility

$631.00

Hospital Charge Code	270331018
Hospital Revenue Code	272
Min. Negotiated Rate	$94.65
Max. Negotiated Rate	$94.65
Rate for Payer: Qualcare PPO/HMO/WC	$94.65

FOLIC ACID 1 MG TAB

Facility

$4.00

Service Code	NDC 63739053710
Hospital Charge Code	60628482
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

FOLIC ACID 1 MG TAB

Facility

$4.00

Service Code	NDC 63739053710
Hospital Charge Code	60628482
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

FOLIC ACID 5 MG/ML INJ

Facility

$21.44

Service Code	NDC 63323018410
Hospital Charge Code	6002513
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.72
Rate for Payer: Aetna Commercial	$8.15
Rate for Payer: Aetna Medicare Advantage	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.47
Rate for Payer: Cigna Commercial	$10.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.57
Rate for Payer: Oxford Commercial	$4.29
Rate for Payer: Qualcare PPO/HMO/WC	$3.22
Rate for Payer: UnitedHealthcare Commercial	$4.29
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

FOLIC ACID 5 MG/ML INJ

Facility

$21.44

Service Code	NDC 63323018410
Hospital Charge Code	6002513
Hospital Revenue Code	250
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$3.22
Rate for Payer: Qualcare PPO/HMO/WC	$3.22

FOLLOER URET BOUGIE 18 FR

Facility

$551.15

Hospital Charge Code	270664314
Hospital Revenue Code	270
Min. Negotiated Rate	$82.67
Max. Negotiated Rate	$82.67
Rate for Payer: Qualcare PPO/HMO/WC	$82.67

FOLLOER URET BOUGIE 18 FR

Facility

$551.15

Hospital Charge Code	270664314
Hospital Revenue Code	270
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$275.57
Rate for Payer: Aetna Commercial	$209.44
Rate for Payer: Aetna Medicare Advantage	$165.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.54
Rate for Payer: Cigna Commercial	$275.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.30
Rate for Payer: Oxford Commercial	$110.23
Rate for Payer: Qualcare PPO/HMO/WC	$82.67
Rate for Payer: UnitedHealthcare Commercial	$110.23
Rate for Payer: UnitedHealthcare Community & State	$17.42
Rate for Payer: Wellpoint Medicaid Managed Care	$15.65

FOLLOWER BOUGIE URETERAL 10FR

Facility

$920.00

Hospital Charge Code	270678181
Hospital Revenue Code	272
Min. Negotiated Rate	$26.13
Max. Negotiated Rate	$460.00
Rate for Payer: Aetna Commercial	$349.60
Rate for Payer: Aetna Medicare Advantage	$276.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$234.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$234.60
Rate for Payer: Cigna Commercial	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$239.20
Rate for Payer: Oxford Commercial	$184.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.00
Rate for Payer: UnitedHealthcare Commercial	$184.00
Rate for Payer: UnitedHealthcare Community & State	$29.07
Rate for Payer: Wellpoint Medicaid Managed Care	$26.13

FOLLOWER BOUGIE URETERAL 10FR

Facility

$920.00

Hospital Charge Code	270678181
Hospital Revenue Code	272
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$138.00
Rate for Payer: Qualcare PPO/HMO/WC	$138.00

FOLLOWER BOUGIE URETERAL 12FR

Facility

$947.90

Hospital Charge Code	270678182
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 12FR

Facility

$947.90

Hospital Charge Code	270678182
Hospital Revenue Code	272
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$360.20
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.45
Rate for Payer: Oxford Commercial	$189.58
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$189.58
Rate for Payer: UnitedHealthcare Community & State	$29.95
Rate for Payer: Wellpoint Medicaid Managed Care	$26.92

FOLLOWER BOUGIE URETERAL 14FR

Facility

$947.90

Hospital Charge Code	270678187
Hospital Revenue Code	272
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$360.20
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.45
Rate for Payer: Oxford Commercial	$189.58
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$189.58
Rate for Payer: UnitedHealthcare Community & State	$29.95
Rate for Payer: Wellpoint Medicaid Managed Care	$26.92

FOLLOWER BOUGIE URETERAL 14FR

Facility

$947.90

Hospital Charge Code	270678187
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 16FR

Facility

$947.90

Hospital Charge Code	270678183
Hospital Revenue Code	272
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$360.20
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.45
Rate for Payer: Oxford Commercial	$189.58
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$189.58
Rate for Payer: UnitedHealthcare Community & State	$29.95
Rate for Payer: Wellpoint Medicaid Managed Care	$26.92

FOLLOWER BOUGIE URETERAL 16FR

Facility

$947.90

Hospital Charge Code	270678183
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 20FR

Facility

$947.90

Hospital Charge Code	270678184
Hospital Revenue Code	272
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$360.20
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.45
Rate for Payer: Oxford Commercial	$189.58
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$189.58
Rate for Payer: UnitedHealthcare Community & State	$29.95
Rate for Payer: Wellpoint Medicaid Managed Care	$26.92

FOLLOWER BOUGIE URETERAL 20FR

Facility

$947.90

Hospital Charge Code	270678184
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 22FR

Facility

$947.90

Hospital Charge Code	270678185
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

FOLLOWER BOUGIE URETERAL 22FR

Facility

$947.90

Hospital Charge Code	270678185
Hospital Revenue Code	272
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$360.20
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.45
Rate for Payer: Oxford Commercial	$189.58
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$189.58
Rate for Payer: UnitedHealthcare Community & State	$29.95
Rate for Payer: Wellpoint Medicaid Managed Care	$26.92

FOLLOWER BOUGIE URETERAL 8FR

Facility

$947.90

Hospital Charge Code	270678180
Hospital Revenue Code	272
Min. Negotiated Rate	$26.92
Max. Negotiated Rate	$473.95
Rate for Payer: Aetna Commercial	$360.20
Rate for Payer: Aetna Medicare Advantage	$284.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$241.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$241.71
Rate for Payer: Cigna Commercial	$473.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$246.45
Rate for Payer: Oxford Commercial	$189.58
Rate for Payer: Qualcare PPO/HMO/WC	$142.19
Rate for Payer: UnitedHealthcare Commercial	$189.58
Rate for Payer: UnitedHealthcare Community & State	$29.95
Rate for Payer: Wellpoint Medicaid Managed Care	$26.92

FOLLOWER BOUGIE URETERAL 8FR

Facility

$947.90

Hospital Charge Code	270678180
Hospital Revenue Code	272
Min. Negotiated Rate	$142.19
Max. Negotiated Rate	$142.19
Rate for Payer: Qualcare PPO/HMO/WC	$142.19

Know your out-of-pocket cost for care.

All Charges