Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

POST-TONSILLECTOMY HEMORRH CRT

Facility

$463.00

Service Code	HCPCS 42960
Hospital Charge Code	5770020
Hospital Revenue Code	450
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

POST-TONSILLECTOMY HEMORRH CRT

Facility

$463.00

Service Code	HCPCS 42960
Hospital Charge Code	5770020
Hospital Revenue Code	450
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$2,324.28
Rate for Payer: Aetna Commercial	$1,742.81
Rate for Payer: Aetna Medicare Advantage	$2,076.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,324.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,324.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$640.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$64.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,324.28
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: Cigna Medicare Advantage	$640.74
Rate for Payer: Clover Medicare Advantage	$608.70
Rate for Payer: EmblemHealth Commercial	$1,922.22
Rate for Payer: Humana Medicare Advantage	$659.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$640.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.38
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$13.15

POST TOWER 1 HOLE

Facility

$470.00

Hospital Charge Code	270684454
Hospital Revenue Code	272
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

POST TOWER 1 HOLE

Facility

$470.00

Hospital Charge Code	270684454
Hospital Revenue Code	272
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$235.00
Rate for Payer: Aetna Commercial	$178.60
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.20
Rate for Payer: Oxford Commercial	$94.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$94.00
Rate for Payer: UnitedHealthcare Community & State	$14.85
Rate for Payer: Wellpoint Medicaid Managed Care	$13.35

POST TOWER 2 HOLE

Facility

$470.00

Hospital Charge Code	270684452
Hospital Revenue Code	272
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$70.50
Rate for Payer: Qualcare PPO/HMO/WC	$70.50

POST TOWER 2 HOLE

Facility

$470.00

Hospital Charge Code	270684452
Hospital Revenue Code	272
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$235.00
Rate for Payer: Aetna Commercial	$178.60
Rate for Payer: Aetna Medicare Advantage	$141.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.85
Rate for Payer: Cigna Commercial	$235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.20
Rate for Payer: Oxford Commercial	$94.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.50
Rate for Payer: UnitedHealthcare Commercial	$94.00
Rate for Payer: UnitedHealthcare Community & State	$14.85
Rate for Payer: Wellpoint Medicaid Managed Care	$13.35

POST TRANSFUSION KIT

Facility

$1,392.00

Hospital Charge Code	270339085
Hospital Revenue Code	272
Min. Negotiated Rate	$208.80
Max. Negotiated Rate	$208.80
Rate for Payer: Qualcare PPO/HMO/WC	$208.80

POST TRANSFUSION KIT

Facility

$1,392.00

Hospital Charge Code	270339085
Hospital Revenue Code	272
Min. Negotiated Rate	$39.53
Max. Negotiated Rate	$696.00
Rate for Payer: Aetna Commercial	$528.96
Rate for Payer: Aetna Medicare Advantage	$417.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$354.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$354.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$354.96
Rate for Payer: Cigna Commercial	$696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.92
Rate for Payer: Oxford Commercial	$278.40
Rate for Payer: Qualcare PPO/HMO/WC	$208.80
Rate for Payer: UnitedHealthcare Commercial	$278.40
Rate for Payer: UnitedHealthcare Community & State	$43.99
Rate for Payer: Wellpoint Medicaid Managed Care	$39.53

POST VNGD FEM AUG 60X5 LL/RM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270686456
Hospital Revenue Code	278
Min. Negotiated Rate	$913.50
Max. Negotiated Rate	$1,473.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50

POST VNGD FEM AUG 60X5 LL/RM

Facility

$6,090.00

Service Code	HCPCS C1776
Hospital Charge Code	270686456
Hospital Revenue Code	278
Min. Negotiated Rate	$172.96
Max. Negotiated Rate	$3,045.00
Rate for Payer: Aetna Commercial	$2,314.20
Rate for Payer: Aetna Medicare Advantage	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,552.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,218.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,552.95
Rate for Payer: Cigna Commercial	$3,045.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,473.78
Rate for Payer: Qualcare PPO/HMO/WC	$913.50
Rate for Payer: UnitedHealthcare Community & State	$192.44
Rate for Payer: Wellpoint Medicaid Managed Care	$172.96

POST WIRE SHORT

Facility

$900.70

Hospital Charge Code	270681233
Hospital Revenue Code	272
Min. Negotiated Rate	$25.58
Max. Negotiated Rate	$450.35
Rate for Payer: Aetna Commercial	$342.27
Rate for Payer: Aetna Medicare Advantage	$270.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$229.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$229.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$229.68
Rate for Payer: Cigna Commercial	$450.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.18
Rate for Payer: Oxford Commercial	$180.14
Rate for Payer: Qualcare PPO/HMO/WC	$135.10
Rate for Payer: UnitedHealthcare Commercial	$180.14
Rate for Payer: UnitedHealthcare Community & State	$28.46
Rate for Payer: Wellpoint Medicaid Managed Care	$25.58

POST WIRE SHORT

Facility

$900.70

Hospital Charge Code	270681233
Hospital Revenue Code	272
Min. Negotiated Rate	$135.10
Max. Negotiated Rate	$135.10
Rate for Payer: Qualcare PPO/HMO/WC	$135.10

POST WIRE TALL

Facility

$1,021.65

Hospital Charge Code	270681237
Hospital Revenue Code	272
Min. Negotiated Rate	$153.25
Max. Negotiated Rate	$153.25
Rate for Payer: Qualcare PPO/HMO/WC	$153.25

POST WIRE TALL

Facility

$1,021.65

Hospital Charge Code	270681237
Hospital Revenue Code	272
Min. Negotiated Rate	$29.01
Max. Negotiated Rate	$510.82
Rate for Payer: Aetna Commercial	$388.23
Rate for Payer: Aetna Medicare Advantage	$306.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.52
Rate for Payer: Cigna Commercial	$510.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.63
Rate for Payer: Oxford Commercial	$204.33
Rate for Payer: Qualcare PPO/HMO/WC	$153.25
Rate for Payer: UnitedHealthcare Commercial	$204.33
Rate for Payer: UnitedHealthcare Community & State	$32.28
Rate for Payer: Wellpoint Medicaid Managed Care	$29.01

POTASSIUM BACARBONATE 25MEQ EF

Facility

$4.00

Service Code	NDC 904272046
Hospital Charge Code	6063943160
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

POTASSIUM BACARBONATE 25MEQ EF

Facility

$4.00

Service Code	NDC 904272046
Hospital Charge Code	6063943160
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM CHL 20MEQ (D5W)

Facility

$32.90

Service Code	NDC 409790509
Hospital Charge Code	60627904
Hospital Revenue Code	258
Min. Negotiated Rate	$4.93
Max. Negotiated Rate	$4.93
Rate for Payer: Qualcare PPO/HMO/WC	$4.93

POTASSIUM CHL 20MEQ (D5W)

Facility

$32.90

Service Code	NDC 409790509
Hospital Charge Code	60627904
Hospital Revenue Code	258
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$16.45
Rate for Payer: Aetna Commercial	$12.50
Rate for Payer: Aetna Medicare Advantage	$9.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.39
Rate for Payer: Cigna Commercial	$16.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.55
Rate for Payer: Oxford Commercial	$6.58
Rate for Payer: Qualcare PPO/HMO/WC	$4.93
Rate for Payer: UnitedHealthcare Commercial	$6.58
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.93

POTASSIUM CHL 40MEQ (D5W)

Facility

$112.49

Service Code	NDC 409790609
Hospital Charge Code	60627905
Hospital Revenue Code	258
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$56.24
Rate for Payer: Aetna Commercial	$42.75
Rate for Payer: Aetna Medicare Advantage	$33.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.68
Rate for Payer: Cigna Commercial	$56.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.25
Rate for Payer: Oxford Commercial	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$16.87
Rate for Payer: UnitedHealthcare Commercial	$22.50
Rate for Payer: UnitedHealthcare Community & State	$3.55
Rate for Payer: Wellpoint Medicaid Managed Care	$3.19

POTASSIUM CHL 40MEQ (D5W)

Facility

$112.49

Service Code	NDC 409790609
Hospital Charge Code	60627905
Hospital Revenue Code	258
Min. Negotiated Rate	$16.87
Max. Negotiated Rate	$16.87
Rate for Payer: Qualcare PPO/HMO/WC	$16.87

POTASSIUM CHL INJ 20MEQ/10ML

Facility

$8.04

Service Code	HCPCS J3480
Hospital Charge Code	60627923
Hospital Revenue Code	636
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

POTASSIUM CHL INJ 20MEQ/10ML

Facility

$8.04

Service Code	HCPCS J3480
Hospital Charge Code	60627923
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

POTASSIUM CHL INJ 40MEQ/20ML

Facility

$10.65

Service Code	HCPCS J3480
Hospital Charge Code	60627926
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.60

POTASSIUM CHL INJ 40MEQ/20ML

Facility

$10.65

Service Code	HCPCS J3480
Hospital Charge Code	60627926
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.33
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare Advantage	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.72
Rate for Payer: Cigna Commercial	$5.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.58
Rate for Payer: Qualcare PPO/HMO/WC	$1.60
Rate for Payer: UnitedHealthcare Community & State	$0.34
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

POTASSIUM CHL IVPB 10MEQ/100ML

Facility

$18.63

Service Code	HCPCS J3480
Hospital Charge Code	60628788
Hospital Revenue Code	636
Min. Negotiated Rate	$2.79
Max. Negotiated Rate	$4.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$2.79

Know your out-of-pocket cost for care.

All Charges