Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

POTASSIUM PHOSPHATE, MONOBAS 5

Facility

$4.00

Service Code	NDC 486111105
Hospital Charge Code	6063943269
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM PHOSPHATE, MONOBAS 5

Facility

$4.00

Service Code	NDC 486111105
Hospital Charge Code	6063943269
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, SERUM

Facility

$390.00

Service Code	HCPCS 84132
Hospital Charge Code	3002151
Hospital Revenue Code	301
Min. Negotiated Rate	$3.81
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Medicare Advantage	$15.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.27
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.76
Rate for Payer: Clover Medicare Advantage	$4.52
Rate for Payer: EmblemHealth Commercial	$14.28
Rate for Payer: Humana Medicare Advantage	$4.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.76
Rate for Payer: Wellcare Medicare Advantage	$4.76
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

POTASSIUM, SERUM

Facility

$390.00

Service Code	HCPCS 84132
Hospital Charge Code	3002151
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POTASSIUM,SERUM K

Facility

$117.00

Service Code	HCPCS 84132
Hospital Charge Code	38472551
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

POTASSIUM,SERUM K

Facility

$117.00

Service Code	HCPCS 84132
Hospital Charge Code	38472551
Hospital Revenue Code	301
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Medicare Advantage	$15.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.27
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: Cigna Medicare Advantage	$4.76
Rate for Payer: Clover Medicare Advantage	$4.52
Rate for Payer: EmblemHealth Commercial	$14.28
Rate for Payer: Humana Medicare Advantage	$4.90
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.42
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.76
Rate for Payer: Wellcare Medicare Advantage	$4.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.32

POTASSIUM SODIUM CITRATE SOL

Facility

$30.15

Service Code	NDC 60258000216
Hospital Charge Code	60627886
Hospital Revenue Code	250
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$4.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.52

POTASSIUM SODIUM CITRATE SOL

Facility

$30.15

Service Code	NDC 60258000216
Hospital Charge Code	60627886
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$15.07
Rate for Payer: Aetna Commercial	$11.46
Rate for Payer: Aetna Medicare Advantage	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.69
Rate for Payer: Cigna Commercial	$15.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.84
Rate for Payer: Oxford Commercial	$6.03
Rate for Payer: Qualcare PPO/HMO/WC	$4.52
Rate for Payer: UnitedHealthcare Commercial	$6.03
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

POTASSIUM SODIUM PHOSPH POWD

Facility

$4.00

Service Code	NDC 60258000601
Hospital Charge Code	60627932
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 SODIUM PHOSPH POWD

Facility

$4.00

Service Code	NDC 60258000601
Hospital Charge Code	60627932
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POTASSIUM URINE

Facility

$390.00

Service Code	HCPCS 84133
Hospital Charge Code	39990241I
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

POTASSIUM URINE

Facility

$390.00

Service Code	HCPCS 84133
Hospital Charge Code	39990241I
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

POTASSIUM, URINE

Facility

$169.89

Service Code	HCPCS 84133
Hospital Charge Code	3030814
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$84.94
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.17
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.48
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$4.82

POTASSIUM, URINE

Facility

$169.89

Service Code	HCPCS 84133
Hospital Charge Code	3030814
Hospital Revenue Code	301
Min. Negotiated Rate	$25.48
Max. Negotiated Rate	$25.48
Rate for Payer: Qualcare PPO/HMO/WC	$25.48

POTASSIUM, URINE, 24 HOUR

Facility

$667.59

Service Code	HCPCS 84133
Hospital Charge Code	3030889
Hospital Revenue Code	301
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

POTASSIUM, URINE, 24 HOUR

Facility

$667.59

Service Code	HCPCS 84133
Hospital Charge Code	3030889
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

POTASSIUM,URINE K

Facility

$119.00

Service Code	HCPCS 84133
Hospital Charge Code	38472554
Hospital Revenue Code	301
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$12.87
Rate for Payer: Aetna Medicare Advantage	$15.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.16
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: Cigna Medicare Advantage	$4.73
Rate for Payer: Clover Medicare Advantage	$4.49
Rate for Payer: EmblemHealth Commercial	$14.19
Rate for Payer: Humana Medicare Advantage	$4.87
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.73
Rate for Payer: Wellcare Medicare Advantage	$4.73
Rate for Payer: Wellpoint Medicaid Managed Care	$3.38

POTASSIUM,URINE K

Facility

$119.00

Service Code	HCPCS 84133
Hospital Charge Code	38472554
Hospital Revenue Code	301
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

POUCH DRAINA 1 3/4 45MM 413312

Facility

$10.47

Hospital Charge Code	270649908
Hospital Revenue Code	270
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.24
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna Medicare Advantage	$3.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.67
Rate for Payer: Cigna Commercial	$5.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.72
Rate for Payer: Oxford Commercial	$2.09
Rate for Payer: Qualcare PPO/HMO/WC	$1.57
Rate for Payer: UnitedHealthcare Commercial	$2.09
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

POUCH DRAINA 1 3/4 45MM 413312

Facility

$10.47

Hospital Charge Code	270649908
Hospital Revenue Code	270
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$1.57
Rate for Payer: Qualcare PPO/HMO/WC	$1.57

POUCH DRAINAGE 2-3/4 413314

Facility

$10.27

Hospital Charge Code	270649949
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.13
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.62
Rate for Payer: Cigna Commercial	$5.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.67
Rate for Payer: Oxford Commercial	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$2.05
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

POUCH DRAINAGE 2-3/4 413314

Facility

$10.27

Hospital Charge Code	270649949
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

POUCH DRAIN INVISICLOSE 2-1/4

Facility

$10.27

Hospital Charge Code	270650524
Hospital Revenue Code	272
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.13
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.62
Rate for Payer: Cigna Commercial	$5.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.67
Rate for Payer: Oxford Commercial	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$2.05
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

POUCH DRAIN INVISICLOSE 2-1/4

Facility

$10.27

Hospital Charge Code	270650524
Hospital Revenue Code	272
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

POUCH IRRIGATION LG 19x24

Facility

$22.85

Hospital Charge Code	270676344
Hospital Revenue Code	272
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.43
Rate for Payer: Aetna Commercial	$8.68
Rate for Payer: Aetna Medicare Advantage	$6.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.83
Rate for Payer: Cigna Commercial	$11.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.94
Rate for Payer: Oxford Commercial	$4.57
Rate for Payer: Qualcare PPO/HMO/WC	$3.43
Rate for Payer: UnitedHealthcare Commercial	$4.57
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

Know your out-of-pocket cost for care.

All Charges