Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SAGITTAL SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674163
Hospital Revenue Code	272
Min. Negotiated Rate	$1,488.60
Max. Negotiated Rate	$1,488.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60

SAGITTAL SAW ATTACHMENT

Facility

$9,924.00

Hospital Charge Code	270674163
Hospital Revenue Code	272
Min. Negotiated Rate	$281.84
Max. Negotiated Rate	$4,962.00
Rate for Payer: Aetna Commercial	$3,771.12
Rate for Payer: Aetna Medicare Advantage	$2,977.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,530.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,530.62
Rate for Payer: Cigna Commercial	$4,962.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,580.24
Rate for Payer: Oxford Commercial	$1,984.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.60
Rate for Payer: UnitedHealthcare Commercial	$1,984.80
Rate for Payer: UnitedHealthcare Community & State	$313.60
Rate for Payer: Wellpoint Medicaid Managed Care	$281.84

SALICYLATE, BLOOD (ASPIRIN)

Facility

$667.59

Service Code	HCPCS 80329
Hospital Charge Code	3002391
Hospital Revenue Code	301
Min. Negotiated Rate	$16.48
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
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	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

SALICYLATE, BLOOD (ASPIRIN)

Facility

$667.59

Service Code	HCPCS 80329
Hospital Charge Code	3002391
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SALICYLATE,SERUM

Facility

$226.00

Service Code	HCPCS 80329
Hospital Charge Code	38472602
Hospital Revenue Code	301
Min. Negotiated Rate	$33.90
Max. Negotiated Rate	$33.90
Rate for Payer: Qualcare PPO/HMO/WC	$33.90

SALICYLATE,SERUM

Facility

$226.00

Service Code	HCPCS 80329
Hospital Charge Code	38472602
Hospital Revenue Code	301
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$85.88
Rate for Payer: Aetna Medicare Advantage	$67.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.63
Rate for Payer: Cigna Commercial	$113.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$33.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.48
Rate for Payer: Wellpoint Medicaid Managed Care	$6.42

SALINE 9 UNIT DOSE 15 ML

Facility

$0.82

Hospital Charge Code	270632373
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.12

SALINE 9 UNIT DOSE 15 ML

Facility

$0.82

Hospital Charge Code	270632373
Hospital Revenue Code	270
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.41
Rate for Payer: Aetna Commercial	$0.31
Rate for Payer: Aetna Medicare Advantage	$0.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.21
Rate for Payer: Cigna Commercial	$0.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.21
Rate for Payer: Oxford Commercial	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.12
Rate for Payer: UnitedHealthcare Commercial	$0.16
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

SALIVARY GLAND PROCEDURES

Facility

$58,504.80

Service Code	MSDRG 139
Min. Negotiated Rate	$17,813.96
Max. Negotiated Rate	$58,504.80
Rate for Payer: Aetna Commercial	$43,526.32
Rate for Payer: Aetna Medicare Advantage	$58,504.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32,968.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32,968.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18,751.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32,968.95
Rate for Payer: Cigna Commercial	$26,943.32
Rate for Payer: Cigna Medicare Advantage	$18,751.54
Rate for Payer: Clover Medicare Advantage	$17,813.96
Rate for Payer: EmblemHealth Commercial	$56,254.62
Rate for Payer: Humana Medicare Advantage	$19,314.09
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18,751.54
Rate for Payer: Oxford Commercial	$21,295.53
Rate for Payer: UnitedHealthcare Commercial	$28,504.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$18,751.54
Rate for Payer: Wellcare Medicare Advantage	$18,751.54

SALIVA SUBSTITUTE/120ML

Facility

$90.45

Service Code	NDC 50930009808
Hospital Charge Code	60634632
Hospital Revenue Code	250
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$13.57
Rate for Payer: Qualcare PPO/HMO/WC	$13.57

SALIVA SUBSTITUTE/120ML

Facility

$90.45

Service Code	NDC 50930009808
Hospital Charge Code	60634632
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$45.23
Rate for Payer: Aetna Commercial	$34.37
Rate for Payer: Aetna Medicare Advantage	$27.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.06
Rate for Payer: Cigna Commercial	$45.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.52
Rate for Payer: Oxford Commercial	$18.09
Rate for Payer: Qualcare PPO/HMO/WC	$13.57
Rate for Payer: UnitedHealthcare Commercial	$18.09
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

SALMONELLA AB I

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB I

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149A
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SALMONELLA AB II

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149B
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SALMONELLA AB II

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB III

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB III

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149C
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SALMONELLA AB IV

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149D
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SALMONELLA AB IV

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB V

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149E
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMONELLA AB V

Facility

$390.00

Service Code	HCPCS 86768
Hospital Charge Code	39990149E
Hospital Revenue Code	302
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$35.88
Rate for Payer: Aetna Medicare Advantage	$42.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.85
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.19
Rate for Payer: Clover Medicare Advantage	$12.53
Rate for Payer: EmblemHealth Commercial	$39.57
Rate for Payer: Humana Medicare Advantage	$13.59
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.19
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	$10.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.19
Rate for Payer: Wellcare Medicare Advantage	$13.19
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SALMON IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003F
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SALMON IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003F
Hospital Revenue Code	302
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.20
Rate for Payer: Aetna Medicare Advantage	$16.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.94
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.22
Rate for Payer: Clover Medicare Advantage	$4.96
Rate for Payer: EmblemHealth Commercial	$15.66
Rate for Payer: Humana Medicare Advantage	$5.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.22
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	$4.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.22
Rate for Payer: Wellcare Medicare Advantage	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SALPINGECTOMY COMPL/PART UL/BL

Facility

$8,767.70

Service Code	HCPCS 58700
Hospital Charge Code	16001010
Hospital Revenue Code	360
Min. Negotiated Rate	$1,315.15
Max. Negotiated Rate	$1,315.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,315.15

SALPINGECTOMY COMPL/PART UL/BL

Facility

$8,767.70

Service Code	HCPCS 58700
Hospital Charge Code	16001010
Hospital Revenue Code	360
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,331.73
Rate for Payer: Aetna Medicare Advantage	$2,630.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,235.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,235.76
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	$2,235.76
Rate for Payer: Cigna Commercial	$4,383.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,279.60
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,315.15
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$277.06
Rate for Payer: Wellpoint Medicaid Managed Care	$249.00

Know your out-of-pocket cost for care.

All Charges