Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SALPINGO-OOPHOR COML/PART UL/B

Facility

$9,154.20

Service Code	HCPCS 58720
Hospital Charge Code	16000766
Hospital Revenue Code	360
Min. Negotiated Rate	$1,373.13
Max. Negotiated Rate	$1,373.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.13

SALPINGO-OOPHOR COML/PART UL/B

Facility

$9,154.20

Service Code	HCPCS 58720
Hospital Charge Code	16000766
Hospital Revenue Code	360
Min. Negotiated Rate	$259.98
Max. Negotiated Rate	$12,906.00
Rate for Payer: Aetna Commercial	$3,478.60
Rate for Payer: Aetna Medicare Advantage	$2,746.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,334.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,334.32
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	$2,334.32
Rate for Payer: Cigna Commercial	$4,577.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,380.09
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,373.13
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$289.27
Rate for Payer: Wellpoint Medicaid Managed Care	$259.98

SAME DAY SURG EA ADD 30 MIN

Facility

$2,548.00

Hospital Charge Code	100042
Hospital Revenue Code	360
Min. Negotiated Rate	$72.36
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$968.24
Rate for Payer: Aetna Medicare Advantage	$764.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$649.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$649.74
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	$649.74
Rate for Payer: Cigna Commercial	$1,274.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$662.48
Rate for Payer: Qualcare PPO/HMO/WC	$382.20
Rate for Payer: UnitedHealthcare Community & State	$80.52
Rate for Payer: Wellpoint Medicaid Managed Care	$72.36

SAME DAY SURG EA ADD 30 MIN

Facility

$2,548.00

Hospital Charge Code	100042
Hospital Revenue Code	360
Min. Negotiated Rate	$382.20
Max. Negotiated Rate	$382.20
Rate for Payer: Qualcare PPO/HMO/WC	$382.20

SAME DAY SURGERY CHARGE

Facility

$7,256.20

Hospital Charge Code	100040
Hospital Revenue Code	360
Min. Negotiated Rate	$206.08
Max. Negotiated Rate	$3,628.10
Rate for Payer: Cigna Commercial	$3,628.10
Rate for Payer: Aetna Commercial	$2,757.36
Rate for Payer: Aetna Medicare Advantage	$2,176.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,850.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,850.33
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	$1,850.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,886.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,088.43
Rate for Payer: UnitedHealthcare Community & State	$229.30
Rate for Payer: Wellpoint Medicaid Managed Care	$206.08

SAME DAY SURGERY CHARGE

Facility

$7,256.20

Hospital Charge Code	100040
Hospital Revenue Code	360
Min. Negotiated Rate	$1,088.43
Max. Negotiated Rate	$1,088.43
Rate for Payer: Qualcare PPO/HMO/WC	$1,088.43

SAMPLE LINE 2.3 M GAS ADULT

Facility

$45.74

Hospital Charge Code	270683949
Hospital Revenue Code	272
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$22.87
Rate for Payer: Aetna Commercial	$17.38
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.66
Rate for Payer: Cigna Commercial	$22.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.89
Rate for Payer: Oxford Commercial	$9.15
Rate for Payer: Qualcare PPO/HMO/WC	$6.86
Rate for Payer: UnitedHealthcare Commercial	$9.15
Rate for Payer: UnitedHealthcare Community & State	$1.45
Rate for Payer: Wellpoint Medicaid Managed Care	$1.30

SAMPLE LINE 2.3 M GAS ADULT

Facility

$45.74

Hospital Charge Code	270683949
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$6.86

SAPHENOUS VEIN IMPLANT

Facility

$24,000.00

Hospital Charge Code	270339088
Hospital Revenue Code	278
Min. Negotiated Rate	$681.60
Max. Negotiated Rate	$12,000.00
Rate for Payer: Aetna Commercial	$9,120.00
Rate for Payer: Aetna Medicare Advantage	$7,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,120.00
Rate for Payer: Cigna Commercial	$12,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00
Rate for Payer: UnitedHealthcare Community & State	$758.40
Rate for Payer: Wellpoint Medicaid Managed Care	$681.60

SAPHENOUS VEIN IMPLANT

Facility

$24,000.00

Hospital Charge Code	270339088
Hospital Revenue Code	278
Min. Negotiated Rate	$3,600.00
Max. Negotiated Rate	$5,808.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,808.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,600.00

SAQUINAVIR MESYLATE 200 MG CAP

Facility

$30.62

Service Code	NDC 4024515
Hospital Charge Code	60629027
Hospital Revenue Code	250
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$4.59
Rate for Payer: Qualcare PPO/HMO/WC	$4.59

SAQUINAVIR MESYLATE 200 MG CAP

Facility

$30.62

Service Code	NDC 4024515
Hospital Charge Code	60629027
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$15.31
Rate for Payer: Aetna Commercial	$11.64
Rate for Payer: Aetna Medicare Advantage	$9.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.81
Rate for Payer: Cigna Commercial	$15.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.96
Rate for Payer: Oxford Commercial	$6.12
Rate for Payer: Qualcare PPO/HMO/WC	$4.59
Rate for Payer: UnitedHealthcare Commercial	$6.12
Rate for Payer: UnitedHealthcare Community & State	$0.97
Rate for Payer: Wellpoint Medicaid Managed Care	$0.87

SARS-COV-2 COVID-19 ANTIBODY

Facility

$387.00

Service Code	HCPCS 86769
Hospital Charge Code	401386769
Hospital Revenue Code	302
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$114.59
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.83
Rate for Payer: Cigna Commercial	$193.50
Rate for Payer: Cigna Medicare Advantage	$42.13
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$100.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.05
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Medicare Advantage	$42.13
Rate for Payer: Wellpoint Medicaid Managed Care	$10.99

SARS-COV-2 COVID-19 ANTIBODY

Facility

$387.00

Service Code	HCPCS 86769
Hospital Charge Code	401386769
Hospital Revenue Code	302
Min. Negotiated Rate	$58.05
Max. Negotiated Rate	$58.05
Rate for Payer: Qualcare PPO/HMO/WC	$58.05

SARSCO V2 &INFO AB RSV AMP PRB

Facility

$1,400.00

Service Code	HCPCS 87637
Hospital Charge Code	4013878044
Hospital Revenue Code	306
Min. Negotiated Rate	$39.76
Max. Negotiated Rate	$700.00
Rate for Payer: Aetna Commercial	$387.95
Rate for Payer: Aetna Medicare Advantage	$462.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$142.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$235.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.39
Rate for Payer: Cigna Commercial	$700.00
Rate for Payer: Cigna Medicare Advantage	$142.63
Rate for Payer: Clover Medicare Advantage	$135.50
Rate for Payer: EmblemHealth Commercial	$427.89
Rate for Payer: Humana Medicare Advantage	$146.91
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$142.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$364.00
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$114.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$142.63
Rate for Payer: Wellcare Medicare Advantage	$142.63
Rate for Payer: Wellpoint Medicaid Managed Care	$39.76

SARSCO V2 &INFO AB RSV AMP PRB

Facility

$1,400.00

Service Code	HCPCS 87637
Hospital Charge Code	4013878044
Hospital Revenue Code	306
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$210.00

SARSCOV2NUCLEOCAPIGMSPIKEQL

Facility

$210.65

Service Code	HCPCS 86769
Hospital Charge Code	401386769D
Hospital Revenue Code	302
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$31.60
Rate for Payer: Qualcare PPO/HMO/WC	$31.60

SARSCOV2NUCLEOCAPIGMSPIKEQL

Facility

$210.65

Service Code	HCPCS 86769
Hospital Charge Code	401386769D
Hospital Revenue Code	302
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$114.59
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.83
Rate for Payer: Cigna Commercial	$105.33
Rate for Payer: Cigna Medicare Advantage	$42.13
Rate for Payer: Clover Medicare Advantage	$40.02
Rate for Payer: EmblemHealth Commercial	$126.39
Rate for Payer: Humana Medicare Advantage	$43.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$42.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.77
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$33.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.13
Rate for Payer: Wellcare Medicare Advantage	$42.13
Rate for Payer: Wellpoint Medicaid Managed Care	$5.98

SARS-COV-2 RNA PCR COVID19 QUE

Facility

$345.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798
Hospital Revenue Code	306
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$51.75
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

SARS-COV-2 RNA PCR COVID19 QUE

Facility

$345.00

Service Code	HCPCS 87798
Hospital Charge Code	401387798
Hospital Revenue Code	306
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$172.50
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.70
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

SATURATE MIXING SYSTEM

Facility

$126.83

Hospital Charge Code	270670677
Hospital Revenue Code	272
Min. Negotiated Rate	$19.02
Max. Negotiated Rate	$19.02
Rate for Payer: Qualcare PPO/HMO/WC	$19.02

SATURATE MIXING SYSTEM

Facility

$126.83

Hospital Charge Code	270670677
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$63.41
Rate for Payer: Aetna Commercial	$48.20
Rate for Payer: Aetna Medicare Advantage	$38.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.34
Rate for Payer: Cigna Commercial	$63.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.98
Rate for Payer: Oxford Commercial	$25.37
Rate for Payer: Qualcare PPO/HMO/WC	$19.02
Rate for Payer: UnitedHealthcare Commercial	$25.37
Rate for Payer: UnitedHealthcare Community & State	$4.01
Rate for Payer: Wellpoint Medicaid Managed Care	$3.60

SAVER CELL AUTOTRANS

Facility

$2,874.45

Hospital Charge Code	270601081
Hospital Revenue Code	272
Min. Negotiated Rate	$431.17
Max. Negotiated Rate	$431.17
Rate for Payer: Qualcare PPO/HMO/WC	$431.17

SAVER CELL AUTOTRANS

Facility

$2,874.45

Hospital Charge Code	270601081
Hospital Revenue Code	272
Min. Negotiated Rate	$81.63
Max. Negotiated Rate	$1,437.22
Rate for Payer: Aetna Commercial	$1,092.29
Rate for Payer: Aetna Medicare Advantage	$862.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$732.98
Rate for Payer: Cigna Commercial	$1,437.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$747.36
Rate for Payer: Oxford Commercial	$574.89
Rate for Payer: Qualcare PPO/HMO/WC	$431.17
Rate for Payer: UnitedHealthcare Commercial	$574.89
Rate for Payer: UnitedHealthcare Community & State	$90.83
Rate for Payer: Wellpoint Medicaid Managed Care	$81.63

SAW 105 DEG 12x11.5x0.4MM/70MM

Facility

$430.50

Hospital Charge Code	270674677
Hospital Revenue Code	272
Min. Negotiated Rate	$64.58
Max. Negotiated Rate	$64.58
Rate for Payer: Qualcare PPO/HMO/WC	$64.58

Know your out-of-pocket cost for care.

All Charges