Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

S/B LESION

Facility

$1,083.25

Service Code	HCPCS 11057
Hospital Charge Code	87502565
Hospital Revenue Code	761
Min. Negotiated Rate	$162.49
Max. Negotiated Rate	$162.49
Rate for Payer: Qualcare PPO/HMO/WC	$162.49

SBRT DELIVERY

Facility

$9,462.75

Service Code	HCPCS 77373
Hospital Charge Code	85000675
Hospital Revenue Code	333
Min. Negotiated Rate	$268.74
Max. Negotiated Rate	$7,705.72
Rate for Payer: Aetna Commercial	$5,777.96
Rate for Payer: Aetna Medicare Advantage	$6,882.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,705.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,705.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,124.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,705.72
Rate for Payer: Cigna Commercial	$4,258.06
Rate for Payer: Cigna Medicare Advantage	$1,486.97
Rate for Payer: Clover Medicare Advantage	$2,018.04
Rate for Payer: EmblemHealth Commercial	$6,372.75
Rate for Payer: Humana Medicare Advantage	$2,187.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,124.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,460.32
Rate for Payer: Oxford Commercial	$1,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,419.41
Rate for Payer: UnitedHealthcare Commercial	$1,770.00
Rate for Payer: UnitedHealthcare Community & State	$299.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,124.25
Rate for Payer: Wellcare Medicare Advantage	$2,124.25
Rate for Payer: Wellpoint Medicaid Managed Care	$268.74

SBRT DELIVERY

Facility

$9,462.75

Service Code	HCPCS 77373
Hospital Charge Code	85000675
Hospital Revenue Code	333
Min. Negotiated Rate	$1,419.41
Max. Negotiated Rate	$1,419.41
Rate for Payer: Qualcare PPO/HMO/WC	$1,419.41

SBRT MANAGEMENT

Facility

$3,300.35

Service Code	HCPCS 77435
Hospital Charge Code	85000795
Hospital Revenue Code	333
Min. Negotiated Rate	$93.73
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,254.13
Rate for Payer: Aetna Medicare Advantage	$990.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$841.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$841.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$841.59
Rate for Payer: Cigna Commercial	$1,650.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$858.09
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$495.05
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$104.29
Rate for Payer: Wellpoint Medicaid Managed Care	$93.73

SBRT MANAGEMENT

Facility

$3,300.35

Service Code	HCPCS 77435
Hospital Charge Code	85000795
Hospital Revenue Code	333
Min. Negotiated Rate	$495.05
Max. Negotiated Rate	$495.05
Rate for Payer: Qualcare PPO/HMO/WC	$495.05

SCALLOP IGE

Facility

$390.00

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

SCALLOP IGE

Facility

$390.00

Service Code	HCPCS 86003
Hospital Charge Code	401186003A
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

SCALP DISPOSABLE CLIP APPLIER

Facility

$2,750.00

Hospital Charge Code	270665367
Hospital Revenue Code	270
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

SCALP DISPOSABLE CLIP APPLIER

Facility

$2,750.00

Hospital Charge Code	270665367
Hospital Revenue Code	270
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.00
Rate for Payer: Oxford Commercial	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Commercial	$550.00
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

SCALPEL BLADE #10 STER DISP

Facility

$5.86

Hospital Charge Code	270650075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.52
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SCALPEL BLADE #10 STER DISP

Facility

$5.86

Hospital Charge Code	270650075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

SCALPEL BLADE #11 STER DISP

Facility

$5.29

Hospital Charge Code	270650095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: Qualcare PPO/HMO/WC	$0.79

SCALPEL BLADE #11 STER DISP

Facility

$5.29

Hospital Charge Code	270650095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.65
Rate for Payer: Aetna Commercial	$2.01
Rate for Payer: Aetna Medicare Advantage	$1.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.35
Rate for Payer: Cigna Commercial	$2.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.38
Rate for Payer: Oxford Commercial	$1.06
Rate for Payer: Qualcare PPO/HMO/WC	$0.79
Rate for Payer: UnitedHealthcare Commercial	$1.06
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SCALPEL BLADE #15 STER DISP

Facility

$5.86

Hospital Charge Code	270650074
Hospital Revenue Code	272
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.88

SCALPEL BLADE #15 STER DISP

Facility

$5.86

Hospital Charge Code	270650074
Hospital Revenue Code	272
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.93
Rate for Payer: Aetna Commercial	$2.23
Rate for Payer: Aetna Medicare Advantage	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.49
Rate for Payer: Cigna Commercial	$2.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.52
Rate for Payer: Oxford Commercial	$1.17
Rate for Payer: Qualcare PPO/HMO/WC	$0.88
Rate for Payer: UnitedHealthcare Commercial	$1.17
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

SCALPEL HARMONIC WAVW 18cm

Facility

$1,792.69

Hospital Charge Code	270638223
Hospital Revenue Code	272
Min. Negotiated Rate	$268.90
Max. Negotiated Rate	$268.90
Rate for Payer: Qualcare PPO/HMO/WC	$268.90

SCALPEL HARMONIC WAVW 18cm

Facility

$1,792.69

Hospital Charge Code	270638223
Hospital Revenue Code	272
Min. Negotiated Rate	$50.91
Max. Negotiated Rate	$896.35
Rate for Payer: Aetna Commercial	$681.22
Rate for Payer: Aetna Medicare Advantage	$537.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$457.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$457.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$457.14
Rate for Payer: Cigna Commercial	$896.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$466.10
Rate for Payer: Oxford Commercial	$358.54
Rate for Payer: Qualcare PPO/HMO/WC	$268.90
Rate for Payer: UnitedHealthcare Commercial	$358.54
Rate for Payer: UnitedHealthcare Community & State	$56.65
Rate for Payer: Wellpoint Medicaid Managed Care	$50.91

SCALPEL JJ HARMONIC 5 50 CS14C

Facility

$1,706.25

Hospital Charge Code	270624569
Hospital Revenue Code	272
Min. Negotiated Rate	$48.46
Max. Negotiated Rate	$853.12
Rate for Payer: Aetna Commercial	$648.38
Rate for Payer: Aetna Medicare Advantage	$511.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$435.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$435.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$435.09
Rate for Payer: Cigna Commercial	$853.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$443.62
Rate for Payer: Oxford Commercial	$341.25
Rate for Payer: Qualcare PPO/HMO/WC	$255.94
Rate for Payer: UnitedHealthcare Commercial	$341.25
Rate for Payer: UnitedHealthcare Community & State	$53.92
Rate for Payer: Wellpoint Medicaid Managed Care	$48.46

SCALPEL JJ HARMONIC 5 50 CS14C

Facility

$1,706.25

Hospital Charge Code	270624569
Hospital Revenue Code	272
Min. Negotiated Rate	$255.94
Max. Negotiated Rate	$255.94
Rate for Payer: Qualcare PPO/HMO/WC	$255.94

SCALPEL STER DISP #10

Facility

$7.93

Hospital Charge Code	270301905
Hospital Revenue Code	272
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

SCALPEL STER DISP #10

Facility

$7.93

Hospital Charge Code	270301905W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

SCALPEL STER DISP #10

Facility

$7.93

Hospital Charge Code	270301905W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.01
Rate for Payer: Aetna Medicare Advantage	$2.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.02
Rate for Payer: Cigna Commercial	$3.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.06
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.19
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

SCALPEL STER DISP #10

Facility

$7.93

Hospital Charge Code	270301905
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.01
Rate for Payer: Aetna Medicare Advantage	$2.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.02
Rate for Payer: Cigna Commercial	$3.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.06
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.19
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

SCALPEL STER DISP #11

Facility

$7.93

Hospital Charge Code	270301910W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

SCALPEL STER DISP #11

Facility

$7.93

Hospital Charge Code	270301910
Hospital Revenue Code	272
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$1.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.19

Know your out-of-pocket cost for care.

All Charges