Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SCOPE NANONEEDLE 125MM

Facility

$2,625.00

Service Code	HCPCS A4649
Hospital Charge Code	270699064
Hospital Revenue Code	272
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

SCOPE SPYGLASS

Facility

$3,950.00

Hospital Charge Code	270664632
Hospital Revenue Code	272
Min. Negotiated Rate	$592.50
Max. Negotiated Rate	$592.50
Rate for Payer: Qualcare PPO/HMO/WC	$592.50

SCOPE SPYGLASS

Facility

$3,950.00

Hospital Charge Code	270664632
Hospital Revenue Code	272
Min. Negotiated Rate	$112.18
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,501.00
Rate for Payer: Aetna Medicare Advantage	$1,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,007.25
Rate for Payer: Cigna Commercial	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,027.00
Rate for Payer: Oxford Commercial	$790.00
Rate for Payer: Qualcare PPO/HMO/WC	$592.50
Rate for Payer: UnitedHealthcare Commercial	$790.00
Rate for Payer: UnitedHealthcare Community & State	$124.82
Rate for Payer: Wellpoint Medicaid Managed Care	$112.18

SCOPE TOTE

Facility

$9.00

Hospital Charge Code	270658304
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.34
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.26

SCOPE TOTE

Facility

$9.00

Hospital Charge Code	270658304
Hospital Revenue Code	270
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

SCOPOLAMINE 1.5 MG/24 HR TDM

Facility

$40.13

Service Code	NDC 67434604
Hospital Charge Code	60629044
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$20.07
Rate for Payer: Aetna Commercial	$15.25
Rate for Payer: Aetna Medicare Advantage	$12.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.23
Rate for Payer: Cigna Commercial	$20.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.43
Rate for Payer: Oxford Commercial	$8.03
Rate for Payer: Qualcare PPO/HMO/WC	$6.02
Rate for Payer: UnitedHealthcare Commercial	$8.03
Rate for Payer: UnitedHealthcare Community & State	$1.27
Rate for Payer: Wellpoint Medicaid Managed Care	$1.14

SCOPOLAMINE 1.5 MG/24 HR TDM

Facility

$40.13

Service Code	NDC 67434604
Hospital Charge Code	60629044
Hospital Revenue Code	250
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$6.02

SCORPION MINI KIT IMPL SYSTEM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270661232
Hospital Revenue Code	278
Min. Negotiated Rate	$821.25
Max. Negotiated Rate	$1,324.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25

SCORPION MINI KIT IMPL SYSTEM

Facility

$5,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270661232
Hospital Revenue Code	278
Min. Negotiated Rate	$155.49
Max. Negotiated Rate	$2,737.50
Rate for Payer: Aetna Commercial	$2,080.50
Rate for Payer: Aetna Medicare Advantage	$1,642.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,396.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,396.12
Rate for Payer: Cigna Commercial	$2,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.95
Rate for Payer: Qualcare PPO/HMO/WC	$821.25
Rate for Payer: UnitedHealthcare Community & State	$173.01
Rate for Payer: Wellpoint Medicaid Managed Care	$155.49

SCORPION NEEDLE KNEE

Facility

$975.00

Hospital Charge Code	270682511
Hospital Revenue Code	272
Min. Negotiated Rate	$146.25
Max. Negotiated Rate	$146.25
Rate for Payer: Qualcare PPO/HMO/WC	$146.25

SCORPION NEEDLE KNEE

Facility

$975.00

Hospital Charge Code	270682511
Hospital Revenue Code	272
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$487.50
Rate for Payer: Aetna Commercial	$370.50
Rate for Payer: Aetna Medicare Advantage	$292.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$248.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$248.62
Rate for Payer: Cigna Commercial	$487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.50
Rate for Payer: Oxford Commercial	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$146.25
Rate for Payer: UnitedHealthcare Commercial	$195.00
Rate for Payer: UnitedHealthcare Community & State	$30.81
Rate for Payer: Wellpoint Medicaid Managed Care	$27.69

SCOTCHCAST 2 SPLINTING SYSTEM

Facility

$92.00

Hospital Charge Code	270332283
Hospital Revenue Code	272
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$46.00
Rate for Payer: Aetna Commercial	$34.96
Rate for Payer: Aetna Medicare Advantage	$27.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.46
Rate for Payer: Cigna Commercial	$46.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.92
Rate for Payer: Oxford Commercial	$18.40
Rate for Payer: Qualcare PPO/HMO/WC	$13.80
Rate for Payer: UnitedHealthcare Commercial	$18.40
Rate for Payer: UnitedHealthcare Community & State	$2.91
Rate for Payer: Wellpoint Medicaid Managed Care	$2.61

SCOTCHCAST 2 SPLINTING SYSTEM

Facility

$92.00

Hospital Charge Code	270332283
Hospital Revenue Code	272
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$13.80
Rate for Payer: Qualcare PPO/HMO/WC	$13.80

SCOTCH CAST-2 TAPE 2'

Facility

$25.00

Hospital Charge Code	270332239
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

SCOTCH CAST-2 TAPE 2'

Facility

$25.00

Hospital Charge Code	270332239
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$12.50
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare Advantage	$7.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.38
Rate for Payer: Cigna Commercial	$12.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.50
Rate for Payer: Oxford Commercial	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.75
Rate for Payer: UnitedHealthcare Commercial	$5.00
Rate for Payer: UnitedHealthcare Community & State	$0.79
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

SCOTCH CAST-2 TAPE 3

Facility

$30.00

Hospital Charge Code	270332244
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Commercial	$11.40
Rate for Payer: Aetna Medicare Advantage	$9.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.65
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$6.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Community & State	$0.95
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

SCOTCH CAST-2 TAPE 3

Facility

$30.00

Hospital Charge Code	270332244
Hospital Revenue Code	272
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

SCOTCH CAST-2 TAPE 4'

Facility

$39.00

Hospital Charge Code	270332246
Hospital Revenue Code	272
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

SCOTCH CAST-2 TAPE 4'

Facility

$39.00

Hospital Charge Code	270332246
Hospital Revenue Code	272
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Medicare Advantage	$11.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$7.80
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$7.80
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

SCOTCH CAST-2 TAPE 5

Facility

$48.00

Hospital Charge Code	270332248
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SCOTCH CAST-2 TAPE 5

Facility

$48.00

Hospital Charge Code	270332248
Hospital Revenue Code	272
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

SCPCOMPFTANKLKT5CCDEL11GX120MM

Facility

$23,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270696479
Hospital Revenue Code	278
Min. Negotiated Rate	$3,495.00
Max. Negotiated Rate	$5,638.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,638.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00

SCPCOMPFTANKLKT5CCDEL11GX120MM

Facility

$23,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270696479
Hospital Revenue Code	278
Min. Negotiated Rate	$661.72
Max. Negotiated Rate	$11,650.00
Rate for Payer: Aetna Commercial	$8,854.00
Rate for Payer: Aetna Medicare Advantage	$6,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,941.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,941.50
Rate for Payer: Cigna Commercial	$11,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,638.60
Rate for Payer: Qualcare PPO/HMO/WC	$3,495.00
Rate for Payer: UnitedHealthcare Community & State	$736.28
Rate for Payer: Wellpoint Medicaid Managed Care	$661.72

SCR BON CORT 150x50HAA60-15050

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270635000
Hospital Revenue Code	278
Min. Negotiated Rate	$119.62
Max. Negotiated Rate	$193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62

SCR BON CORT 150x50HAA60-15050

Facility

$797.50

Service Code	HCPCS C1713
Hospital Charge Code	270635000
Hospital Revenue Code	278
Min. Negotiated Rate	$22.65
Max. Negotiated Rate	$398.75
Rate for Payer: Aetna Commercial	$303.05
Rate for Payer: Aetna Medicare Advantage	$239.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$203.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$159.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$203.36
Rate for Payer: Cigna Commercial	$398.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.00
Rate for Payer: Qualcare PPO/HMO/WC	$119.62
Rate for Payer: UnitedHealthcare Community & State	$25.20
Rate for Payer: Wellpoint Medicaid Managed Care	$22.65

Know your out-of-pocket cost for care.

All Charges