Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SEDIMENTATION RATE, NON-AUTO

Facility

$256.00

Service Code	HCPCS 85651
Hospital Charge Code	38473009
Hospital Revenue Code	305
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$128.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$66.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$38.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$7.27

SEDIMENTATION RATE, NON-AUTO

Facility

$256.00

Service Code	HCPCS 85651
Hospital Charge Code	38473009
Hospital Revenue Code	305
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$38.40
Rate for Payer: Qualcare PPO/HMO/WC	$38.40

SED RATE, ERYTHROCYTE,AUTO

Facility

$19.00

Service Code	HCPCS 85652
Hospital Charge Code	38474123
Hospital Revenue Code	305
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$7.34
Rate for Payer: Aetna Medicare Advantage	$8.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.79
Rate for Payer: Cigna Commercial	$9.50
Rate for Payer: Cigna Medicare Advantage	$2.70
Rate for Payer: Clover Medicare Advantage	$2.56
Rate for Payer: EmblemHealth Commercial	$8.10
Rate for Payer: Humana Medicare Advantage	$2.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.70
Rate for Payer: Wellcare Medicare Advantage	$2.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.54

SED RATE, ERYTHROCYTE,AUTO

Facility

$19.00

Service Code	HCPCS 85652
Hospital Charge Code	38474123
Hospital Revenue Code	305
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$2.85
Rate for Payer: Qualcare PPO/HMO/WC	$2.85

SEGMENT FEMORAL ELLIPTICL 7cmR

Facility

$60,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270667955
Hospital Revenue Code	278
Min. Negotiated Rate	$1,709.96
Max. Negotiated Rate	$30,105.00
Rate for Payer: Aetna Commercial	$22,879.80
Rate for Payer: Aetna Medicare Advantage	$18,063.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,353.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,353.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,353.55
Rate for Payer: Cigna Commercial	$30,105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,570.82
Rate for Payer: Qualcare PPO/HMO/WC	$9,031.50
Rate for Payer: UnitedHealthcare Community & State	$1,902.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1,709.96

SEGMENT FEMORAL ELLIPTICL 7cmR

Facility

$60,210.00

Service Code	HCPCS C1776
Hospital Charge Code	270667955
Hospital Revenue Code	278
Min. Negotiated Rate	$9,031.50
Max. Negotiated Rate	$14,570.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12,042.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,570.82
Rate for Payer: Qualcare PPO/HMO/WC	$9,031.50

SEGURA BASKET 4 WIRE BASKET

Facility

$2,050.00

Hospital Charge Code	270332041
Hospital Revenue Code	272
Min. Negotiated Rate	$307.50
Max. Negotiated Rate	$307.50
Rate for Payer: Qualcare PPO/HMO/WC	$307.50

SEGURA BASKET 4 WIRE BASKET

Facility

$2,050.00

Hospital Charge Code	270332041
Hospital Revenue Code	272
Min. Negotiated Rate	$58.22
Max. Negotiated Rate	$1,025.00
Rate for Payer: Aetna Commercial	$779.00
Rate for Payer: Aetna Medicare Advantage	$615.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$522.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$522.75
Rate for Payer: Cigna Commercial	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$533.00
Rate for Payer: Oxford Commercial	$410.00
Rate for Payer: Qualcare PPO/HMO/WC	$307.50
Rate for Payer: UnitedHealthcare Commercial	$410.00
Rate for Payer: UnitedHealthcare Community & State	$64.78
Rate for Payer: Wellpoint Medicaid Managed Care	$58.22

SEIZURE

Facility

$11,566.49

Service Code	APR-DRG 0533
Min. Negotiated Rate	$11,339.70
Max. Negotiated Rate	$11,566.49
Rate for Payer: UnitedHealthcare Community & State	$11,339.70
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$11,566.49
Rate for Payer: Wellpoint Medicaid Managed Care	$11,339.70

SEIZURE

Facility

$6,513.50

Service Code	APR-DRG 0531
Min. Negotiated Rate	$6,385.78
Max. Negotiated Rate	$6,513.50
Rate for Payer: UnitedHealthcare Community & State	$6,385.78
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$6,513.50
Rate for Payer: Wellpoint Medicaid Managed Care	$6,385.78

SEIZURE

Facility

$26,042.85

Service Code	APR-DRG 0534
Min. Negotiated Rate	$25,532.21
Max. Negotiated Rate	$26,042.85
Rate for Payer: UnitedHealthcare Community & State	$25,532.21
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,042.85
Rate for Payer: Wellpoint Medicaid Managed Care	$25,532.21

SEIZURE

Facility

$8,468.44

Service Code	APR-DRG 0532
Min. Negotiated Rate	$8,302.39
Max. Negotiated Rate	$8,468.44
Rate for Payer: UnitedHealthcare Community & State	$8,302.39
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,468.44
Rate for Payer: Wellpoint Medicaid Managed Care	$8,302.39

SEIZURES WITH MCC

Facility

$80,655.03

Service Code	MSDRG 100
Min. Negotiated Rate	$24,558.42
Max. Negotiated Rate	$80,655.03
Rate for Payer: Aetna Commercial	$59,301.95
Rate for Payer: Aetna Medicare Advantage	$80,655.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54,855.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54,855.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25,850.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54,855.90
Rate for Payer: Cigna Commercial	$43,177.08
Rate for Payer: Cigna Medicare Advantage	$25,850.97
Rate for Payer: Clover Medicare Advantage	$24,558.42
Rate for Payer: EmblemHealth Commercial	$77,552.91
Rate for Payer: Humana Medicare Advantage	$26,626.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25,850.97
Rate for Payer: Oxford Commercial	$34,126.42
Rate for Payer: UnitedHealthcare Commercial	$45,679.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$25,850.97
Rate for Payer: Wellcare Medicare Advantage	$25,850.97

SEIZURES WITHOUT MCC

Facility

$47,981.01

Service Code	MSDRG 101
Min. Negotiated Rate	$14,609.60
Max. Negotiated Rate	$47,981.01
Rate for Payer: Aetna Commercial	$36,031.14
Rate for Payer: Aetna Medicare Advantage	$47,981.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25,211.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25,211.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,378.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25,211.55
Rate for Payer: Cigna Commercial	$20,121.66
Rate for Payer: Cigna Medicare Advantage	$15,378.53
Rate for Payer: Clover Medicare Advantage	$14,609.60
Rate for Payer: EmblemHealth Commercial	$46,135.59
Rate for Payer: Humana Medicare Advantage	$15,839.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,378.53
Rate for Payer: Oxford Commercial	$15,903.81
Rate for Payer: UnitedHealthcare Commercial	$21,287.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,378.53
Rate for Payer: Wellcare Medicare Advantage	$15,378.53

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	411036015
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	411036015
Hospital Revenue Code	361
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.34
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$11.34
Rate for Payer: Wellpoint Medicaid Managed Care	$10.20

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	366836015R
Hospital Revenue Code	361
Min. Negotiated Rate	$53.85
Max. Negotiated Rate	$53.85
Rate for Payer: Qualcare PPO/HMO/WC	$53.85

SEL CATH PLACEMENT PUL ART

Facility

$359.00

Service Code	HCPCS 36015RT
Hospital Charge Code	366836015R
Hospital Revenue Code	361
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$136.42
Rate for Payer: Aetna Medicare Advantage	$107.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.55
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	$91.55
Rate for Payer: Cigna Commercial	$179.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.34
Rate for Payer: Qualcare PPO/HMO/WC	$53.85
Rate for Payer: UnitedHealthcare Community & State	$11.34
Rate for Payer: Wellpoint Medicaid Managed Care	$10.20

SELEGILINE 5 MG TAB

Facility

$15.41

Service Code	NDC 60505005501
Hospital Charge Code	6027064
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$7.71
Rate for Payer: Aetna Commercial	$5.86
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.71
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.01
Rate for Payer: Oxford Commercial	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$3.08
Rate for Payer: UnitedHealthcare Community & State	$0.49
Rate for Payer: Wellpoint Medicaid Managed Care	$0.44

SELEGILINE 5 MG TAB

Facility

$15.41

Service Code	NDC 60505005501
Hospital Charge Code	6027064
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

SELENIUM

Facility

$449.00

Service Code	HCPCS 84255
Hospital Charge Code	38472609
Hospital Revenue Code	301
Min. Negotiated Rate	$67.35
Max. Negotiated Rate	$67.35
Rate for Payer: Qualcare PPO/HMO/WC	$67.35

SELENIUM

Facility

$449.00

Service Code	HCPCS 84255
Hospital Charge Code	38472609
Hospital Revenue Code	301
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$224.50
Rate for Payer: Aetna Commercial	$69.44
Rate for Payer: Aetna Medicare Advantage	$82.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.61
Rate for Payer: Cigna Commercial	$224.50
Rate for Payer: Cigna Medicare Advantage	$25.53
Rate for Payer: Clover Medicare Advantage	$24.25
Rate for Payer: EmblemHealth Commercial	$76.59
Rate for Payer: Humana Medicare Advantage	$26.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.74
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$67.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.53
Rate for Payer: Wellcare Medicare Advantage	$25.53
Rate for Payer: Wellpoint Medicaid Managed Care	$12.75

SELENIUM

Facility

$175.50

Service Code	HCPCS 84255
Hospital Charge Code	39900130
Hospital Revenue Code	301
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$26.32
Rate for Payer: Qualcare PPO/HMO/WC	$26.32

SELENIUM

Facility

$175.50

Service Code	HCPCS 84255
Hospital Charge Code	39900130
Hospital Revenue Code	301
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$69.44
Rate for Payer: Aetna Medicare Advantage	$82.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$92.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$92.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$25.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$48.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$92.61
Rate for Payer: Cigna Commercial	$87.75
Rate for Payer: Cigna Medicare Advantage	$25.53
Rate for Payer: Clover Medicare Advantage	$24.25
Rate for Payer: EmblemHealth Commercial	$76.59
Rate for Payer: Humana Medicare Advantage	$26.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$25.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$45.63
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.32
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$20.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.53
Rate for Payer: Wellcare Medicare Advantage	$25.53
Rate for Payer: Wellpoint Medicaid Managed Care	$4.98

selenium sulfide topical 2.5%

Facility

$132.66

Service Code	NDC 45802004064
Hospital Charge Code	6063943318
Hospital Revenue Code	250
Min. Negotiated Rate	$19.90
Max. Negotiated Rate	$19.90
Rate for Payer: Qualcare PPO/HMO/WC	$19.90

Know your out-of-pocket cost for care.

All Charges