Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SEMEN ANALYSIS, COMPLETE

Facility

$790.00

Service Code	HCPCS 89320
Hospital Charge Code	38473033
Hospital Revenue Code	309
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$118.50
Rate for Payer: Qualcare PPO/HMO/WC	$118.50

SEMEN ANALYSIS, PRESENCE

Facility

$85.00

Service Code	HCPCS 89321
Hospital Charge Code	38473034
Hospital Revenue Code	309
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$12.75
Rate for Payer: Qualcare PPO/HMO/WC	$12.75

SEMEN ANALYSIS, PRESENCE

Facility

$85.00

Service Code	HCPCS 89321
Hospital Charge Code	38473034
Hospital Revenue Code	309
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare Advantage	$39.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.71
Rate for Payer: Cigna Commercial	$42.50
Rate for Payer: Cigna Medicare Advantage	$12.05
Rate for Payer: Clover Medicare Advantage	$11.45
Rate for Payer: EmblemHealth Commercial	$36.15
Rate for Payer: Humana Medicare Advantage	$12.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.10
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.05
Rate for Payer: Wellcare Medicare Advantage	$12.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.41

SEMEN ANALYSIS PRESENCE MOTILT

Facility

$24.00

Service Code	HCPCS 89300
Hospital Charge Code	38477021
Hospital Revenue Code	300
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

SEMEN ANALYSIS PRESENCE MOTILT

Facility

$24.00

Service Code	HCPCS 89300
Hospital Charge Code	38477021
Hospital Revenue Code	300
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$26.76
Rate for Payer: Aetna Medicare Advantage	$31.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.69
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: Cigna Medicare Advantage	$9.84
Rate for Payer: Clover Medicare Advantage	$9.35
Rate for Payer: EmblemHealth Commercial	$29.52
Rate for Payer: Humana Medicare Advantage	$10.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.84
Rate for Payer: Wellcare Medicare Advantage	$9.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

SEMEN ANALYSIS-VOLUM/CNT/MOT

Facility

$109.00

Service Code	HCPCS 89322
Hospital Charge Code	38477131
Hospital Revenue Code	300
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$42.16
Rate for Payer: Aetna Medicare Advantage	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.23
Rate for Payer: Cigna Commercial	$54.50
Rate for Payer: Cigna Medicare Advantage	$15.50
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.50
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$28.34
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$16.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.50
Rate for Payer: Wellcare Medicare Advantage	$15.50
Rate for Payer: Wellpoint Medicaid Managed Care	$3.10

SEMEN ANALYSIS-VOLUM/CNT/MOT

Facility

$109.00

Service Code	HCPCS 89322
Hospital Charge Code	38477131
Hospital Revenue Code	300
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$16.35
Rate for Payer: Qualcare PPO/HMO/WC	$16.35

SEMITENDINOSIS GRAFT FROZEN

Facility

$9,750.00

Hospital Charge Code	270678186
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

SEMITENDINOSIS GRAFT FROZEN

Facility

$9,750.00

Hospital Charge Code	270678186
Hospital Revenue Code	278
Min. Negotiated Rate	$276.90
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$308.10
Rate for Payer: Wellpoint Medicaid Managed Care	$276.90

SEMITENDINOSUS GRAFT W/GRACIL

Facility

$8,615.00

Hospital Charge Code	270656958
Hospital Revenue Code	278
Min. Negotiated Rate	$1,292.25
Max. Negotiated Rate	$2,084.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,084.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,292.25

SEMITENDINOSUS GRAFT W/GRACIL

Facility

$8,615.00

Hospital Charge Code	270656958
Hospital Revenue Code	278
Min. Negotiated Rate	$244.67
Max. Negotiated Rate	$4,307.50
Rate for Payer: Aetna Commercial	$3,273.70
Rate for Payer: Aetna Medicare Advantage	$2,584.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,196.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,196.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,196.82
Rate for Payer: Cigna Commercial	$4,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,084.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,292.25
Rate for Payer: UnitedHealthcare Community & State	$272.23
Rate for Payer: Wellpoint Medicaid Managed Care	$244.67

SEMITENDINOSUS W/GRACELIS

Facility

$8,565.00

Service Code	HCPCS C1762
Hospital Charge Code	270671214
Hospital Revenue Code	278
Min. Negotiated Rate	$1,284.75
Max. Negotiated Rate	$2,072.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75

SEMITENDINOSUS W/GRACELIS

Facility

$8,565.00

Service Code	HCPCS C1762
Hospital Charge Code	270671214
Hospital Revenue Code	278
Min. Negotiated Rate	$243.25
Max. Negotiated Rate	$4,282.50
Rate for Payer: Aetna Commercial	$3,254.70
Rate for Payer: Aetna Medicare Advantage	$2,569.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,184.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,713.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,184.07
Rate for Payer: Cigna Commercial	$4,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,072.73
Rate for Payer: Qualcare PPO/HMO/WC	$1,284.75
Rate for Payer: UnitedHealthcare Community & State	$270.65
Rate for Payer: Wellpoint Medicaid Managed Care	$243.25

SEM PRESS FIR STEM SZ 12

Facility

$7,803.00

Hospital Charge Code	270689493
Hospital Revenue Code	272
Min. Negotiated Rate	$221.61
Max. Negotiated Rate	$3,901.50
Rate for Payer: Aetna Commercial	$2,965.14
Rate for Payer: Aetna Medicare Advantage	$2,340.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.77
Rate for Payer: Cigna Commercial	$3,901.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,028.78
Rate for Payer: Oxford Commercial	$1,560.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.45
Rate for Payer: UnitedHealthcare Commercial	$1,560.60
Rate for Payer: UnitedHealthcare Community & State	$246.57
Rate for Payer: Wellpoint Medicaid Managed Care	$221.61

SEM PRESS FIR STEM SZ 12

Facility

$7,803.00

Hospital Charge Code	270689493
Hospital Revenue Code	272
Min. Negotiated Rate	$1,170.45
Max. Negotiated Rate	$1,170.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.45

SENNA 8.6 MG TAB

Facility

$4.00

Service Code	NDC 67618030050
Hospital Charge Code	60628702
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SENNA 8.6 MG TAB

Facility

$4.00

Service Code	NDC 67618030050
Hospital Charge Code	60628702
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SENNA 8.8 MG/5 ML SYRUP

Facility

$4.00

Service Code	NDC 59390012541
Hospital Charge Code	60629038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SENNA 8.8 MG/5 ML SYRUP

Facility

$4.00

Service Code	NDC 59390012541
Hospital Charge Code	60629038
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SENSATION STANDARD OVAL

Facility

$4.25

Hospital Charge Code	270654279
Hospital Revenue Code	272
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.12
Rate for Payer: Aetna Commercial	$1.61
Rate for Payer: Aetna Medicare Advantage	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.08
Rate for Payer: Cigna Commercial	$2.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.10
Rate for Payer: Oxford Commercial	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.64
Rate for Payer: UnitedHealthcare Commercial	$0.85
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

SENSATION STANDARD OVAL

Facility

$4.25

Hospital Charge Code	270654279
Hospital Revenue Code	272
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$0.64
Rate for Payer: Qualcare PPO/HMO/WC	$0.64

SENSIPAR 60MG TAB

Facility

$294.26

Service Code	NDC 55513007430
Hospital Charge Code	606361030
Hospital Revenue Code	250
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$147.13
Rate for Payer: Aetna Commercial	$111.82
Rate for Payer: Aetna Medicare Advantage	$88.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.04
Rate for Payer: Cigna Commercial	$147.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.51
Rate for Payer: Oxford Commercial	$58.85
Rate for Payer: Qualcare PPO/HMO/WC	$44.14
Rate for Payer: UnitedHealthcare Commercial	$58.85
Rate for Payer: UnitedHealthcare Community & State	$9.30
Rate for Payer: Wellpoint Medicaid Managed Care	$8.36

SENSIPAR 60MG TAB

Facility

$294.26

Service Code	NDC 55513007430
Hospital Charge Code	606361030
Hospital Revenue Code	250
Min. Negotiated Rate	$44.14
Max. Negotiated Rate	$44.14
Rate for Payer: Qualcare PPO/HMO/WC	$44.14

SENSOR ADULT/NEONATAL DISP

Facility

$124.69

Hospital Charge Code	270643750
Hospital Revenue Code	272
Min. Negotiated Rate	$18.70
Max. Negotiated Rate	$18.70
Rate for Payer: Qualcare PPO/HMO/WC	$18.70

SENSOR ADULT/NEONATAL DISP

Facility

$124.69

Hospital Charge Code	270643750
Hospital Revenue Code	272
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$62.34
Rate for Payer: Aetna Commercial	$47.38
Rate for Payer: Aetna Medicare Advantage	$37.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.80
Rate for Payer: Cigna Commercial	$62.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.42
Rate for Payer: Oxford Commercial	$24.94
Rate for Payer: Qualcare PPO/HMO/WC	$18.70
Rate for Payer: UnitedHealthcare Commercial	$24.94
Rate for Payer: UnitedHealthcare Community & State	$3.94
Rate for Payer: Wellpoint Medicaid Managed Care	$3.54

Know your out-of-pocket cost for care.

All Charges