Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SM AND SM/RNP AB II

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SM AND SM/RNP AB II

Facility

$390.00

Service Code	HCPCS 8623591
Hospital Charge Code	39990080B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SMART PORT CT TI 8FRX66CM CATH

Facility

$1,705.00

Service Code	HCPCS C1788
Hospital Charge Code	270698053
Hospital Revenue Code	278
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$852.50
Rate for Payer: Aetna Commercial	$647.90
Rate for Payer: Aetna Medicare Advantage	$511.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.77
Rate for Payer: Cigna Commercial	$852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: Qualcare PPO/HMO/WC	$255.75
Rate for Payer: UnitedHealthcare Community & State	$53.88
Rate for Payer: Wellpoint Medicaid Managed Care	$48.42

SMART PORT CT TI 8FRX66CM CATH

Facility

$1,705.00

Service Code	HCPCS C1788
Hospital Charge Code	270698053
Hospital Revenue Code	278
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$412.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: Qualcare PPO/HMO/WC	$255.75

SM DISP BAYONET 18CMX1.5MM TIP

Facility

$10,980.00

Hospital Charge Code	270692098
Hospital Revenue Code	272
Min. Negotiated Rate	$311.83
Max. Negotiated Rate	$5,490.00
Rate for Payer: Aetna Commercial	$4,172.40
Rate for Payer: Aetna Medicare Advantage	$3,294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,799.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,799.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,799.90
Rate for Payer: Cigna Commercial	$5,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,854.80
Rate for Payer: Oxford Commercial	$2,196.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,647.00
Rate for Payer: UnitedHealthcare Commercial	$2,196.00
Rate for Payer: UnitedHealthcare Community & State	$346.97
Rate for Payer: Wellpoint Medicaid Managed Care	$311.83

SM DISP BAYONET 18CMX1.5MM TIP

Facility

$10,980.00

Hospital Charge Code	270692098
Hospital Revenue Code	272
Min. Negotiated Rate	$1,647.00
Max. Negotiated Rate	$1,647.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,647.00

SMEAR FLUORESCENT/ACID STAIN

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	401087206
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SMEAR FLUORESCENT/ACID STAIN

Facility

$390.00

Service Code	HCPCS 87206
Hospital Charge Code	401087206
Hospital Revenue Code	306
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.66
Rate for Payer: Aetna Medicare Advantage	$17.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.55
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.39
Rate for Payer: Clover Medicare Advantage	$5.12
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Humana Medicare Advantage	$5.55
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.39
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	$4.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.39
Rate for Payer: Wellcare Medicare Advantage	$5.39
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SMEAR,FOR OVA& PARASITES

Facility

$126.00

Service Code	HCPCS 87209
Hospital Charge Code	38475079
Hospital Revenue Code	309
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$18.90
Rate for Payer: Qualcare PPO/HMO/WC	$18.90

SMEAR,FOR OVA& PARASITES

Facility

$126.00

Service Code	HCPCS 87209
Hospital Charge Code	38475079
Hospital Revenue Code	309
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.91
Rate for Payer: Aetna Medicare Advantage	$58.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.22
Rate for Payer: Cigna Commercial	$63.00
Rate for Payer: Cigna Medicare Advantage	$17.98
Rate for Payer: Clover Medicare Advantage	$17.08
Rate for Payer: EmblemHealth Commercial	$53.94
Rate for Payer: Humana Medicare Advantage	$18.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$32.76
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$18.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.98
Rate for Payer: Wellcare Medicare Advantage	$17.98
Rate for Payer: Wellpoint Medicaid Managed Care	$3.58

SMEAR GRAM STAIN-SO

Facility

$94.66

Service Code	HCPCS 87205
Hospital Charge Code	4013388B
Hospital Revenue Code	306
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$14.20
Rate for Payer: Qualcare PPO/HMO/WC	$14.20

SMEAR GRAM STAIN-SO

Facility

$94.66

Service Code	HCPCS 87205
Hospital Charge Code	4013388B
Hospital Revenue Code	306
Min. Negotiated Rate	$2.69
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	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$47.33
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	$24.61
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.20
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	$2.69

SMEAR GRAM STAIN-SO

Facility

$63.94

Service Code	HCPCS 87205
Hospital Charge Code	40134446C
Hospital Revenue Code	306
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$9.59
Rate for Payer: Qualcare PPO/HMO/WC	$9.59

SMEAR GRAM STAIN-SO

Facility

$63.94

Service Code	HCPCS 87205
Hospital Charge Code	40134446C
Hospital Revenue Code	306
Min. Negotiated Rate	$1.82
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	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$31.97
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	$16.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.59
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	$1.82

SMEAR GRAM STAIN-SO

Facility

$149.72

Service Code	HCPCS 87205
Hospital Charge Code	40464556B
Hospital Revenue Code	306
Min. Negotiated Rate	$3.42
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	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$74.86
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	$38.93
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.46
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	$4.25

SMEAR GRAM STAIN-SO

Facility

$149.72

Service Code	HCPCS 87205
Hospital Charge Code	40464556B
Hospital Revenue Code	306
Min. Negotiated Rate	$22.46
Max. Negotiated Rate	$22.46
Rate for Payer: Qualcare PPO/HMO/WC	$22.46

SMEAR GRAM STAIN-SO

Facility

$103.94

Service Code	HCPCS 87205
Hospital Charge Code	40134469B
Hospital Revenue Code	306
Min. Negotiated Rate	$2.95
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	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$51.97
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	$27.02
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.59
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	$2.95

SMEAR GRAM STAIN-SO

Facility

$103.94

Service Code	HCPCS 87205
Hospital Charge Code	40134469B
Hospital Revenue Code	306
Min. Negotiated Rate	$15.59
Max. Negotiated Rate	$15.59
Rate for Payer: Qualcare PPO/HMO/WC	$15.59

SM INTESTINE F/U MULT ADD-ON

Facility

$5,100.00

Service Code	HCPCS 74248
Hospital Charge Code	404174248
Hospital Revenue Code	320
Min. Negotiated Rate	$60.72
Max. Negotiated Rate	$2,550.00
Rate for Payer: Aetna Commercial	$1,938.00
Rate for Payer: Aetna Medicare Advantage	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,300.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,300.50
Rate for Payer: Cigna Commercial	$2,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

SM INTESTINE F/U MULT ADD-ON

Facility

$5,100.00

Service Code	HCPCS 74248
Hospital Charge Code	404174248
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

SML BONE FIXATION SYST 1.6MM

Facility

$575.00

Hospital Charge Code	270339447
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

SML BONE FIXATION SYST 1.6MM

Facility

$575.00

Hospital Charge Code	270339447
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

SMOFLIPID 20% FAT EMULS 500ML

Facility

$273.36

Service Code	NDC 63323082050
Hospital Charge Code	606390484
Hospital Revenue Code	250
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$136.68
Rate for Payer: Aetna Commercial	$103.88
Rate for Payer: Aetna Medicare Advantage	$82.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.71
Rate for Payer: Cigna Commercial	$136.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.07
Rate for Payer: Oxford Commercial	$54.67
Rate for Payer: Qualcare PPO/HMO/WC	$41.00
Rate for Payer: UnitedHealthcare Commercial	$54.67
Rate for Payer: UnitedHealthcare Community & State	$8.64
Rate for Payer: Wellpoint Medicaid Managed Care	$7.76

SMOFLIPID 20% FAT EMULS 500ML

Facility

$273.36

Service Code	NDC 63323082050
Hospital Charge Code	606390484
Hospital Revenue Code	250
Min. Negotiated Rate	$41.00
Max. Negotiated Rate	$41.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.00

SMOOTH LOCK PEG 2.2MM X 20MM

Facility

$468.00

Service Code	HCPCS C1713
Hospital Charge Code	270681157
Hospital Revenue Code	278
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$177.84
Rate for Payer: Aetna Medicare Advantage	$140.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$93.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.34
Rate for Payer: Cigna Commercial	$234.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$113.26
Rate for Payer: Qualcare PPO/HMO/WC	$70.20
Rate for Payer: UnitedHealthcare Community & State	$14.79
Rate for Payer: Wellpoint Medicaid Managed Care	$13.29

Know your out-of-pocket cost for care.

All Charges