Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SNARE SENSATION STANDARD OVAL

Facility

$72.50

Service Code	HCPCS C1773
Hospital Charge Code	270603903
Hospital Revenue Code	278
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$36.25
Rate for Payer: Aetna Commercial	$27.55
Rate for Payer: Aetna Medicare Advantage	$21.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.49
Rate for Payer: Cigna Commercial	$36.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.88
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.06

SNARE WC STD OVAL AS-1

Facility

$86.00

Hospital Charge Code	270623499
Hospital Revenue Code	272
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$12.90
Rate for Payer: Qualcare PPO/HMO/WC	$12.90

SNARE WC STD OVAL AS-1

Facility

$86.00

Hospital Charge Code	270623499
Hospital Revenue Code	272
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$43.00
Rate for Payer: Aetna Commercial	$32.68
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.93
Rate for Payer: Cigna Commercial	$43.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.36
Rate for Payer: Oxford Commercial	$17.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.90
Rate for Payer: UnitedHealthcare Commercial	$17.20
Rate for Payer: UnitedHealthcare Community & State	$2.72
Rate for Payer: Wellpoint Medicaid Managed Care	$2.44

S&N CAP-FI

Facility

$2,749.95

Hospital Charge Code	270704951
Hospital Revenue Code	279
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,374.97
Rate for Payer: Aetna Commercial	$1,044.98
Rate for Payer: Aetna Medicare Advantage	$824.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.24
Rate for Payer: Cigna Commercial	$1,374.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$714.99
Rate for Payer: Oxford Commercial	$549.99
Rate for Payer: Qualcare PPO/HMO/WC	$412.49
Rate for Payer: UnitedHealthcare Commercial	$549.99
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

S&N CAP-FI

Facility

$2,749.95

Hospital Charge Code	270704951
Hospital Revenue Code	279
Min. Negotiated Rate	$412.49
Max. Negotiated Rate	$412.49
Rate for Payer: Qualcare PPO/HMO/WC	$412.49

SNT PRTG EFLX PRB35-07-030-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644086C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SNT PRTG EFLX PRB35-07-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644086N
Hospital Revenue Code	278
Min. Negotiated Rate	$138.45
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$154.05
Rate for Payer: Wellpoint Medicaid Managed Care	$138.45

SNT PRTG EFLX PRB35-07-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644086N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

SNT PRTG EFLX PRB35-07-030-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644086C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087N
Hospital Revenue Code	278
Min. Negotiated Rate	$138.45
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$154.05
Rate for Payer: Wellpoint Medicaid Managed Care	$138.45

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

SNT PRTG EFLX PRB35-08-030-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

SODIUM ACETATE 2MEQ/ML

Facility

$4.00

Service Code	NDC 409729973
Hospital Charge Code	60630106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM ACETATE 2MEQ/ML

Facility

$4.00

Service Code	NDC 409729973
Hospital Charge Code	60630106
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

SODIUM BICARB INJ INF 4.2%

Facility

$20.10

Service Code	NDC 409553434
Hospital Charge Code	60627889
Hospital Revenue Code	250
Min. Negotiated Rate	$3.02
Max. Negotiated Rate	$3.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02

SODIUM BICARB INJ INF 4.2%

Facility

$20.10

Service Code	NDC 409553434
Hospital Charge Code	60627889
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$10.05
Rate for Payer: Aetna Commercial	$7.64
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.13
Rate for Payer: Cigna Commercial	$10.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.23
Rate for Payer: Oxford Commercial	$4.02
Rate for Payer: Qualcare PPO/HMO/WC	$3.02
Rate for Payer: UnitedHealthcare Commercial	$4.02
Rate for Payer: UnitedHealthcare Community & State	$0.64
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SODIUM BICARBONATE 2.5 MEQ/5 ML VIAL

Facility

$20.50

Service Code	NDC 63323002605
Hospital Charge Code	6063943242
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$3.08
Rate for Payer: Qualcare PPO/HMO/WC	$3.08

SODIUM BICARBONATE 2.5 MEQ/5 ML VIAL

Facility

$20.50

Service Code	NDC 63323002605
Hospital Charge Code	6063943242
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$10.25
Rate for Payer: Aetna Commercial	$7.79
Rate for Payer: Aetna Medicare Advantage	$6.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.23
Rate for Payer: Cigna Commercial	$10.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.33
Rate for Payer: Oxford Commercial	$4.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.08
Rate for Payer: UnitedHealthcare Commercial	$4.10
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.58

SODIUM BICARBONATE 650 MG TAB

Facility

$4.00

Service Code	NDC 64980018210
Hospital Charge Code	60628112
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

SODIUM BICARBONATE 650 MG TAB

Facility

$4.00

Service Code	NDC 64980018210
Hospital Charge Code	60628112
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SODIUM BICARBONATE 7.5% 50ML S

Facility

$97.15

Service Code	NDC 409491634
Hospital Charge Code	6063943243
Hospital Revenue Code	250
Min. Negotiated Rate	$14.57
Max. Negotiated Rate	$14.57
Rate for Payer: Qualcare PPO/HMO/WC	$14.57

SODIUM BICARBONATE 7.5% 50ML S

Facility

$97.15

Service Code	NDC 409491634
Hospital Charge Code	6063943243
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$48.58
Rate for Payer: Aetna Commercial	$36.92
Rate for Payer: Aetna Medicare Advantage	$29.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.77
Rate for Payer: Cigna Commercial	$48.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.26
Rate for Payer: Oxford Commercial	$19.43
Rate for Payer: Qualcare PPO/HMO/WC	$14.57
Rate for Payer: UnitedHealthcare Commercial	$19.43
Rate for Payer: UnitedHealthcare Community & State	$3.07
Rate for Payer: Wellpoint Medicaid Managed Care	$2.76

SODIUM BICARBONATE (8.4%)

Facility

$4.42

Service Code	NDC 409662502
Hospital Charge Code	60627890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.21
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna Medicare Advantage	$1.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.13
Rate for Payer: Cigna Commercial	$2.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.15
Rate for Payer: Oxford Commercial	$0.88
Rate for Payer: Qualcare PPO/HMO/WC	$0.66
Rate for Payer: UnitedHealthcare Commercial	$0.88
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SODIUM BICARBONATE (8.4%)

Facility

$4.42

Service Code	NDC 409662502
Hospital Charge Code	60627890
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Qualcare PPO/HMO/WC	$0.66

Know your out-of-pocket cost for care.

All Charges