Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SODIUM,FECES

Facility

$33.45

Service Code	HCPCS 84302
Hospital Charge Code	39900133
Hospital Revenue Code	301
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$13.22
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.63
Rate for Payer: Cigna Commercial	$16.73
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.70
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.02
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.86
Rate for Payer: Wellcare Medicare Advantage	$4.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

SODIUM,FECES

Facility

$33.45

Service Code	HCPCS 84302
Hospital Charge Code	39900133
Hospital Revenue Code	301
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$5.02
Rate for Payer: Qualcare PPO/HMO/WC	$5.02

SODIUM;OTHER SOURCE

Facility

$34.00

Service Code	HCPCS 84302
Hospital Charge Code	38477039
Hospital Revenue Code	301
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$13.22
Rate for Payer: Aetna Medicare Advantage	$15.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.63
Rate for Payer: Cigna Commercial	$17.00
Rate for Payer: Cigna Medicare Advantage	$4.86
Rate for Payer: Clover Medicare Advantage	$4.62
Rate for Payer: EmblemHealth Commercial	$14.58
Rate for Payer: Humana Medicare Advantage	$5.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.84
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.86
Rate for Payer: Wellcare Medicare Advantage	$4.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

SODIUM;OTHER SOURCE

Facility

$34.00

Service Code	HCPCS 84302
Hospital Charge Code	38477039
Hospital Revenue Code	301
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

SODIUM PHOS INJ 15ML

Facility

$9.58

Service Code	NDC 409739172
Hospital Charge Code	60627936
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.79
Rate for Payer: Aetna Commercial	$3.64
Rate for Payer: Aetna Medicare Advantage	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.44
Rate for Payer: Cigna Commercial	$4.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.49
Rate for Payer: Oxford Commercial	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.44
Rate for Payer: UnitedHealthcare Commercial	$1.92
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

SODIUM PHOS INJ 15ML

Facility

$9.58

Service Code	NDC 409739172
Hospital Charge Code	60627936
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Qualcare PPO/HMO/WC	$1.44

SODIUM PLSTY SULF SSP15GM/60ML

Facility

$207.70

Service Code	NDC 46287000660
Hospital Charge Code	60627940
Hospital Revenue Code	250
Min. Negotiated Rate	$31.16
Max. Negotiated Rate	$31.16
Rate for Payer: Qualcare PPO/HMO/WC	$31.16

SODIUM PLSTY SULF SSP15GM/60ML

Facility

$207.70

Service Code	NDC 46287000660
Hospital Charge Code	60627940
Hospital Revenue Code	250
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$103.85
Rate for Payer: Aetna Commercial	$78.93
Rate for Payer: Aetna Medicare Advantage	$62.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.96
Rate for Payer: Cigna Commercial	$103.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.00
Rate for Payer: Oxford Commercial	$41.54
Rate for Payer: Qualcare PPO/HMO/WC	$31.16
Rate for Payer: UnitedHealthcare Commercial	$41.54
Rate for Payer: UnitedHealthcare Community & State	$6.56
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

SODIUM, RANDOM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002481
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, RANDOM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002481
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
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	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SODIUM, SERUM

Facility

$94.00

Service Code	HCPCS 84295
Hospital Charge Code	38472608
Hospital Revenue Code	301
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna Medicare Advantage	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.45
Rate for Payer: Cigna Commercial	$47.00
Rate for Payer: Cigna Medicare Advantage	$4.81
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.44
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.10
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Medicare Advantage	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2.67

SODIUM, SERUM

Facility

$94.00

Service Code	HCPCS 84295
Hospital Charge Code	38472608
Hospital Revenue Code	301
Min. Negotiated Rate	$14.10
Max. Negotiated Rate	$14.10
Rate for Payer: Qualcare PPO/HMO/WC	$14.10

SODIUM, SERUM (NA)

Facility

$390.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, SERUM (NA)

Facility

$390.00

Service Code	HCPCS 84295
Hospital Charge Code	3002474
Hospital Revenue Code	301
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.08
Rate for Payer: Aetna Medicare Advantage	$15.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.81
Rate for Payer: Clover Medicare Advantage	$4.57
Rate for Payer: EmblemHealth Commercial	$14.43
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.81
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	$3.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.81
Rate for Payer: Wellcare Medicare Advantage	$4.81
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	39990241J
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
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	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SODIUM URINE

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	39990241J
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SODIUM, URINE

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38472611
Hospital Revenue Code	301
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Qualcare PPO/HMO/WC	$17.55

SODIUM, URINE

Facility

$117.00

Service Code	HCPCS 84300
Hospital Charge Code	38472611
Hospital Revenue Code	301
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$58.50
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.42
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.55
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$3.32

SODIUM, URINE 24 HOUR

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002482
Hospital Revenue Code	301
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Medicare Advantage	$16.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.06
Rate for Payer: Clover Medicare Advantage	$4.81
Rate for Payer: EmblemHealth Commercial	$15.18
Rate for Payer: Humana Medicare Advantage	$5.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.06
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	$4.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.06
Rate for Payer: Wellcare Medicare Advantage	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SODIUM, URINE 24 HOUR

Facility

$390.00

Service Code	HCPCS 84300
Hospital Charge Code	3002482
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SOFAMOR DANEK

Facility

$400.00

Hospital Charge Code	270339543
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

SOFAMOR DANEK

Facility

$400.00

Hospital Charge Code	270339543
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

SOFRADIM MESH PCO-1510 6X4

Facility

$905.00

Hospital Charge Code	270338746
Hospital Revenue Code	278
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$452.50
Rate for Payer: Aetna Commercial	$343.90
Rate for Payer: Aetna Medicare Advantage	$271.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$230.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$230.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$230.78
Rate for Payer: Cigna Commercial	$452.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.01
Rate for Payer: Qualcare PPO/HMO/WC	$135.75
Rate for Payer: UnitedHealthcare Community & State	$28.60
Rate for Payer: Wellpoint Medicaid Managed Care	$25.70

SOFRADIM MESH PCO-1510 6X4

Facility

$905.00

Hospital Charge Code	270338746
Hospital Revenue Code	278
Min. Negotiated Rate	$135.75
Max. Negotiated Rate	$219.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$181.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$219.01
Rate for Payer: Qualcare PPO/HMO/WC	$135.75

SOFRADIM MESH PCO-2015 8X6

Facility

$1,227.00

Hospital Charge Code	270338747
Hospital Revenue Code	278
Min. Negotiated Rate	$184.05
Max. Negotiated Rate	$296.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$245.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.93
Rate for Payer: Qualcare PPO/HMO/WC	$184.05

Know your out-of-pocket cost for care.

All Charges