Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SOLIDLOK HEX TIP 3.5MM

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	270689271
Hospital Revenue Code	278
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$60.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SOLID SCREWDRIVER SHANK S-CP

Facility

$605.00

Hospital Charge Code	270686086
Hospital Revenue Code	272
Min. Negotiated Rate	$90.75
Max. Negotiated Rate	$90.75
Rate for Payer: Qualcare PPO/HMO/WC	$90.75

SOLID SCREWDRIVER SHANK S-CP

Facility

$605.00

Hospital Charge Code	270686086
Hospital Revenue Code	272
Min. Negotiated Rate	$17.18
Max. Negotiated Rate	$302.50
Rate for Payer: Aetna Commercial	$229.90
Rate for Payer: Aetna Medicare Advantage	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.28
Rate for Payer: Cigna Commercial	$302.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.30
Rate for Payer: Oxford Commercial	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.75
Rate for Payer: UnitedHealthcare Commercial	$121.00
Rate for Payer: UnitedHealthcare Community & State	$19.12
Rate for Payer: Wellpoint Medicaid Managed Care	$17.18

SOLIUM CHLOR 0.9% IRRIG 3000ml

Facility

$35.00

Hospital Charge Code	270649754
Hospital Revenue Code	272
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$5.25
Rate for Payer: Qualcare PPO/HMO/WC	$5.25

SOLIUM CHLOR 0.9% IRRIG 3000ml

Facility

$35.00

Hospital Charge Code	270649754
Hospital Revenue Code	272
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$17.50
Rate for Payer: Aetna Commercial	$13.30
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.93
Rate for Payer: Cigna Commercial	$17.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.10
Rate for Payer: Oxford Commercial	$7.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.25
Rate for Payer: UnitedHealthcare Commercial	$7.00
Rate for Payer: UnitedHealthcare Community & State	$1.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.99

SOLUABLE TRANSFERRING RECEPTOR

Facility

$667.59

Service Code	HCPCS 84238
Hospital Charge Code	39900451
Hospital Revenue Code	301
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$99.47
Rate for Payer: Aetna Medicare Advantage	$118.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.66
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$36.57
Rate for Payer: Clover Medicare Advantage	$34.74
Rate for Payer: EmblemHealth Commercial	$109.71
Rate for Payer: Humana Medicare Advantage	$37.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$36.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$29.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.57
Rate for Payer: Wellcare Medicare Advantage	$36.57
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

SOLUABLE TRANSFERRING RECEPTOR

Facility

$667.59

Service Code	HCPCS 84238
Hospital Charge Code	39900451
Hospital Revenue Code	301
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

SOLUBLE TRANSFERRIN RECEPTOR

Facility

$290.00

Service Code	HCPCS 84238
Hospital Charge Code	38472301
Hospital Revenue Code	301
Min. Negotiated Rate	$43.50
Max. Negotiated Rate	$43.50
Rate for Payer: Qualcare PPO/HMO/WC	$43.50

SOLUBLE TRANSFERRIN RECEPTOR

Facility

$290.00

Service Code	HCPCS 84238
Hospital Charge Code	38472301
Hospital Revenue Code	301
Min. Negotiated Rate	$8.24
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$99.47
Rate for Payer: Aetna Medicare Advantage	$118.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$132.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$132.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$78.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$132.66
Rate for Payer: Cigna Commercial	$145.00
Rate for Payer: Cigna Medicare Advantage	$36.57
Rate for Payer: Clover Medicare Advantage	$34.74
Rate for Payer: EmblemHealth Commercial	$109.71
Rate for Payer: Humana Medicare Advantage	$37.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$36.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$43.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$29.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.57
Rate for Payer: Wellcare Medicare Advantage	$36.57
Rate for Payer: Wellpoint Medicaid Managed Care	$8.24

SOLU-MEDROL 40MG VIAL

Facility

$16.00

Hospital Charge Code	83652591
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

SOLU-MEDROL 40MG VIAL

Facility

$16.00

Hospital Charge Code	83652591
Hospital Revenue Code	636
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.87
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

SOLUTION 9NACL IRR 1000 2B7231

Facility

$154.50

Hospital Charge Code	270629461
Hospital Revenue Code	272
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$77.25
Rate for Payer: Aetna Commercial	$58.71
Rate for Payer: Aetna Medicare Advantage	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.40
Rate for Payer: Cigna Commercial	$77.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.17
Rate for Payer: Oxford Commercial	$30.90
Rate for Payer: Qualcare PPO/HMO/WC	$23.18
Rate for Payer: UnitedHealthcare Commercial	$30.90
Rate for Payer: UnitedHealthcare Community & State	$4.88
Rate for Payer: Wellpoint Medicaid Managed Care	$4.39

SOLUTION 9NACL IRR 1000 2B7231

Facility

$154.50

Hospital Charge Code	270629461
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$23.18
Rate for Payer: Qualcare PPO/HMO/WC	$23.18

SOLUTION ANTI-FOG FOG OUT

Facility

$528.25

Hospital Charge Code	270656228
Hospital Revenue Code	271
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$264.12
Rate for Payer: Aetna Commercial	$200.74
Rate for Payer: Aetna Medicare Advantage	$158.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.70
Rate for Payer: Cigna Commercial	$264.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.34
Rate for Payer: Oxford Commercial	$105.65
Rate for Payer: Qualcare PPO/HMO/WC	$79.24
Rate for Payer: UnitedHealthcare Commercial	$105.65
Rate for Payer: UnitedHealthcare Community & State	$16.69
Rate for Payer: Wellpoint Medicaid Managed Care	$15.00

SOLUTION ANTI-FOG FOG OUT

Facility

$528.25

Hospital Charge Code	270656228
Hospital Revenue Code	271
Min. Negotiated Rate	$79.24
Max. Negotiated Rate	$79.24
Rate for Payer: Qualcare PPO/HMO/WC	$79.24

SOLUTION BSS+

Facility

$241.55

Hospital Charge Code	270600188
Hospital Revenue Code	272
Min. Negotiated Rate	$6.86
Max. Negotiated Rate	$120.78
Rate for Payer: Aetna Commercial	$91.79
Rate for Payer: Aetna Medicare Advantage	$72.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.60
Rate for Payer: Cigna Commercial	$120.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.80
Rate for Payer: Oxford Commercial	$48.31
Rate for Payer: Qualcare PPO/HMO/WC	$36.23
Rate for Payer: UnitedHealthcare Commercial	$48.31
Rate for Payer: UnitedHealthcare Community & State	$7.63
Rate for Payer: Wellpoint Medicaid Managed Care	$6.86

SOLUTION BSS+

Facility

$241.55

Hospital Charge Code	270600188
Hospital Revenue Code	272
Min. Negotiated Rate	$36.23
Max. Negotiated Rate	$36.23
Rate for Payer: Qualcare PPO/HMO/WC	$36.23

SOLUTION BSS 15ml 079515

Facility

$12.45

Hospital Charge Code	270626716
Hospital Revenue Code	272
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Qualcare PPO/HMO/WC	$1.87

SOLUTION BSS 15ml 079515

Facility

$12.45

Hospital Charge Code	270626716
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.22
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare Advantage	$3.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.17
Rate for Payer: Cigna Commercial	$6.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.24
Rate for Payer: Oxford Commercial	$2.49
Rate for Payer: Qualcare PPO/HMO/WC	$1.87
Rate for Payer: UnitedHealthcare Commercial	$2.49
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

SOLUTION BSS 500 ML PLUS

Facility

$266.15

Hospital Charge Code	270684102
Hospital Revenue Code	272
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$133.07
Rate for Payer: Aetna Commercial	$101.14
Rate for Payer: Aetna Medicare Advantage	$79.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.87
Rate for Payer: Cigna Commercial	$133.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.20
Rate for Payer: Oxford Commercial	$53.23
Rate for Payer: Qualcare PPO/HMO/WC	$39.92
Rate for Payer: UnitedHealthcare Commercial	$53.23
Rate for Payer: UnitedHealthcare Community & State	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$7.56

SOLUTION BSS 500 ML PLUS

Facility

$266.15

Hospital Charge Code	270684102
Hospital Revenue Code	272
Min. Negotiated Rate	$39.92
Max. Negotiated Rate	$39.92
Rate for Payer: Qualcare PPO/HMO/WC	$39.92

SOLUTION DEX 10% INJ 500ml

Facility

$22.50

Hospital Charge Code	270649137
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

SOLUTION DEX 10% INJ 500ml

Facility

$22.50

Hospital Charge Code	270649137
Hospital Revenue Code	258
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

SOLUTION DEX 5% INJ 500ml

Facility

$22.50

Hospital Charge Code	270649139
Hospital Revenue Code	258
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$8.55
Rate for Payer: Aetna Medicare Advantage	$6.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.74
Rate for Payer: Cigna Commercial	$11.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.85
Rate for Payer: Oxford Commercial	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$3.38
Rate for Payer: UnitedHealthcare Commercial	$4.50
Rate for Payer: UnitedHealthcare Community & State	$0.71
Rate for Payer: Wellpoint Medicaid Managed Care	$0.64

SOLUTION DEX 5% INJ 500ml

Facility

$22.50

Hospital Charge Code	270649139
Hospital Revenue Code	258
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$3.38
Rate for Payer: Qualcare PPO/HMO/WC	$3.38

Know your out-of-pocket cost for care.

All Charges