Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SONIC TURBO MINI FLARED

Facility

$375.00

Hospital Charge Code	270660134
Hospital Revenue Code	272
Min. Negotiated Rate	$10.65
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$97.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$11.85
Rate for Payer: Wellpoint Medicaid Managed Care	$10.65

SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	83653025
Hospital Revenue Code	402
Min. Negotiated Rate	$374.85
Max. Negotiated Rate	$374.85
Rate for Payer: Qualcare PPO/HMO/WC	$374.85

SONOGRAM ABDOMINAL

Facility

$2,499.00

Service Code	HCPCS 76700
Hospital Charge Code	83653025
Hospital Revenue Code	402
Min. Negotiated Rate	$70.97
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$649.74
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$374.85
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$78.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellpoint Medicaid Managed Care	$70.97

SONOGRAM OB- COMPLETE

Facility

$1,408.00

Service Code	HCPCS 76805
Hospital Charge Code	83653040
Hospital Revenue Code	402
Min. Negotiated Rate	$211.20
Max. Negotiated Rate	$211.20
Rate for Payer: Qualcare PPO/HMO/WC	$211.20

SONOGRAM OB- COMPLETE

Facility

$1,408.00

Service Code	HCPCS 76805
Hospital Charge Code	83653040
Hospital Revenue Code	402
Min. Negotiated Rate	$39.99
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$106.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$366.08
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$211.20
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$44.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.88
Rate for Payer: Wellpoint Medicaid Managed Care	$39.99

SONOGRAM OB-REPEAT EA ADDTL FE

Facility

$1,278.20

Service Code	HCPCS 76816
Hospital Charge Code	83653075
Hospital Revenue Code	402
Min. Negotiated Rate	$191.73
Max. Negotiated Rate	$191.73
Rate for Payer: Qualcare PPO/HMO/WC	$191.73

SONOGRAM OB-REPEAT EA ADDTL FE

Facility

$1,278.20

Service Code	HCPCS 76816
Hospital Charge Code	83653075
Hospital Revenue Code	402
Min. Negotiated Rate	$36.30
Max. Negotiated Rate	$2,904.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$57.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$124.20
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.33
Rate for Payer: Oxford Commercial	$2,697.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.73
Rate for Payer: UnitedHealthcare Commercial	$2,904.00
Rate for Payer: UnitedHealthcare Community & State	$40.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$407.67
Rate for Payer: Wellpoint Medicaid Managed Care	$36.30

SORBITOL 70%/30ML

Facility

$27.14

Service Code	NDC 46287050030
Hospital Charge Code	60634966
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna Commercial	$10.31
Rate for Payer: Aetna Medicare Advantage	$8.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.92
Rate for Payer: Cigna Commercial	$13.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.06
Rate for Payer: Oxford Commercial	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$4.07
Rate for Payer: UnitedHealthcare Commercial	$5.43
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

SORBITOL 70%/30ML

Facility

$27.14

Service Code	NDC 46287050030
Hospital Charge Code	60634966
Hospital Revenue Code	250
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.07

SORBITOL 70%/473ML

Facility

$39.40

Service Code	NDC 10135013708
Hospital Charge Code	60633913
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$19.70
Rate for Payer: Aetna Commercial	$14.97
Rate for Payer: Aetna Medicare Advantage	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.05
Rate for Payer: Cigna Commercial	$19.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.24
Rate for Payer: Oxford Commercial	$7.88
Rate for Payer: Qualcare PPO/HMO/WC	$5.91
Rate for Payer: UnitedHealthcare Commercial	$7.88
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.12

SORBITOL 70%/473ML

Facility

$39.40

Service Code	NDC 10135013708
Hospital Charge Code	60633913
Hospital Revenue Code	250
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$5.91
Rate for Payer: Qualcare PPO/HMO/WC	$5.91

SORBITOL MANNITOL IRRIG 3000ml

Facility

$37.45

Hospital Charge Code	270650083
Hospital Revenue Code	270
Min. Negotiated Rate	$5.62
Max. Negotiated Rate	$5.62
Rate for Payer: Qualcare PPO/HMO/WC	$5.62

SORBITOL MANNITOL IRRIG 3000ml

Facility

$37.45

Hospital Charge Code	270650083
Hospital Revenue Code	270
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$18.73
Rate for Payer: Aetna Commercial	$14.23
Rate for Payer: Aetna Medicare Advantage	$11.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.55
Rate for Payer: Cigna Commercial	$18.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.74
Rate for Payer: Oxford Commercial	$7.49
Rate for Payer: Qualcare PPO/HMO/WC	$5.62
Rate for Payer: UnitedHealthcare Commercial	$7.49
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

SORBITOL-MANNITOL IRRIG 3000ml

Facility

$61.80

Hospital Charge Code	270649323
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$30.90
Rate for Payer: Aetna Commercial	$23.48
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.76
Rate for Payer: Cigna Commercial	$30.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.07
Rate for Payer: Oxford Commercial	$12.36
Rate for Payer: Qualcare PPO/HMO/WC	$9.27
Rate for Payer: UnitedHealthcare Commercial	$12.36
Rate for Payer: UnitedHealthcare Community & State	$1.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

SORBITOL-MANNITOL IRRIG 3000ml

Facility

$61.80

Hospital Charge Code	270649323
Hospital Revenue Code	272
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$9.27
Rate for Payer: Qualcare PPO/HMO/WC	$9.27

SORBITOL/MANNITOL IRRIGATION

Facility

$73.00

Hospital Charge Code	270335084
Hospital Revenue Code	272
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$36.50
Rate for Payer: Aetna Commercial	$27.74
Rate for Payer: Aetna Medicare Advantage	$21.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.61
Rate for Payer: Cigna Commercial	$36.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.98
Rate for Payer: Oxford Commercial	$14.60
Rate for Payer: Qualcare PPO/HMO/WC	$10.95
Rate for Payer: UnitedHealthcare Commercial	$14.60
Rate for Payer: UnitedHealthcare Community & State	$2.31
Rate for Payer: Wellpoint Medicaid Managed Care	$2.07

SORBITOL/MANNITOL IRRIGATION

Facility

$73.00

Hospital Charge Code	270335084
Hospital Revenue Code	272
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$10.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.95

SORBOFIX REF# 0113080

Facility

$2,835.00

Hospital Charge Code	270339450
Hospital Revenue Code	278
Min. Negotiated Rate	$80.51
Max. Negotiated Rate	$1,417.50
Rate for Payer: Aetna Commercial	$1,077.30
Rate for Payer: Aetna Medicare Advantage	$850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$722.92
Rate for Payer: Cigna Commercial	$1,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.07
Rate for Payer: Qualcare PPO/HMO/WC	$425.25
Rate for Payer: UnitedHealthcare Community & State	$89.59
Rate for Payer: Wellpoint Medicaid Managed Care	$80.51

SORBOFIX REF# 0113080

Facility

$2,835.00

Hospital Charge Code	270339450
Hospital Revenue Code	278
Min. Negotiated Rate	$425.25
Max. Negotiated Rate	$686.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$567.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.07
Rate for Payer: Qualcare PPO/HMO/WC	$425.25

SORB ORTHO

Facility

$3,012.00

Hospital Charge Code	270335034
Hospital Revenue Code	278
Min. Negotiated Rate	$451.80
Max. Negotiated Rate	$728.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$602.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.90
Rate for Payer: Qualcare PPO/HMO/WC	$451.80

SORB ORTHO

Facility

$3,012.00

Hospital Charge Code	270335034
Hospital Revenue Code	278
Min. Negotiated Rate	$85.54
Max. Negotiated Rate	$1,506.00
Rate for Payer: Aetna Commercial	$1,144.56
Rate for Payer: Aetna Medicare Advantage	$903.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$768.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$602.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$768.06
Rate for Payer: Cigna Commercial	$1,506.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$728.90
Rate for Payer: Qualcare PPO/HMO/WC	$451.80
Rate for Payer: UnitedHealthcare Community & State	$95.18
Rate for Payer: Wellpoint Medicaid Managed Care	$85.54

SORIN COLLECTION RESERVOIR

Facility

$342.50

Hospital Charge Code	270659423
Hospital Revenue Code	272
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$171.25
Rate for Payer: Aetna Commercial	$130.15
Rate for Payer: Aetna Medicare Advantage	$102.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.34
Rate for Payer: Cigna Commercial	$171.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.05
Rate for Payer: Oxford Commercial	$68.50
Rate for Payer: Qualcare PPO/HMO/WC	$51.38
Rate for Payer: UnitedHealthcare Commercial	$68.50
Rate for Payer: UnitedHealthcare Community & State	$10.82
Rate for Payer: Wellpoint Medicaid Managed Care	$9.73

SORIN COLLECTION RESERVOIR

Facility

$342.50

Hospital Charge Code	270659423
Hospital Revenue Code	272
Min. Negotiated Rate	$51.38
Max. Negotiated Rate	$51.38
Rate for Payer: Qualcare PPO/HMO/WC	$51.38

SOTALOL 120MG TAB

Facility

$22.91

Service Code	NDC 60505015900
Hospital Charge Code	60635771
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$11.46
Rate for Payer: Aetna Commercial	$8.71
Rate for Payer: Aetna Medicare Advantage	$6.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.84
Rate for Payer: Cigna Commercial	$11.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.96
Rate for Payer: Oxford Commercial	$4.58
Rate for Payer: Qualcare PPO/HMO/WC	$3.44
Rate for Payer: UnitedHealthcare Commercial	$4.58
Rate for Payer: UnitedHealthcare Community & State	$0.72
Rate for Payer: Wellpoint Medicaid Managed Care	$0.65

SOTALOL 120MG TAB

Facility

$22.91

Service Code	NDC 60505015900
Hospital Charge Code	60635771
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$3.44
Rate for Payer: Qualcare PPO/HMO/WC	$3.44

Know your out-of-pocket cost for care.

All Charges