Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SOTALOL 80 MG TAB

Facility

$17.49

Service Code	NDC 245001201
Hospital Charge Code	60628706
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$8.74
Rate for Payer: Aetna Commercial	$6.65
Rate for Payer: Aetna Medicare Advantage	$5.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.46
Rate for Payer: Cigna Commercial	$8.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.55
Rate for Payer: Oxford Commercial	$3.50
Rate for Payer: Qualcare PPO/HMO/WC	$2.62
Rate for Payer: UnitedHealthcare Commercial	$3.50
Rate for Payer: UnitedHealthcare Community & State	$0.55
Rate for Payer: Wellpoint Medicaid Managed Care	$0.50

SOTALOL 80 MG TAB

Facility

$17.49

Service Code	NDC 245001201
Hospital Charge Code	60628706
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$2.62
Rate for Payer: Qualcare PPO/HMO/WC	$2.62

SOTRADECOL 1% 20MG/2ML

Facility

$628.13

Service Code	NDC 67457016202
Hospital Charge Code	606390233
Hospital Revenue Code	250
Min. Negotiated Rate	$17.84
Max. Negotiated Rate	$314.06
Rate for Payer: Aetna Commercial	$238.69
Rate for Payer: Aetna Medicare Advantage	$188.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.17
Rate for Payer: Cigna Commercial	$314.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.31
Rate for Payer: Oxford Commercial	$125.63
Rate for Payer: Qualcare PPO/HMO/WC	$94.22
Rate for Payer: UnitedHealthcare Commercial	$125.63
Rate for Payer: UnitedHealthcare Community & State	$19.85
Rate for Payer: Wellpoint Medicaid Managed Care	$17.84

SOTRADECOL 1% 20MG/2ML

Facility

$628.13

Service Code	NDC 67457016202
Hospital Charge Code	606390233
Hospital Revenue Code	250
Min. Negotiated Rate	$94.22
Max. Negotiated Rate	$94.22
Rate for Payer: Qualcare PPO/HMO/WC	$94.22

SOTROVIMAB 500MG INJ EUA

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	606390475
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

SOTROVIMAB 500MG INJ EUA

Facility

$0.01

Service Code	HCPCS Q0247
Hospital Charge Code	606390475
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SP 2.6MM FIBER TAK SUTURE ANCH

Facility

$2,111.50

Service Code	HCPCS C1713
Hospital Charge Code	270705067
Hospital Revenue Code	278
Min. Negotiated Rate	$316.73
Max. Negotiated Rate	$510.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.98
Rate for Payer: Qualcare PPO/HMO/WC	$316.73

SP 2.6MM FIBER TAK SUTURE ANCH

Facility

$2,111.50

Service Code	HCPCS C1713
Hospital Charge Code	270705067
Hospital Revenue Code	278
Min. Negotiated Rate	$59.97
Max. Negotiated Rate	$1,055.75
Rate for Payer: Aetna Commercial	$802.37
Rate for Payer: Aetna Medicare Advantage	$633.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$538.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$538.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$422.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$538.43
Rate for Payer: Cigna Commercial	$1,055.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$510.98
Rate for Payer: Qualcare PPO/HMO/WC	$316.73
Rate for Payer: UnitedHealthcare Community & State	$66.72
Rate for Payer: Wellpoint Medicaid Managed Care	$59.97

SPACEBANDER

Facility

$375.00

Hospital Charge Code	270701114
Hospital Revenue Code	250
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

SPACEBANDER

Facility

$375.00

Hospital Charge Code	270701114
Hospital Revenue Code	250
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

SPACEMAKER DISSEC. BALLOON

Facility

$1,386.00

Hospital Charge Code	270332700
Hospital Revenue Code	278
Min. Negotiated Rate	$207.90
Max. Negotiated Rate	$335.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.41
Rate for Payer: Qualcare PPO/HMO/WC	$207.90

SPACEMAKER DISSEC. BALLOON

Facility

$1,386.00

Hospital Charge Code	270332700
Hospital Revenue Code	278
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$693.00
Rate for Payer: Aetna Commercial	$526.68
Rate for Payer: Aetna Medicare Advantage	$415.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$353.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$353.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$353.43
Rate for Payer: Cigna Commercial	$693.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$335.41
Rate for Payer: Qualcare PPO/HMO/WC	$207.90
Rate for Payer: UnitedHealthcare Community & State	$43.80
Rate for Payer: Wellpoint Medicaid Managed Care	$39.36

SPACER 13MM FORTILINK

Facility

$18,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692467
Hospital Revenue Code	278
Min. Negotiated Rate	$525.40
Max. Negotiated Rate	$9,250.00
Rate for Payer: Aetna Commercial	$7,030.00
Rate for Payer: Aetna Medicare Advantage	$5,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,717.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,717.50
Rate for Payer: Cigna Commercial	$9,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,477.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,775.00
Rate for Payer: UnitedHealthcare Community & State	$584.60
Rate for Payer: Wellpoint Medicaid Managed Care	$525.40

SPACER 13MM FORTILINK

Facility

$18,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270692467
Hospital Revenue Code	278
Min. Negotiated Rate	$2,775.00
Max. Negotiated Rate	$4,477.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,477.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,775.00

SPACER 8X18X55MM 10D

Facility

$36,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270703546
Hospital Revenue Code	278
Min. Negotiated Rate	$1,025.95
Max. Negotiated Rate	$18,062.50
Rate for Payer: Aetna Commercial	$13,727.50
Rate for Payer: Aetna Medicare Advantage	$10,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,211.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,211.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,211.88
Rate for Payer: Cigna Commercial	$18,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,742.25
Rate for Payer: Qualcare PPO/HMO/WC	$5,418.75
Rate for Payer: UnitedHealthcare Community & State	$1,141.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1,025.95

SPACER 8X18X55MM 10D

Facility

$36,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270703546
Hospital Revenue Code	278
Min. Negotiated Rate	$5,418.75
Max. Negotiated Rate	$8,742.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,742.25
Rate for Payer: Qualcare PPO/HMO/WC	$5,418.75

SPACER 8X34X24MM 10DEG

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704557
Hospital Revenue Code	278
Min. Negotiated Rate	$4,968.75
Max. Negotiated Rate	$8,016.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75

SPACER 8X34X24MM 10DEG

Facility

$33,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270704557
Hospital Revenue Code	278
Min. Negotiated Rate	$940.75
Max. Negotiated Rate	$16,562.50
Rate for Payer: Aetna Commercial	$12,587.50
Rate for Payer: Aetna Medicare Advantage	$9,937.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,446.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,446.88
Rate for Payer: Cigna Commercial	$16,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,016.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,968.75
Rate for Payer: UnitedHealthcare Community & State	$1,046.75
Rate for Payer: Wellpoint Medicaid Managed Care	$940.75

SPACER ALTERA 10X26 9-13MM 15D

Facility

$32,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698396
Hospital Revenue Code	278
Min. Negotiated Rate	$908.80
Max. Negotiated Rate	$16,000.00
Rate for Payer: Aetna Commercial	$12,160.00
Rate for Payer: Aetna Medicare Advantage	$9,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,160.00
Rate for Payer: Cigna Commercial	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00
Rate for Payer: UnitedHealthcare Community & State	$1,011.20
Rate for Payer: Wellpoint Medicaid Managed Care	$908.80

SPACER ALTERA 10X26 9-13MM 15D

Facility

$32,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270698396
Hospital Revenue Code	278
Min. Negotiated Rate	$4,800.00
Max. Negotiated Rate	$7,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00

SPACERALTERA10X31 10 14MM15DEG

Facility

$32,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694881
Hospital Revenue Code	278
Min. Negotiated Rate	$4,800.00
Max. Negotiated Rate	$7,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00

SPACERALTERA10X31 10 14MM15DEG

Facility

$32,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270694881
Hospital Revenue Code	278
Min. Negotiated Rate	$908.80
Max. Negotiated Rate	$16,000.00
Rate for Payer: Aetna Commercial	$12,160.00
Rate for Payer: Aetna Medicare Advantage	$9,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,160.00
Rate for Payer: Cigna Commercial	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00
Rate for Payer: UnitedHealthcare Community & State	$1,011.20
Rate for Payer: Wellpoint Medicaid Managed Care	$908.80

SPACER ALTERA 10X31 12-16MM15D

Facility

$32,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695755
Hospital Revenue Code	278
Min. Negotiated Rate	$908.80
Max. Negotiated Rate	$16,000.00
Rate for Payer: Aetna Commercial	$12,160.00
Rate for Payer: Aetna Medicare Advantage	$9,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,160.00
Rate for Payer: Cigna Commercial	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00
Rate for Payer: UnitedHealthcare Community & State	$1,011.20
Rate for Payer: Wellpoint Medicaid Managed Care	$908.80

SPACER ALTERA 10X31 12-16MM15D

Facility

$32,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270695755
Hospital Revenue Code	278
Min. Negotiated Rate	$4,800.00
Max. Negotiated Rate	$7,744.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00

SPACER ALTERA 10X31 8-12MM 8D

Facility

$32,000.00

Service Code	HCPCS C1889
Hospital Charge Code	270697430
Hospital Revenue Code	278
Min. Negotiated Rate	$908.80
Max. Negotiated Rate	$16,000.00
Rate for Payer: Aetna Commercial	$12,160.00
Rate for Payer: Aetna Medicare Advantage	$9,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,160.00
Rate for Payer: Cigna Commercial	$16,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,744.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,800.00
Rate for Payer: UnitedHealthcare Community & State	$1,011.20
Rate for Payer: Wellpoint Medicaid Managed Care	$908.80

Know your out-of-pocket cost for care.

All Charges