Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPECIAL TELETX PORT PLAN-GL

Facility

$1,887.22

Service Code	HCPCS 77321
Hospital Charge Code	85000520
Hospital Revenue Code	333
Min. Negotiated Rate	$283.08
Max. Negotiated Rate	$283.08
Rate for Payer: Qualcare PPO/HMO/WC	$283.08

SPECIAL TELETX PORT PLAN-GL

Facility

$1,887.22

Service Code	HCPCS 77321
Hospital Charge Code	85000520
Hospital Revenue Code	333
Min. Negotiated Rate	$53.60
Max. Negotiated Rate	$6,851.00
Rate for Payer: Aetna Commercial	$1,209.94
Rate for Payer: Aetna Medicare Advantage	$1,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,613.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$444.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,613.62
Rate for Payer: Cigna Commercial	$891.65
Rate for Payer: Cigna Medicare Advantage	$311.38
Rate for Payer: Clover Medicare Advantage	$422.59
Rate for Payer: EmblemHealth Commercial	$1,334.49
Rate for Payer: Humana Medicare Advantage	$458.17
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$444.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$490.68
Rate for Payer: Oxford Commercial	$6,034.00
Rate for Payer: Qualcare PPO/HMO/WC	$283.08
Rate for Payer: UnitedHealthcare Commercial	$6,851.00
Rate for Payer: UnitedHealthcare Community & State	$59.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$444.83
Rate for Payer: Wellcare Medicare Advantage	$444.83
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$425.46
Rate for Payer: Wellpoint Medicaid Managed Care	$53.60

SPECIFIC GRAVITY, FLUID

Facility

$95.00

Service Code	HCPCS 84315
Hospital Charge Code	38473056
Hospital Revenue Code	301
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$14.25
Rate for Payer: Qualcare PPO/HMO/WC	$14.25

SPECIFIC GRAVITY, FLUID

Facility

$95.00

Service Code	HCPCS 84315
Hospital Charge Code	38473056
Hospital Revenue Code	301
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.90
Rate for Payer: Cigna Commercial	$47.50
Rate for Payer: Cigna Medicare Advantage	$3.28
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.70
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$14.25
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Medicare Advantage	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.70

SPECIFIC GRAVITY, SYNOVIAL FLD

Facility

$390.00

Service Code	HCPCS 84315
Hospital Charge Code	3008654
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECIFIC GRAVITY, SYNOVIAL FLD

Facility

$390.00

Service Code	HCPCS 84315
Hospital Charge Code	3008654
Hospital Revenue Code	301
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$8.92
Rate for Payer: Aetna Medicare Advantage	$10.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.90
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.28
Rate for Payer: Clover Medicare Advantage	$3.12
Rate for Payer: EmblemHealth Commercial	$9.84
Rate for Payer: Humana Medicare Advantage	$3.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.28
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	$2.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.28
Rate for Payer: Wellcare Medicare Advantage	$3.28
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SPECIFIC GRAVITY, URINE

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	3003555
Hospital Revenue Code	307
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$9.47
Rate for Payer: Aetna Medicare Advantage	$11.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$3.48
Rate for Payer: Clover Medicare Advantage	$3.31
Rate for Payer: EmblemHealth Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3.48
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	$2.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.48
Rate for Payer: Wellcare Medicare Advantage	$3.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SPECIFIC GRAVITY, URINE

Facility

$390.00

Service Code	HCPCS 81002
Hospital Charge Code	3003555
Hospital Revenue Code	307
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECIMEN BAG

Facility

$268.00

Hospital Charge Code	270338724
Hospital Revenue Code	272
Min. Negotiated Rate	$40.20
Max. Negotiated Rate	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.20

SPECIMEN BAG

Facility

$268.00

Hospital Charge Code	270338724
Hospital Revenue Code	272
Min. Negotiated Rate	$7.61
Max. Negotiated Rate	$134.00
Rate for Payer: Aetna Commercial	$101.84
Rate for Payer: Aetna Medicare Advantage	$80.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.34
Rate for Payer: Cigna Commercial	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.68
Rate for Payer: Oxford Commercial	$53.60
Rate for Payer: Qualcare PPO/HMO/WC	$40.20
Rate for Payer: UnitedHealthcare Commercial	$53.60
Rate for Payer: UnitedHealthcare Community & State	$8.47
Rate for Payer: Wellpoint Medicaid Managed Care	$7.61

SPECIMEN INFECT AGNT CONCNT

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	401087015
Hospital Revenue Code	306
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$18.17
Rate for Payer: Aetna Medicare Advantage	$21.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$6.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.23
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$6.68
Rate for Payer: Clover Medicare Advantage	$6.35
Rate for Payer: EmblemHealth Commercial	$20.04
Rate for Payer: Humana Medicare Advantage	$6.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$6.68
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	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.68
Rate for Payer: Wellcare Medicare Advantage	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SPECIMEN INFECT AGNT CONCNT

Facility

$390.00

Service Code	HCPCS 87015
Hospital Charge Code	401087015
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPECTRAPENILEPROSTHES9.5X16CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270663878
Hospital Revenue Code	278
Min. Negotiated Rate	$932.51
Max. Negotiated Rate	$16,417.50
Rate for Payer: Aetna Commercial	$12,477.30
Rate for Payer: Aetna Medicare Advantage	$9,850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,372.92
Rate for Payer: Cigna Commercial	$16,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25
Rate for Payer: UnitedHealthcare Community & State	$1,037.59
Rate for Payer: Wellpoint Medicaid Managed Care	$932.51

SPECTRAPENILEPROSTHES9.5X16CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270663878
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$7,946.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRA PENILE PROSTHESIS

Facility

$57,475.00

Service Code	HCPCS C2622
Hospital Charge Code	270685525
Hospital Revenue Code	278
Min. Negotiated Rate	$8,621.25
Max. Negotiated Rate	$13,908.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,908.95
Rate for Payer: Qualcare PPO/HMO/WC	$8,621.25

SPECTRA PENILE PROSTHESIS

Facility

$57,475.00

Service Code	HCPCS C2622
Hospital Charge Code	270685525
Hospital Revenue Code	278
Min. Negotiated Rate	$1,632.29
Max. Negotiated Rate	$28,737.50
Rate for Payer: Aetna Commercial	$21,840.50
Rate for Payer: Aetna Medicare Advantage	$17,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,656.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,656.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,656.12
Rate for Payer: Cigna Commercial	$28,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,908.95
Rate for Payer: Qualcare PPO/HMO/WC	$8,621.25
Rate for Payer: UnitedHealthcare Community & State	$1,816.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.29

SPECTRAPENILEPROSTHESIS12X12CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270661187
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$7,946.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRAPENILEPROSTHESIS12X12CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270661187
Hospital Revenue Code	278
Min. Negotiated Rate	$932.51
Max. Negotiated Rate	$16,417.50
Rate for Payer: Aetna Commercial	$12,477.30
Rate for Payer: Aetna Medicare Advantage	$9,850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,372.92
Rate for Payer: Cigna Commercial	$16,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25
Rate for Payer: UnitedHealthcare Community & State	$1,037.59
Rate for Payer: Wellpoint Medicaid Managed Care	$932.51

SPECTRA REAR TIP EXTENDER 9.5

Facility

$21.40

Service Code	HCPCS C1813
Hospital Charge Code	270663879
Hospital Revenue Code	278
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.70
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare Advantage	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.46
Rate for Payer: Cigna Commercial	$10.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

SPECTRA REAR TIP EXTENDER 9.5

Facility

$21.40

Service Code	HCPCS C1813
Hospital Charge Code	270663879
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SPECULUM VAG DISPOS W/BUILT IN

Facility

$21.27

Hospital Charge Code	270654043
Hospital Revenue Code	272
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.19

SPECULUM VAG DISPOS W/BUILT IN

Facility

$21.27

Hospital Charge Code	270654043
Hospital Revenue Code	272
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna Commercial	$8.08
Rate for Payer: Aetna Medicare Advantage	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.42
Rate for Payer: Cigna Commercial	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.53
Rate for Payer: Oxford Commercial	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.19
Rate for Payer: UnitedHealthcare Commercial	$4.25
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.60

SPECULUM VAGINAL DISP

Facility

$4.85

Hospital Charge Code	270301895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.26
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.15
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

SPECULUM VAGINAL DISP

Facility

$4.85

Hospital Charge Code	270301895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

SPECULUM VAGINAL LARGE DISP.

Facility

$8.64

Hospital Charge Code	270658820
Hospital Revenue Code	270
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.32
Rate for Payer: Aetna Commercial	$3.28
Rate for Payer: Aetna Medicare Advantage	$2.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.20
Rate for Payer: Cigna Commercial	$4.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.25
Rate for Payer: Oxford Commercial	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.30
Rate for Payer: UnitedHealthcare Commercial	$1.73
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

Know your out-of-pocket cost for care.

All Charges