Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPIROMETER INCENTIVE

Facility

$37.65

Hospital Charge Code	270607014
Hospital Revenue Code	270
Min. Negotiated Rate	$5.65
Max. Negotiated Rate	$5.65
Rate for Payer: Qualcare PPO/HMO/WC	$5.65

SPIROMETER INCENTIVE DEVICE

Facility

$32.00

Hospital Charge Code	270603159
Hospital Revenue Code	272
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$4.80

SPIROMETER INCENTIVE DEVICE

Facility

$32.00

Hospital Charge Code	270603159
Hospital Revenue Code	272
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna Commercial	$12.16
Rate for Payer: Aetna Medicare Advantage	$9.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.16
Rate for Payer: Cigna Commercial	$16.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.32
Rate for Payer: Oxford Commercial	$6.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.80
Rate for Payer: UnitedHealthcare Commercial	$6.40
Rate for Payer: UnitedHealthcare Community & State	$1.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.91

SPIROMETRY PRE AND POST NEB RX

Facility

$354.00

Service Code	HCPCS 94060
Hospital Charge Code	83652375
Hospital Revenue Code	460
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SPIROMETRY PRE AND POST NEB RX

Facility

$354.00

Service Code	HCPCS 94060
Hospital Charge Code	83652375
Hospital Revenue Code	460
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,608.14
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.04
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.10
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$11.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.05

SPIROMETRY PRE & POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502875
Hospital Revenue Code	460
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.42

SPIROMETRY PRE & POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502875
Hospital Revenue Code	460
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,608.14
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.40
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.42
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

SPIROMETRY PRE&POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502730
Hospital Revenue Code	460
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$1,205.83
Rate for Payer: Aetna Medicare Advantage	$1,436.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,608.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$443.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$238.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,608.14
Rate for Payer: Cigna Commercial	$888.63
Rate for Payer: Cigna Medicare Advantage	$443.32
Rate for Payer: Clover Medicare Advantage	$421.15
Rate for Payer: EmblemHealth Commercial	$1,329.96
Rate for Payer: Humana Medicare Advantage	$456.62
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$443.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.40
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.42
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$443.32
Rate for Payer: Wellcare Medicare Advantage	$443.32
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

SPIROMETRY PRE&POST NEB RX

Facility

$36.16

Service Code	HCPCS 94060
Hospital Charge Code	87502730
Hospital Revenue Code	460
Min. Negotiated Rate	$5.42
Max. Negotiated Rate	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$5.42

SPIROMETRY W GRAPHIC REC(MACHI

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	83652373
Hospital Revenue Code	460
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.53
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.04
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.10
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$11.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.05

SPIROMETRY W GRAPHIC REC(MACHI

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	83652373
Hospital Revenue Code	460
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SPIRONOLACTONE 25 MG TAB

Facility

$4.00

Service Code	NDC 51079010320
Hospital Charge Code	60627976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SPIRONOLACTONE 25 MG TAB

Facility

$4.00

Service Code	NDC 51079010320
Hospital Charge Code	60627976
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SPIRONOLACTONE (ALDACTONE) 50M

Facility

$5.76

Service Code	NDC 68084020701
Hospital Charge Code	60630142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Qualcare PPO/HMO/WC	$0.86

SPIRONOLACTONE (ALDACTONE) 50M

Facility

$5.76

Service Code	NDC 68084020701
Hospital Charge Code	60630142
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.19
Rate for Payer: Aetna Medicare Advantage	$1.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.47
Rate for Payer: Cigna Commercial	$2.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.50
Rate for Payer: Oxford Commercial	$1.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.86
Rate for Payer: UnitedHealthcare Commercial	$1.15
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SPIROTOMY W GRAPHIC REC (MACH)

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	87502725
Hospital Revenue Code	460
Min. Negotiated Rate	$53.10
Max. Negotiated Rate	$53.10
Rate for Payer: Qualcare PPO/HMO/WC	$53.10

SPIROTOMY W GRAPHIC REC (MACH)

Facility

$354.00

Service Code	HCPCS 94010
Hospital Charge Code	87502725
Hospital Revenue Code	460
Min. Negotiated Rate	$10.05
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$697.73
Rate for Payer: Aetna Medicare Advantage	$831.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$930.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$256.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$174.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$930.53
Rate for Payer: Cigna Commercial	$514.20
Rate for Payer: Cigna Medicare Advantage	$256.52
Rate for Payer: Clover Medicare Advantage	$243.69
Rate for Payer: EmblemHealth Commercial	$769.56
Rate for Payer: Humana Medicare Advantage	$264.22
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$256.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$92.04
Rate for Payer: Oxford Commercial	$2,184.00
Rate for Payer: Qualcare PPO/HMO/WC	$53.10
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$11.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$256.52
Rate for Payer: Wellcare Medicare Advantage	$256.52
Rate for Payer: Wellpoint Medicaid Managed Care	$10.05

SPL AVULSE NP,SGL

Facility

$723.29

Service Code	HCPCS 11730
Hospital Charge Code	1600000565
Hospital Revenue Code	360
Min. Negotiated Rate	$20.54
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.06
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$108.49
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$22.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$20.54

SPL AVULSE NP,SGL

Facility

$723.29

Service Code	HCPCS 11730
Hospital Charge Code	1600000565
Hospital Revenue Code	360
Min. Negotiated Rate	$108.49
Max. Negotiated Rate	$108.49
Rate for Payer: Qualcare PPO/HMO/WC	$108.49

SPLENECTOMY,TOTAL

Facility

$12,780.80

Service Code	HCPCS 38100
Hospital Charge Code	1600000498
Hospital Revenue Code	360
Min. Negotiated Rate	$362.97
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$4,856.70
Rate for Payer: Aetna Medicare Advantage	$3,834.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,259.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,259.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,259.10
Rate for Payer: Cigna Commercial	$6,390.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,323.01
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.12
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$403.87
Rate for Payer: Wellpoint Medicaid Managed Care	$362.97

SPLENECTOMY,TOTAL

Facility

$12,780.80

Service Code	HCPCS 38100
Hospital Charge Code	1600000498
Hospital Revenue Code	360
Min. Negotiated Rate	$1,917.12
Max. Negotiated Rate	$1,917.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.12

SPLENECTOMY WITH CC

Facility

$108,223.60

Service Code	MSDRG 800
Min. Negotiated Rate	$32,952.70
Max. Negotiated Rate	$108,223.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78,128.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78,128.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78,128.10

SPLENECTOMY WITH MCC

Facility

$162,548.72

Service Code	MSDRG 799
Min. Negotiated Rate	$49,494.00
Max. Negotiated Rate	$162,548.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137,139.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137,139.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137,139.75

SPLENECTOMY WITHOUT CC/MCC

Facility

$79,773.60

Service Code	MSDRG 801
Min. Negotiated Rate	$24,290.04
Max. Negotiated Rate	$79,773.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,591.95

SPLENIC PROCEDURES

Facility

$35,390.38

Service Code	APR-DRG 6503
Min. Negotiated Rate	$34,696.45
Max. Negotiated Rate	$35,390.38
Rate for Payer: UnitedHealthcare Community & State	$34,696.45
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$35,390.38
Rate for Payer: Wellpoint Medicaid Managed Care	$34,696.45

Know your out-of-pocket cost for care.

All Charges