Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPLINT/THUMB WRIST L S

Facility

$69.75

Hospital Charge Code	270665593
Hospital Revenue Code	270
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$34.88
Rate for Payer: Aetna Commercial	$26.50
Rate for Payer: Aetna Medicare Advantage	$20.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.79
Rate for Payer: Cigna Commercial	$34.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.14
Rate for Payer: Oxford Commercial	$13.95
Rate for Payer: Qualcare PPO/HMO/WC	$10.46
Rate for Payer: UnitedHealthcare Commercial	$13.95
Rate for Payer: UnitedHealthcare Community & State	$2.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.98

SPLINT THUMB/WRIST R L

Facility

$72.00

Hospital Charge Code	270665598
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

SPLINT THUMB/WRIST R L

Facility

$72.00

Hospital Charge Code	270665598
Hospital Revenue Code	270
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

SPLINT THUMB/WRIST R M

Facility

$72.00

Hospital Charge Code	270665596
Hospital Revenue Code	270
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

SPLINT THUMB/WRIST R M

Facility

$72.00

Hospital Charge Code	270665596
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

Splint Thumb Wrist Rt sm 70313

Facility

$72.00

Hospital Charge Code	270665606
Hospital Revenue Code	270
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

Splint Thumb Wrist Rt sm 70313

Facility

$72.00

Hospital Charge Code	270665606
Hospital Revenue Code	270
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

SPLINT WRIST L 8 LG

Facility

$47.15

Hospital Charge Code	270600800
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$23.57
Rate for Payer: Aetna Commercial	$17.92
Rate for Payer: Aetna Medicare Advantage	$14.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.02
Rate for Payer: Cigna Commercial	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.26
Rate for Payer: Oxford Commercial	$9.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.07
Rate for Payer: UnitedHealthcare Commercial	$9.43
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

SPLINT WRIST L 8 LG

Facility

$47.15

Hospital Charge Code	270600800
Hospital Revenue Code	270
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$7.07
Rate for Payer: Qualcare PPO/HMO/WC	$7.07

SPLINT WRIST R 8 MED

Facility

$47.15

Hospital Charge Code	270600801
Hospital Revenue Code	270
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$7.07
Rate for Payer: Qualcare PPO/HMO/WC	$7.07

SPLINT WRIST R 8 MED

Facility

$47.15

Hospital Charge Code	270600801
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$23.57
Rate for Payer: Aetna Commercial	$17.92
Rate for Payer: Aetna Medicare Advantage	$14.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.02
Rate for Payer: Cigna Commercial	$23.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.26
Rate for Payer: Oxford Commercial	$9.43
Rate for Payer: Qualcare PPO/HMO/WC	$7.07
Rate for Payer: UnitedHealthcare Commercial	$9.43
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.34

SPLIT BLOOD UNIT

Facility

$1,255.00

Hospital Charge Code	38471157
Hospital Revenue Code	390
Min. Negotiated Rate	$35.64
Max. Negotiated Rate	$1,167.00
Rate for Payer: Aetna Commercial	$476.90
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.30
Rate for Payer: Oxford Commercial	$1,028.00
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$39.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.64

SPLIT BLOOD UNIT

Facility

$1,255.00

Hospital Charge Code	38471157
Hospital Revenue Code	390
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$188.25
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

SPLIT SHEET TIBURON

Facility

$23.95

Hospital Charge Code	270665839
Hospital Revenue Code	270
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$11.97
Rate for Payer: Aetna Commercial	$9.10
Rate for Payer: Aetna Medicare Advantage	$7.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.11
Rate for Payer: Cigna Commercial	$11.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.23
Rate for Payer: Oxford Commercial	$4.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.59
Rate for Payer: UnitedHealthcare Commercial	$4.79
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

SPLIT SHEET TIBURON

Facility

$23.95

Hospital Charge Code	270665839
Hospital Revenue Code	270
Min. Negotiated Rate	$3.59
Max. Negotiated Rate	$3.59
Rate for Payer: Qualcare PPO/HMO/WC	$3.59

SPLITTING OF BLOOD

Facility

$296.00

Service Code	HCPCS 86985
Hospital Charge Code	38471153
Hospital Revenue Code	309
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$44.40
Rate for Payer: Qualcare PPO/HMO/WC	$44.40

SPLITTING OF BLOOD

Facility

$296.00

Service Code	HCPCS 86985
Hospital Charge Code	38471153
Hospital Revenue Code	309
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$734.21
Rate for Payer: Aetna Commercial	$550.53
Rate for Payer: Aetna Medicare Advantage	$655.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$734.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$202.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$734.21
Rate for Payer: Cigna Commercial	$405.73
Rate for Payer: Cigna Medicare Advantage	$202.40
Rate for Payer: Clover Medicare Advantage	$192.28
Rate for Payer: EmblemHealth Commercial	$607.20
Rate for Payer: Humana Medicare Advantage	$208.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$202.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$76.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$44.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$25.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.40
Rate for Payer: Wellcare Medicare Advantage	$202.40
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

S. PNEUMONIAE AG LA

Facility

$390.00

Service Code	HCPCS 86403
Hospital Charge Code	39900222
Hospital Revenue Code	302
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare Advantage	$37.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.86
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.54
Rate for Payer: Clover Medicare Advantage	$10.96
Rate for Payer: EmblemHealth Commercial	$34.62
Rate for Payer: Humana Medicare Advantage	$11.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.54
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	$9.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.54
Rate for Payer: Wellcare Medicare Advantage	$11.54
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

S. PNEUMONIAE AG LA

Facility

$390.00

Service Code	HCPCS 86403
Hospital Charge Code	39900222
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SPN FSN WO DECMPR CERV BELW C2

Facility

$47,548.90

Service Code	HCPCS 22554
Hospital Charge Code	16000607
Hospital Revenue Code	360
Min. Negotiated Rate	$1,350.39
Max. Negotiated Rate	$55,329.13
Rate for Payer: Aetna Commercial	$41,487.32
Rate for Payer: Aetna Medicare Advantage	$49,418.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55,329.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15,252.69
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	$55,329.13
Rate for Payer: Cigna Commercial	$30,573.98
Rate for Payer: Cigna Medicare Advantage	$15,252.69
Rate for Payer: Clover Medicare Advantage	$14,490.06
Rate for Payer: EmblemHealth Commercial	$45,758.07
Rate for Payer: Humana Medicare Advantage	$15,710.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15,252.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,362.71
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,502.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$15,252.69
Rate for Payer: Wellcare Medicare Advantage	$15,252.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1,350.39

SPN FSN WO DECMPR CERV BELW C2

Facility

$47,548.90

Service Code	HCPCS 22554
Hospital Charge Code	16000607
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

SPN FUSE&RMV CRV BLW C2,EA ADL

Facility

$47,548.90

Service Code	HCPCS 22552
Hospital Charge Code	16000606
Hospital Revenue Code	360
Min. Negotiated Rate	$1,350.39
Max. Negotiated Rate	$23,774.45
Rate for Payer: Aetna Commercial	$18,068.58
Rate for Payer: Aetna Medicare Advantage	$14,264.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,124.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,124.97
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	$12,124.97
Rate for Payer: Cigna Commercial	$23,774.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,362.71
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$1,502.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1,350.39

SPN FUSE&RMV CRV BLW C2,EA ADL

Facility

$47,548.90

Service Code	HCPCS 22552
Hospital Charge Code	16000606
Hospital Revenue Code	360
Min. Negotiated Rate	$7,132.34
Max. Negotiated Rate	$7,132.34
Rate for Payer: Qualcare PPO/HMO/WC	$7,132.34

SPONGE 3 PLY 4X4 N/STER

Facility

$0.05

Hospital Charge Code	270649004
Hospital Revenue Code	272
Max. Negotiated Rate	$0.03
Rate for Payer: Aetna Commercial	$0.02
Rate for Payer: Aetna Medicare Advantage	$0.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.01
Rate for Payer: Cigna Commercial	$0.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.01
Rate for Payer: Oxford Commercial	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01
Rate for Payer: UnitedHealthcare Commercial	$0.01
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

SPONGE 3 PLY 4X4 N/STER

Facility

$0.05

Hospital Charge Code	270649004
Hospital Revenue Code	272
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Qualcare PPO/HMO/WC	$0.01

Know your out-of-pocket cost for care.

All Charges