Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SPONGE NS 4 X 4 PLY BULK

Facility

$9.53

Hospital Charge Code	270654159
Hospital Revenue Code	270
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Qualcare PPO/HMO/WC	$1.43

SPONGE PEANUT 3/8 7103

Facility

$10.41

Hospital Charge Code	270645141
Hospital Revenue Code	272
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$5.21
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare Advantage	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.65
Rate for Payer: Cigna Commercial	$5.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.71
Rate for Payer: Oxford Commercial	$2.08
Rate for Payer: Qualcare PPO/HMO/WC	$1.56
Rate for Payer: UnitedHealthcare Commercial	$2.08
Rate for Payer: UnitedHealthcare Community & State	$0.33
Rate for Payer: Wellpoint Medicaid Managed Care	$0.30

SPONGE PEANUT 3/8 7103

Facility

$10.41

Hospital Charge Code	270645141
Hospital Revenue Code	272
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.56

SPONGE PEANUT DISSECTOR

Facility

$2,446.50

Hospital Charge Code	270652834
Hospital Revenue Code	272
Min. Negotiated Rate	$366.98
Max. Negotiated Rate	$366.98
Rate for Payer: Qualcare PPO/HMO/WC	$366.98

SPONGE PEANUT DISSECTOR

Facility

$2,446.50

Hospital Charge Code	270652834
Hospital Revenue Code	272
Min. Negotiated Rate	$69.48
Max. Negotiated Rate	$1,223.25
Rate for Payer: Aetna Commercial	$929.67
Rate for Payer: Aetna Medicare Advantage	$733.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$623.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$623.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$623.86
Rate for Payer: Cigna Commercial	$1,223.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$636.09
Rate for Payer: Oxford Commercial	$489.30
Rate for Payer: Qualcare PPO/HMO/WC	$366.98
Rate for Payer: UnitedHealthcare Commercial	$489.30
Rate for Payer: UnitedHealthcare Community & State	$77.31
Rate for Payer: Wellpoint Medicaid Managed Care	$69.48

SPONGE PRE-WASHED STR LAP 4X18

Facility

$6.92

Hospital Charge Code	270648974
Hospital Revenue Code	270
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$1.04
Rate for Payer: Qualcare PPO/HMO/WC	$1.04

SPONGE PRE-WASHED STR LAP 4X18

Facility

$6.92

Hospital Charge Code	270648974
Hospital Revenue Code	270
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna Commercial	$2.63
Rate for Payer: Aetna Medicare Advantage	$2.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.76
Rate for Payer: Cigna Commercial	$3.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.80
Rate for Payer: Oxford Commercial	$1.38
Rate for Payer: Qualcare PPO/HMO/WC	$1.04
Rate for Payer: UnitedHealthcare Commercial	$1.38
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

SPONGE RAYTEC GAUZE 4X4

Facility

$0.53

Hospital Charge Code	270061520
Hospital Revenue Code	271
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Qualcare PPO/HMO/WC	$0.08

SPONGE RAYTEC GAUZE 4X4

Facility

$0.53

Hospital Charge Code	270061520
Hospital Revenue Code	271
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.27
Rate for Payer: Aetna Commercial	$0.20
Rate for Payer: Aetna Medicare Advantage	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.14
Rate for Payer: Cigna Commercial	$0.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.14
Rate for Payer: Oxford Commercial	$0.11
Rate for Payer: Qualcare PPO/HMO/WC	$0.08
Rate for Payer: UnitedHealthcare Commercial	$0.11
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

SPONGE SCERAL SILCONE 3MM

Facility

$300.00

Hospital Charge Code	270331534
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

SPONGE SCERAL SILCONE 3MM

Facility

$300.00

Hospital Charge Code	270331534
Hospital Revenue Code	272
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

SPONGE TONSIL MEDIUM

Facility

$6.81

Hospital Charge Code	270651112
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.40
Rate for Payer: Aetna Commercial	$2.59
Rate for Payer: Aetna Medicare Advantage	$2.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.74
Rate for Payer: Cigna Commercial	$3.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.77
Rate for Payer: Oxford Commercial	$1.36
Rate for Payer: Qualcare PPO/HMO/WC	$1.02
Rate for Payer: UnitedHealthcare Commercial	$1.36
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

SPONGE TONSIL MEDIUM

Facility

$6.81

Hospital Charge Code	270651112
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$1.02

SPONGE TONSIL PK LG 10606

Facility

$13.65

Hospital Charge Code	270600312
Hospital Revenue Code	272
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

SPONGE TONSIL PK LG 10606

Facility

$13.65

Hospital Charge Code	270600312
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

SPONGE TONSIL PK MED 10604

Facility

$9.65

Hospital Charge Code	270600313
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

SPONGE TONSIL PK MED 10604

Facility

$9.65

Hospital Charge Code	270600313
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

SPONGE XRAY DETECTABLE 4x4

Facility

$2.66

Hospital Charge Code	27061520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$1.33
Rate for Payer: Aetna Commercial	$1.01
Rate for Payer: Aetna Medicare Advantage	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.68
Rate for Payer: Cigna Commercial	$1.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.69
Rate for Payer: Oxford Commercial	$0.53
Rate for Payer: Qualcare PPO/HMO/WC	$0.40
Rate for Payer: UnitedHealthcare Commercial	$0.53
Rate for Payer: UnitedHealthcare Community & State	$0.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

SPONGE XRAY DETECTABLE 4x4

Facility

$2.66

Hospital Charge Code	27061520
Hospital Revenue Code	270
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Qualcare PPO/HMO/WC	$0.40

SPORANOX/100MG/CAP/U/D

Facility

$163.21

Service Code	NDC 50458029001
Hospital Charge Code	60634825
Hospital Revenue Code	250
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$81.61
Rate for Payer: Aetna Commercial	$62.02
Rate for Payer: Aetna Medicare Advantage	$48.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.62
Rate for Payer: Cigna Commercial	$81.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.43
Rate for Payer: Oxford Commercial	$32.64
Rate for Payer: Qualcare PPO/HMO/WC	$24.48
Rate for Payer: UnitedHealthcare Commercial	$32.64
Rate for Payer: UnitedHealthcare Community & State	$5.16
Rate for Payer: Wellpoint Medicaid Managed Care	$4.64

SPORANOX/100MG/CAP/U/D

Facility

$163.21

Service Code	NDC 50458029001
Hospital Charge Code	60634825
Hospital Revenue Code	250
Min. Negotiated Rate	$24.48
Max. Negotiated Rate	$24.48
Rate for Payer: Qualcare PPO/HMO/WC	$24.48

SPORTS TAPE

Facility

$44.00

Hospital Charge Code	84202125
Hospital Revenue Code	270
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SPORTS TAPE

Facility

$44.00

Hospital Charge Code	84202125
Hospital Revenue Code	270
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SPOT (INDIA INK)

Facility

$190.00

Hospital Charge Code	270630596
Hospital Revenue Code	270
Min. Negotiated Rate	$28.50
Max. Negotiated Rate	$28.50
Rate for Payer: Qualcare PPO/HMO/WC	$28.50

SPOT (INDIA INK)

Facility

$190.00

Hospital Charge Code	270630596
Hospital Revenue Code	270
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$95.00
Rate for Payer: Aetna Commercial	$72.20
Rate for Payer: Aetna Medicare Advantage	$57.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.45
Rate for Payer: Cigna Commercial	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.40
Rate for Payer: Oxford Commercial	$38.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.50
Rate for Payer: UnitedHealthcare Commercial	$38.00
Rate for Payer: UnitedHealthcare Community & State	$6.00
Rate for Payer: Wellpoint Medicaid Managed Care	$5.40

Know your out-of-pocket cost for care.

All Charges