Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SUCRALFATE 1 GRAM/10ML

Facility

$67.40

Service Code	NDC 121074710
Hospital Charge Code	60629338
Hospital Revenue Code	250
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$33.70
Rate for Payer: Aetna Commercial	$25.61
Rate for Payer: Aetna Medicare Advantage	$20.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.19
Rate for Payer: Cigna Commercial	$33.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.52
Rate for Payer: Oxford Commercial	$13.48
Rate for Payer: Qualcare PPO/HMO/WC	$10.11
Rate for Payer: UnitedHealthcare Commercial	$13.48
Rate for Payer: UnitedHealthcare Community & State	$2.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.91

SUCRALFATE 1 G TAB

Facility

$5.36

Service Code	NDC 93221001
Hospital Charge Code	6016521
Hospital Revenue Code	251
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.80

SUCRALFATE 1 G TAB

Facility

$5.36

Service Code	NDC 93221001
Hospital Charge Code	6016521
Hospital Revenue Code	251
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.68
Rate for Payer: Aetna Commercial	$2.04
Rate for Payer: Aetna Medicare Advantage	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.37
Rate for Payer: Cigna Commercial	$2.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.39
Rate for Payer: Oxford Commercial	$1.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.80
Rate for Payer: UnitedHealthcare Commercial	$1.07
Rate for Payer: UnitedHealthcare Community & State	$0.17
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

SUCROSE HE HEMOLYSINS/AGGLUTIN

Facility

$390.00

Service Code	HCPCS 86940
Hospital Charge Code	3035099
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SUCROSE HE HEMOLYSINS/AGGLUTIN

Facility

$390.00

Service Code	HCPCS 86940
Hospital Charge Code	3035099
Hospital Revenue Code	302
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$23.85
Rate for Payer: Aetna Medicare Advantage	$28.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$8.77
Rate for Payer: Clover Medicare Advantage	$8.33
Rate for Payer: EmblemHealth Commercial	$26.31
Rate for Payer: Humana Medicare Advantage	$9.03
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.77
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	$7.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.77
Rate for Payer: Wellcare Medicare Advantage	$8.77
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SUCTION COAG L HOOK 5 MM X 32

Facility

$2,086.90

Hospital Charge Code	270688620
Hospital Revenue Code	272
Min. Negotiated Rate	$313.04
Max. Negotiated Rate	$313.04
Rate for Payer: Qualcare PPO/HMO/WC	$313.04

SUCTION COAG L HOOK 5 MM X 32

Facility

$2,086.90

Hospital Charge Code	270688620
Hospital Revenue Code	272
Min. Negotiated Rate	$59.27
Max. Negotiated Rate	$1,043.45
Rate for Payer: Aetna Commercial	$793.02
Rate for Payer: Aetna Medicare Advantage	$626.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$532.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$532.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$532.16
Rate for Payer: Cigna Commercial	$1,043.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.59
Rate for Payer: Oxford Commercial	$417.38
Rate for Payer: Qualcare PPO/HMO/WC	$313.04
Rate for Payer: UnitedHealthcare Commercial	$417.38
Rate for Payer: UnitedHealthcare Community & State	$65.95
Rate for Payer: Wellpoint Medicaid Managed Care	$59.27

SUCTION COAGULATOR

Facility

$58.15

Hospital Charge Code	270650795
Hospital Revenue Code	272
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$29.07
Rate for Payer: Aetna Commercial	$22.10
Rate for Payer: Aetna Medicare Advantage	$17.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.83
Rate for Payer: Cigna Commercial	$29.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.12
Rate for Payer: Oxford Commercial	$11.63
Rate for Payer: Qualcare PPO/HMO/WC	$8.72
Rate for Payer: UnitedHealthcare Commercial	$11.63
Rate for Payer: UnitedHealthcare Community & State	$1.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1.65

SUCTION COAGULATOR

Facility

$58.15

Hospital Charge Code	270650795
Hospital Revenue Code	272
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$8.72
Rate for Payer: Qualcare PPO/HMO/WC	$8.72

SUCTION COAGULATOR 8FR W/HANDS

Facility

$57.00

Hospital Charge Code	270677264
Hospital Revenue Code	272
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$21.66
Rate for Payer: Aetna Medicare Advantage	$17.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.54
Rate for Payer: Cigna Commercial	$28.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.82
Rate for Payer: Oxford Commercial	$11.40
Rate for Payer: Qualcare PPO/HMO/WC	$8.55
Rate for Payer: UnitedHealthcare Commercial	$11.40
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

SUCTION COAGULATOR 8FR W/HANDS

Facility

$57.00

Hospital Charge Code	270677264
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$8.55
Rate for Payer: Qualcare PPO/HMO/WC	$8.55

SUCTION COLLECTION BOTTLE

Facility

$48.00

Hospital Charge Code	270331831
Hospital Revenue Code	272
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

SUCTION COLLECTION BOTTLE

Facility

$48.00

Hospital Charge Code	270331831
Hospital Revenue Code	272
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.24
Rate for Payer: Aetna Medicare Advantage	$14.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.24
Rate for Payer: Cigna Commercial	$24.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.48
Rate for Payer: Oxford Commercial	$9.60
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.60
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

SUCTION CURVED TIP KAMVAC

Facility

$73.75

Hospital Charge Code	270669175
Hospital Revenue Code	272
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$11.06
Rate for Payer: Qualcare PPO/HMO/WC	$11.06

SUCTION CURVED TIP KAMVAC

Facility

$73.75

Hospital Charge Code	270669175
Hospital Revenue Code	272
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$36.88
Rate for Payer: Aetna Commercial	$28.02
Rate for Payer: Aetna Medicare Advantage	$22.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.81
Rate for Payer: Cigna Commercial	$36.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.18
Rate for Payer: Oxford Commercial	$14.75
Rate for Payer: Qualcare PPO/HMO/WC	$11.06
Rate for Payer: UnitedHealthcare Commercial	$14.75
Rate for Payer: UnitedHealthcare Community & State	$2.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.09

SUCTION Frazier 10FR

Facility

$8.94

Hospital Charge Code	270608640
Hospital Revenue Code	272
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$4.47
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Aetna Medicare Advantage	$2.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.28
Rate for Payer: Cigna Commercial	$4.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.32
Rate for Payer: Oxford Commercial	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.34
Rate for Payer: UnitedHealthcare Commercial	$1.79
Rate for Payer: UnitedHealthcare Community & State	$0.28
Rate for Payer: Wellpoint Medicaid Managed Care	$0.25

SUCTION Frazier 10FR

Facility

$8.94

Hospital Charge Code	270608640
Hospital Revenue Code	272
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.34

SUCTION IRRIGATION

Facility

$243.33

Hospital Charge Code	270654340
Hospital Revenue Code	272
Min. Negotiated Rate	$36.50
Max. Negotiated Rate	$36.50
Rate for Payer: Qualcare PPO/HMO/WC	$36.50

SUCTION IRRIGATION

Facility

$243.33

Hospital Charge Code	270654340
Hospital Revenue Code	272
Min. Negotiated Rate	$6.91
Max. Negotiated Rate	$121.67
Rate for Payer: Aetna Commercial	$92.47
Rate for Payer: Aetna Medicare Advantage	$73.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.05
Rate for Payer: Cigna Commercial	$121.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.27
Rate for Payer: Oxford Commercial	$48.67
Rate for Payer: Qualcare PPO/HMO/WC	$36.50
Rate for Payer: UnitedHealthcare Commercial	$48.67
Rate for Payer: UnitedHealthcare Community & State	$7.69
Rate for Payer: Wellpoint Medicaid Managed Care	$6.91

SUCTION IRRIGATOR SIMPULSE

Facility

$748.75

Hospital Charge Code	270657850
Hospital Revenue Code	270
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$374.38
Rate for Payer: Aetna Commercial	$284.52
Rate for Payer: Aetna Medicare Advantage	$224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$190.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$190.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$190.93
Rate for Payer: Cigna Commercial	$374.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$194.68
Rate for Payer: Oxford Commercial	$149.75
Rate for Payer: Qualcare PPO/HMO/WC	$112.31
Rate for Payer: UnitedHealthcare Commercial	$149.75
Rate for Payer: UnitedHealthcare Community & State	$23.66
Rate for Payer: Wellpoint Medicaid Managed Care	$21.26

SUCTION IRRIGATOR SIMPULSE

Facility

$748.75

Hospital Charge Code	270657850
Hospital Revenue Code	270
Min. Negotiated Rate	$112.31
Max. Negotiated Rate	$112.31
Rate for Payer: Qualcare PPO/HMO/WC	$112.31

SUCTION LIPECTOMY HEAD&NECK

Facility

$15,611.20

Service Code	HCPCS 15876
Hospital Charge Code	16000787
Hospital Revenue Code	360
Min. Negotiated Rate	$443.36
Max. Negotiated Rate	$15,271.92
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,271.92
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,058.91
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,341.68
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$493.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$443.36

SUCTION LIPECTOMY HEAD&NECK

Facility

$15,611.20

Service Code	HCPCS 15876
Hospital Charge Code	16000787
Hospital Revenue Code	360
Min. Negotiated Rate	$2,341.68
Max. Negotiated Rate	$2,341.68
Rate for Payer: Qualcare PPO/HMO/WC	$2,341.68

SUCTION LIPECTOMY,L EXTR

Facility

$31,159.05

Service Code	HCPCS 15879
Hospital Charge Code	16000662
Hospital Revenue Code	360
Min. Negotiated Rate	$4,673.86
Max. Negotiated Rate	$4,673.86
Rate for Payer: Qualcare PPO/HMO/WC	$4,673.86

SUCTION LIPECTOMY,L EXTR

Facility

$31,159.05

Service Code	HCPCS 15879
Hospital Charge Code	16000662
Hospital Revenue Code	360
Min. Negotiated Rate	$884.92
Max. Negotiated Rate	$15,271.92
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,271.92
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,101.35
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,673.86
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$984.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$884.92

Know your out-of-pocket cost for care.

All Charges