Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SUCTION LIPECTOMY,TRUNK

Facility

$26,848.40

Service Code	HCPCS 15877
Hospital Charge Code	16000348
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

SUCTION LIPECTOMY,TRUNK

Facility

$26,848.40

Service Code	HCPCS 15877
Hospital Charge Code	16000348
Hospital Revenue Code	360
Min. Negotiated Rate	$762.49
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	$6,980.58
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$848.41
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	$762.49

SUCTION LIPECTOMY U EXTR

Facility

$26,848.40

Service Code	HCPCS 15878
Hospital Charge Code	1600000401
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

SUCTION LIPECTOMY U EXTR

Facility

$26,848.40

Service Code	HCPCS 15878
Hospital Charge Code	1600000401
Hospital Revenue Code	360
Min. Negotiated Rate	$762.49
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,980.58
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$848.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$762.49

SUCTION LIPECTOMY,U EXTR

Facility

$26,848.40

Service Code	HCPCS 15878
Hospital Charge Code	16000163
Hospital Revenue Code	360
Min. Negotiated Rate	$762.49
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,980.58
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$848.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$762.49

SUCTION LIPECTOMY,U EXTR

Facility

$26,848.40

Service Code	HCPCS 15878
Hospital Charge Code	16000163
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

SUCTION NASOTRACHEAL

Facility

$282.00

Service Code	HCPCS 31720
Hospital Charge Code	366831720
Hospital Revenue Code	361
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$42.30
Rate for Payer: Qualcare PPO/HMO/WC	$42.30

SUCTION NASOTRACHEAL

Facility

$282.00

Service Code	HCPCS 31720
Hospital Charge Code	366831720
Hospital Revenue Code	361
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$707.61
Rate for Payer: Aetna Medicare Advantage	$842.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$943.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$260.15
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	$943.69
Rate for Payer: Cigna Commercial	$521.47
Rate for Payer: Cigna Medicare Advantage	$260.15
Rate for Payer: Clover Medicare Advantage	$247.14
Rate for Payer: EmblemHealth Commercial	$780.45
Rate for Payer: Humana Medicare Advantage	$267.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$260.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$73.32
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.30
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$8.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.15
Rate for Payer: Wellcare Medicare Advantage	$260.15
Rate for Payer: Wellpoint Medicaid Managed Care	$8.01

SUCTION SYSTEM ORTHOPEDIC

Facility

$180.57

Hospital Charge Code	270600351
Hospital Revenue Code	272
Min. Negotiated Rate	$27.09
Max. Negotiated Rate	$27.09
Rate for Payer: Qualcare PPO/HMO/WC	$27.09

SUCTION SYSTEM ORTHOPEDIC

Facility

$180.57

Hospital Charge Code	270600351
Hospital Revenue Code	272
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$90.28
Rate for Payer: Aetna Commercial	$68.62
Rate for Payer: Aetna Medicare Advantage	$54.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.05
Rate for Payer: Cigna Commercial	$90.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.95
Rate for Payer: Oxford Commercial	$36.11
Rate for Payer: Qualcare PPO/HMO/WC	$27.09
Rate for Payer: UnitedHealthcare Commercial	$36.11
Rate for Payer: UnitedHealthcare Community & State	$5.71
Rate for Payer: Wellpoint Medicaid Managed Care	$5.13

SUCTION TIP YANKAUER

Facility

$5.65

Hospital Charge Code	270061415
Hospital Revenue Code	272
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Qualcare PPO/HMO/WC	$0.85

SUCTION TIP YANKAUER

Facility

$5.65

Hospital Charge Code	270061415
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.15
Rate for Payer: Aetna Medicare Advantage	$1.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.47
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.85
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

SUCTION TUBE KAMVAC MINI

Facility

$47.00

Hospital Charge Code	270332484
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$23.50
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna Medicare Advantage	$14.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.98
Rate for Payer: Cigna Commercial	$23.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.22
Rate for Payer: Oxford Commercial	$9.40
Rate for Payer: Qualcare PPO/HMO/WC	$7.05
Rate for Payer: UnitedHealthcare Commercial	$9.40
Rate for Payer: UnitedHealthcare Community & State	$1.49
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

SUCTION TUBE KAMVAC MINI

Facility

$47.00

Hospital Charge Code	270332484
Hospital Revenue Code	272
Min. Negotiated Rate	$7.05
Max. Negotiated Rate	$7.05
Rate for Payer: Qualcare PPO/HMO/WC	$7.05

SUCTION YANKAUER

Facility

$1.60

Hospital Charge Code	270649944
Hospital Revenue Code	272
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.61
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$0.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.32
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

SUCTION YANKAUER

Facility

$1.60

Hospital Charge Code	270649944
Hospital Revenue Code	272
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

SUGAMMADEX 200MG VIAL

Facility

$763.80

Service Code	NDC 6542312
Hospital Charge Code	606390161
Hospital Revenue Code	250
Min. Negotiated Rate	$114.57
Max. Negotiated Rate	$114.57
Rate for Payer: Qualcare PPO/HMO/WC	$114.57

SUGAMMADEX 200MG VIAL

Facility

$763.80

Service Code	NDC 6542312
Hospital Charge Code	606390161
Hospital Revenue Code	250
Min. Negotiated Rate	$21.69
Max. Negotiated Rate	$381.90
Rate for Payer: Aetna Commercial	$290.24
Rate for Payer: Aetna Medicare Advantage	$229.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$194.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$194.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$194.77
Rate for Payer: Cigna Commercial	$381.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.59
Rate for Payer: Oxford Commercial	$152.76
Rate for Payer: Qualcare PPO/HMO/WC	$114.57
Rate for Payer: UnitedHealthcare Commercial	$152.76
Rate for Payer: UnitedHealthcare Community & State	$24.14
Rate for Payer: Wellpoint Medicaid Managed Care	$21.69

SUGAMMADEX 500MG VIAL

Facility

$1,398.96

Service Code	NDC 6542315
Hospital Charge Code	606390162
Hospital Revenue Code	250
Min. Negotiated Rate	$209.84
Max. Negotiated Rate	$209.84
Rate for Payer: Qualcare PPO/HMO/WC	$209.84

SUGAMMADEX 500MG VIAL

Facility

$1,398.96

Service Code	NDC 6542315
Hospital Charge Code	606390162
Hospital Revenue Code	250
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$699.48
Rate for Payer: Aetna Commercial	$531.60
Rate for Payer: Aetna Medicare Advantage	$419.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$356.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$356.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$356.73
Rate for Payer: Cigna Commercial	$699.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.73
Rate for Payer: Oxford Commercial	$279.79
Rate for Payer: Qualcare PPO/HMO/WC	$209.84
Rate for Payer: UnitedHealthcare Commercial	$279.79
Rate for Payer: UnitedHealthcare Community & State	$44.21
Rate for Payer: Wellpoint Medicaid Managed Care	$39.73

SUGARS MULT QUAL @ SPECIMENT

Facility

$39.00

Service Code	HCPCS 84377
Hospital Charge Code	38477044
Hospital Revenue Code	301
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

SUGARS MULT QUAL @ SPECIMENT

Facility

$39.00

Service Code	HCPCS 84377
Hospital Charge Code	38477044
Hospital Revenue Code	301
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

SUGARS SING QUAL @ SPECIMEN

Facility

$39.00

Service Code	HCPCS 84376
Hospital Charge Code	38477043
Hospital Revenue Code	301
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$14.96
Rate for Payer: Aetna Medicare Advantage	$17.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.95
Rate for Payer: Cigna Commercial	$19.50
Rate for Payer: Cigna Medicare Advantage	$5.50
Rate for Payer: Clover Medicare Advantage	$5.22
Rate for Payer: EmblemHealth Commercial	$16.50
Rate for Payer: Humana Medicare Advantage	$5.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.50
Rate for Payer: Wellcare Medicare Advantage	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

SUGARS SING QUAL @ SPECIMEN

Facility

$39.00

Service Code	HCPCS 84376
Hospital Charge Code	38477043
Hospital Revenue Code	301
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$5.85
Rate for Payer: Qualcare PPO/HMO/WC	$5.85

Sulfacetamide 10% opht soln 15

Facility

$351.97

Hospital Charge Code	6063943294
Hospital Revenue Code	250
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$52.80
Rate for Payer: Qualcare PPO/HMO/WC	$52.80

Know your out-of-pocket cost for care.

All Charges