Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SULFONAMIDES UNDIFF SERUM/PLSM

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401180299
Hospital Revenue Code	301
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
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	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SULFONAMIDES UNDIFF SERUM/PLSM

Facility

$390.00

Service Code	HCPCS 80299
Hospital Charge Code	401180299
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SULFONYLUREA

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472607
Hospital Revenue Code	301
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$50.70
Rate for Payer: Aetna Medicare Advantage	$60.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$18.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.62
Rate for Payer: Cigna Commercial	$162.00
Rate for Payer: Cigna Medicare Advantage	$18.64
Rate for Payer: Clover Medicare Advantage	$17.71
Rate for Payer: EmblemHealth Commercial	$55.92
Rate for Payer: Humana Medicare Advantage	$19.20
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$18.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.24
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$48.60
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.64
Rate for Payer: Wellcare Medicare Advantage	$18.64
Rate for Payer: Wellpoint Medicaid Managed Care	$9.20

SULFONYLUREA

Facility

$324.00

Service Code	HCPCS 80299
Hospital Charge Code	38472607
Hospital Revenue Code	301
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.60

SUMATRIPTAN 25 MG TAB

Facility

$222.78

Service Code	NDC 173073500
Hospital Charge Code	60629927
Hospital Revenue Code	250
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$111.39
Rate for Payer: Aetna Commercial	$84.66
Rate for Payer: Aetna Medicare Advantage	$66.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.81
Rate for Payer: Cigna Commercial	$111.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.92
Rate for Payer: Oxford Commercial	$44.56
Rate for Payer: Qualcare PPO/HMO/WC	$33.42
Rate for Payer: UnitedHealthcare Commercial	$44.56
Rate for Payer: UnitedHealthcare Community & State	$7.04
Rate for Payer: Wellpoint Medicaid Managed Care	$6.33

SUMATRIPTAN 25 MG TAB

Facility

$222.78

Service Code	NDC 173073500
Hospital Charge Code	60629927
Hospital Revenue Code	250
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$33.42
Rate for Payer: Qualcare PPO/HMO/WC	$33.42

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$569.50

Service Code	HCPCS J3030
Hospital Charge Code	6007728
Hospital Revenue Code	636
Min. Negotiated Rate	$85.42
Max. Negotiated Rate	$137.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.82
Rate for Payer: Qualcare PPO/HMO/WC	$85.42

SUMATRIPTAN 6 MG/0.5 ML INJ

Facility

$569.50

Service Code	HCPCS J3030
Hospital Charge Code	6007728
Hospital Revenue Code	636
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$284.75
Rate for Payer: Aetna Commercial	$216.41
Rate for Payer: Aetna Medicare Advantage	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$145.22
Rate for Payer: Cigna Commercial	$284.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.82
Rate for Payer: Qualcare PPO/HMO/WC	$85.42
Rate for Payer: UnitedHealthcare Community & State	$18.00
Rate for Payer: Wellpoint Medicaid Managed Care	$16.17

SUPERF SFT TISS BX LEG/ANKLE

Facility

$7,612.30

Service Code	HCPCS 27613
Hospital Charge Code	16000709
Hospital Revenue Code	360
Min. Negotiated Rate	$216.19
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.20
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$240.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$216.19

SUPERF SFT TISS BX LEG/ANKLE

Facility

$7,612.30

Service Code	HCPCS 27613
Hospital Charge Code	16000709
Hospital Revenue Code	360
Min. Negotiated Rate	$1,141.85
Max. Negotiated Rate	$1,141.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85

SUPERSHEATH INTRO WO GWIRE 12F

Facility

$102.90

Service Code	HCPCS C1894
Hospital Charge Code	270662366C
Hospital Revenue Code	272
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$51.45
Rate for Payer: Aetna Commercial	$39.10
Rate for Payer: Aetna Medicare Advantage	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Commercial	$51.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.75
Rate for Payer: Oxford Commercial	$20.58
Rate for Payer: Qualcare PPO/HMO/WC	$15.44
Rate for Payer: UnitedHealthcare Commercial	$20.58
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.92

SUPERSHEATH INTRO WO GWIRE 12F

Facility

$102.90

Service Code	HCPCS C1894
Hospital Charge Code	270662366C
Hospital Revenue Code	272
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$15.44
Rate for Payer: Qualcare PPO/HMO/WC	$15.44

SUPER TURBOVAC W FINGER SWITCH

Facility

$2,185.00

Hospital Charge Code	270652890
Hospital Revenue Code	272
Min. Negotiated Rate	$62.05
Max. Negotiated Rate	$1,092.50
Rate for Payer: Aetna Commercial	$830.30
Rate for Payer: Aetna Medicare Advantage	$655.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$557.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$557.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$557.17
Rate for Payer: Cigna Commercial	$1,092.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.10
Rate for Payer: Oxford Commercial	$437.00
Rate for Payer: Qualcare PPO/HMO/WC	$327.75
Rate for Payer: UnitedHealthcare Commercial	$437.00
Rate for Payer: UnitedHealthcare Community & State	$69.05
Rate for Payer: Wellpoint Medicaid Managed Care	$62.05

SUPER TURBOVAC W FINGER SWITCH

Facility

$2,185.00

Hospital Charge Code	270652890
Hospital Revenue Code	272
Min. Negotiated Rate	$327.75
Max. Negotiated Rate	$327.75
Rate for Payer: Qualcare PPO/HMO/WC	$327.75

SUPPORTA-LINE STANDARD

Facility

$13.33

Hospital Charge Code	270667643
Hospital Revenue Code	270
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.00

SUPPORTA-LINE STANDARD

Facility

$13.33

Hospital Charge Code	270667643
Hospital Revenue Code	270
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$5.07
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.40
Rate for Payer: Cigna Commercial	$6.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.47
Rate for Payer: Oxford Commercial	$2.67
Rate for Payer: Qualcare PPO/HMO/WC	$2.00
Rate for Payer: UnitedHealthcare Commercial	$2.67
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.38

SUPPORT CATH 5F .035X135CM

Facility

$775.00

Service Code	HCPCS C1887
Hospital Charge Code	270670063
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

SUPPORT CATH 5F .035X135CM

Facility

$775.00

Service Code	HCPCS C1887
Hospital Charge Code	270670063
Hospital Revenue Code	278
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$22.01

SUPPORTER ADULT ELASTIC SML

Facility

$42.35

Hospital Charge Code	270649799
Hospital Revenue Code	272
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$6.35
Rate for Payer: Qualcare PPO/HMO/WC	$6.35

SUPPORTER ADULT ELASTIC SML

Facility

$42.35

Hospital Charge Code	270649799
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$21.18
Rate for Payer: Aetna Commercial	$16.09
Rate for Payer: Aetna Medicare Advantage	$12.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.80
Rate for Payer: Cigna Commercial	$21.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.01
Rate for Payer: Oxford Commercial	$8.47
Rate for Payer: Qualcare PPO/HMO/WC	$6.35
Rate for Payer: UnitedHealthcare Commercial	$8.47
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

SUPPORTOR A-3 LG ELAST

Facility

$27.10

Hospital Charge Code	270303080
Hospital Revenue Code	272
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$4.07
Rate for Payer: Qualcare PPO/HMO/WC	$4.07

SUPPORTOR A-3 LG ELAST

Facility

$27.10

Hospital Charge Code	270303080
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$13.55
Rate for Payer: Aetna Commercial	$10.30
Rate for Payer: Aetna Medicare Advantage	$8.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.91
Rate for Payer: Cigna Commercial	$13.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.05
Rate for Payer: Oxford Commercial	$5.42
Rate for Payer: Qualcare PPO/HMO/WC	$4.07
Rate for Payer: UnitedHealthcare Commercial	$5.42
Rate for Payer: UnitedHealthcare Community & State	$0.86
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

SUPPORTOR A-3 MED ELAST

Facility

$27.05

Hospital Charge Code	270303075
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$13.53
Rate for Payer: Aetna Commercial	$10.28
Rate for Payer: Aetna Medicare Advantage	$8.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.90
Rate for Payer: Cigna Commercial	$13.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.03
Rate for Payer: Oxford Commercial	$5.41
Rate for Payer: Qualcare PPO/HMO/WC	$4.06
Rate for Payer: UnitedHealthcare Commercial	$5.41
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

SUPPORTOR A-3 MED ELAST

Facility

$27.05

Hospital Charge Code	270303075
Hospital Revenue Code	272
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$4.06
Rate for Payer: Qualcare PPO/HMO/WC	$4.06

SUPPORT TUBE

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270703248
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges