Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SURE SWAB VI

Facility

$390.00

Service Code	HCPCS 87512
Hospital Charge Code	39990113F
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB VI

Facility

$390.00

Service Code	HCPCS 87512
Hospital Charge Code	39990113F
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$113.59
Rate for Payer: Aetna Medicare Advantage	$135.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$151.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$151.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$41.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$151.48
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$41.76
Rate for Payer: Clover Medicare Advantage	$39.67
Rate for Payer: EmblemHealth Commercial	$125.28
Rate for Payer: Humana Medicare Advantage	$43.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$41.76
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	$33.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.76
Rate for Payer: Wellcare Medicare Advantage	$41.76
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SURE SWAB VII

Facility

$390.00

Service Code	HCPCS 87591
Hospital Charge Code	39990113G
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB VII

Facility

$390.00

Service Code	HCPCS 87591
Hospital Charge Code	39990113G
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SURE SWAB VIII

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39990113H
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare Advantage	$113.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$35.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.29
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$35.09
Rate for Payer: Clover Medicare Advantage	$33.34
Rate for Payer: EmblemHealth Commercial	$105.27
Rate for Payer: Humana Medicare Advantage	$36.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$35.09
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	$28.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$35.09
Rate for Payer: Wellcare Medicare Advantage	$35.09
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SURE SWAB VIII

Facility

$390.00

Service Code	HCPCS 87798
Hospital Charge Code	39990113H
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB X

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113J
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB X

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113J
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SURE SWAB XI

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113K
Hospital Revenue Code	306
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

SURE SWAB XI

Facility

$390.00

Service Code	HCPCS 8779991
Hospital Charge Code	39990113K
Hospital Revenue Code	306
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

SURFAS WANDS

Facility

$724.00

Hospital Charge Code	270332651
Hospital Revenue Code	272
Min. Negotiated Rate	$20.56
Max. Negotiated Rate	$362.00
Rate for Payer: Aetna Commercial	$275.12
Rate for Payer: Aetna Medicare Advantage	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.62
Rate for Payer: Cigna Commercial	$362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.24
Rate for Payer: Oxford Commercial	$144.80
Rate for Payer: Qualcare PPO/HMO/WC	$108.60
Rate for Payer: UnitedHealthcare Commercial	$144.80
Rate for Payer: UnitedHealthcare Community & State	$22.88
Rate for Payer: Wellpoint Medicaid Managed Care	$20.56

SURFAS WANDS

Facility

$724.00

Hospital Charge Code	27033608
Hospital Revenue Code	272
Min. Negotiated Rate	$108.60
Max. Negotiated Rate	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$108.60

SURFAS WANDS

Facility

$724.00

Hospital Charge Code	27033608
Hospital Revenue Code	272
Min. Negotiated Rate	$20.56
Max. Negotiated Rate	$362.00
Rate for Payer: Aetna Commercial	$275.12
Rate for Payer: Aetna Medicare Advantage	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.62
Rate for Payer: Cigna Commercial	$362.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.24
Rate for Payer: Oxford Commercial	$144.80
Rate for Payer: Qualcare PPO/HMO/WC	$108.60
Rate for Payer: UnitedHealthcare Commercial	$144.80
Rate for Payer: UnitedHealthcare Community & State	$22.88
Rate for Payer: Wellpoint Medicaid Managed Care	$20.56

SURFAS WANDS

Facility

$724.00

Hospital Charge Code	270332651
Hospital Revenue Code	272
Min. Negotiated Rate	$108.60
Max. Negotiated Rate	$108.60
Rate for Payer: Qualcare PPO/HMO/WC	$108.60

SUR-FIT NIGHT DRAINAGE

Facility

$207.00

Hospital Charge Code	270331470
Hospital Revenue Code	272
Min. Negotiated Rate	$31.05
Max. Negotiated Rate	$31.05
Rate for Payer: Qualcare PPO/HMO/WC	$31.05

SUR-FIT NIGHT DRAINAGE

Facility

$207.00

Hospital Charge Code	270331470
Hospital Revenue Code	272
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Commercial	$78.66
Rate for Payer: Aetna Medicare Advantage	$62.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.78
Rate for Payer: Cigna Commercial	$103.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.82
Rate for Payer: Oxford Commercial	$41.40
Rate for Payer: Qualcare PPO/HMO/WC	$31.05
Rate for Payer: UnitedHealthcare Commercial	$41.40
Rate for Payer: UnitedHealthcare Community & State	$6.54
Rate for Payer: Wellpoint Medicaid Managed Care	$5.88

SURGERY TIME 1ST HOUR

Facility

$5,093.20

Hospital Charge Code	1600010
Hospital Revenue Code	360
Min. Negotiated Rate	$144.65
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,935.42
Rate for Payer: Aetna Medicare Advantage	$1,527.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,298.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,298.77
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	$1,298.77
Rate for Payer: Cigna Commercial	$2,546.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,324.23
Rate for Payer: Qualcare PPO/HMO/WC	$763.98
Rate for Payer: UnitedHealthcare Community & State	$160.95
Rate for Payer: Wellpoint Medicaid Managed Care	$144.65

SURGERY TIME 1ST HOUR

Facility

$5,093.20

Hospital Charge Code	1600010
Hospital Revenue Code	360
Min. Negotiated Rate	$763.98
Max. Negotiated Rate	$763.98
Rate for Payer: Qualcare PPO/HMO/WC	$763.98

SURGERY TIME EACH ADDTL 30MIN

Facility

$2,543.00

Hospital Charge Code	1600012
Hospital Revenue Code	360
Min. Negotiated Rate	$72.22
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$966.34
Rate for Payer: Aetna Medicare Advantage	$762.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$648.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$648.47
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	$648.47
Rate for Payer: Cigna Commercial	$1,271.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$661.18
Rate for Payer: Qualcare PPO/HMO/WC	$381.45
Rate for Payer: UnitedHealthcare Community & State	$80.36
Rate for Payer: Wellpoint Medicaid Managed Care	$72.22

SURGERY TIME EACH ADDTL 30MIN

Facility

$2,543.00

Hospital Charge Code	1600012
Hospital Revenue Code	360
Min. Negotiated Rate	$381.45
Max. Negotiated Rate	$381.45
Rate for Payer: Qualcare PPO/HMO/WC	$381.45

SURGI-BRA LARGE LATEX FREE

Facility

$177.95

Hospital Charge Code	270650035
Hospital Revenue Code	270
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$88.97
Rate for Payer: Aetna Commercial	$67.62
Rate for Payer: Aetna Medicare Advantage	$53.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.38
Rate for Payer: Cigna Commercial	$88.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.27
Rate for Payer: Oxford Commercial	$35.59
Rate for Payer: Qualcare PPO/HMO/WC	$26.69
Rate for Payer: UnitedHealthcare Commercial	$35.59
Rate for Payer: UnitedHealthcare Community & State	$5.62
Rate for Payer: Wellpoint Medicaid Managed Care	$5.05

SURGI-BRA LARGE LATEX FREE

Facility

$177.95

Hospital Charge Code	270650035
Hospital Revenue Code	270
Min. Negotiated Rate	$26.69
Max. Negotiated Rate	$26.69
Rate for Payer: Qualcare PPO/HMO/WC	$26.69

SURGI-BRA MEDIUM

Facility

$262.40

Hospital Charge Code	270650034
Hospital Revenue Code	272
Min. Negotiated Rate	$7.45
Max. Negotiated Rate	$131.20
Rate for Payer: Aetna Commercial	$99.71
Rate for Payer: Aetna Medicare Advantage	$78.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.91
Rate for Payer: Cigna Commercial	$131.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$68.22
Rate for Payer: Oxford Commercial	$52.48
Rate for Payer: Qualcare PPO/HMO/WC	$39.36
Rate for Payer: UnitedHealthcare Commercial	$52.48
Rate for Payer: UnitedHealthcare Community & State	$8.29
Rate for Payer: Wellpoint Medicaid Managed Care	$7.45

SURGI-BRA MEDIUM

Facility

$262.40

Hospital Charge Code	270650034
Hospital Revenue Code	272
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$39.36
Rate for Payer: Qualcare PPO/HMO/WC	$39.36

SURGI-BRA SMALL

Facility

$215.00

Hospital Charge Code	270330834
Hospital Revenue Code	270
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$107.50
Rate for Payer: Aetna Commercial	$81.70
Rate for Payer: Aetna Medicare Advantage	$64.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.83
Rate for Payer: Cigna Commercial	$107.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.90
Rate for Payer: Oxford Commercial	$43.00
Rate for Payer: Qualcare PPO/HMO/WC	$32.25
Rate for Payer: UnitedHealthcare Commercial	$43.00
Rate for Payer: UnitedHealthcare Community & State	$6.79
Rate for Payer: Wellpoint Medicaid Managed Care	$6.11

Know your out-of-pocket cost for care.

All Charges