Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SURGIFOAM ABSORB GEL POWDER

Facility

$452.26

Hospital Charge Code	270644933C
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$226.13
Rate for Payer: Aetna Commercial	$171.86
Rate for Payer: Aetna Medicare Advantage	$135.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.33
Rate for Payer: Cigna Commercial	$226.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$117.59
Rate for Payer: Oxford Commercial	$90.45
Rate for Payer: Qualcare PPO/HMO/WC	$67.84
Rate for Payer: UnitedHealthcare Commercial	$90.45
Rate for Payer: UnitedHealthcare Community & State	$14.29
Rate for Payer: Wellpoint Medicaid Managed Care	$12.84

SURGIGRIP 10MM SLEEVE TEAL BLU

Facility

$25.25

Hospital Charge Code	270658696
Hospital Revenue Code	272
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$3.79
Rate for Payer: Qualcare PPO/HMO/WC	$3.79

SURGIGRIP 10MM SLEEVE TEAL BLU

Facility

$25.25

Hospital Charge Code	270658696
Hospital Revenue Code	272
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$12.62
Rate for Payer: Aetna Commercial	$9.60
Rate for Payer: Aetna Medicare Advantage	$7.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.44
Rate for Payer: Cigna Commercial	$12.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.57
Rate for Payer: Oxford Commercial	$5.05
Rate for Payer: Qualcare PPO/HMO/WC	$3.79
Rate for Payer: UnitedHealthcare Commercial	$5.05
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.72

SURGILUBE PKT

Facility

$4.00

Service Code	NDC 281020543
Hospital Charge Code	6063943248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

SURGILUBE PKT

Facility

$4.00

Service Code	NDC 281020543
Hospital Charge Code	6063943248
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SURGILUBE TUBE

Facility

$17.89

Service Code	NDC 281020502
Hospital Charge Code	6063943249
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$2.68
Rate for Payer: Qualcare PPO/HMO/WC	$2.68

SURGILUBE TUBE

Facility

$17.89

Service Code	NDC 281020502
Hospital Charge Code	6063943249
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$8.95
Rate for Payer: Aetna Commercial	$6.80
Rate for Payer: Aetna Medicare Advantage	$5.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.56
Rate for Payer: Cigna Commercial	$8.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.65
Rate for Payer: Oxford Commercial	$3.58
Rate for Payer: Qualcare PPO/HMO/WC	$2.68
Rate for Payer: UnitedHealthcare Commercial	$3.58
Rate for Payer: UnitedHealthcare Community & State	$0.57
Rate for Payer: Wellpoint Medicaid Managed Care	$0.51

SURGINEEDLE 150MM LONG NEEDLE

Facility

$271.00

Hospital Charge Code	270334676
Hospital Revenue Code	272
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$135.50
Rate for Payer: Aetna Commercial	$102.98
Rate for Payer: Aetna Medicare Advantage	$81.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.11
Rate for Payer: Cigna Commercial	$135.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.46
Rate for Payer: Oxford Commercial	$54.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.65
Rate for Payer: UnitedHealthcare Commercial	$54.20
Rate for Payer: UnitedHealthcare Community & State	$8.56
Rate for Payer: Wellpoint Medicaid Managed Care	$7.70

SURGINEEDLE 150MM LONG NEEDLE

Facility

$271.00

Hospital Charge Code	270334676
Hospital Revenue Code	272
Min. Negotiated Rate	$40.65
Max. Negotiated Rate	$40.65
Rate for Payer: Qualcare PPO/HMO/WC	$40.65

SURGINEEDLE PNEUMOPERITONEUM

Facility

$491.00

Hospital Charge Code	270334675
Hospital Revenue Code	272
Min. Negotiated Rate	$13.94
Max. Negotiated Rate	$245.50
Rate for Payer: Aetna Commercial	$186.58
Rate for Payer: Aetna Medicare Advantage	$147.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$125.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$125.20
Rate for Payer: Cigna Commercial	$245.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.66
Rate for Payer: Oxford Commercial	$98.20
Rate for Payer: Qualcare PPO/HMO/WC	$73.65
Rate for Payer: UnitedHealthcare Commercial	$98.20
Rate for Payer: UnitedHealthcare Community & State	$15.52
Rate for Payer: Wellpoint Medicaid Managed Care	$13.94

SURGINEEDLE PNEUMOPERITONEUM

Facility

$491.00

Hospital Charge Code	270334675
Hospital Revenue Code	272
Min. Negotiated Rate	$73.65
Max. Negotiated Rate	$73.65
Rate for Payer: Qualcare PPO/HMO/WC	$73.65

SURGIPORTS 10.5 PREMIUM

Facility

$1,679.00

Hospital Charge Code	270335148
Hospital Revenue Code	272
Min. Negotiated Rate	$47.68
Max. Negotiated Rate	$839.50
Rate for Payer: Aetna Commercial	$638.02
Rate for Payer: Aetna Medicare Advantage	$503.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$428.14
Rate for Payer: Cigna Commercial	$839.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$436.54
Rate for Payer: Oxford Commercial	$335.80
Rate for Payer: Qualcare PPO/HMO/WC	$251.85
Rate for Payer: UnitedHealthcare Commercial	$335.80
Rate for Payer: UnitedHealthcare Community & State	$53.06
Rate for Payer: Wellpoint Medicaid Managed Care	$47.68

SURGIPORTS 10.5 PREMIUM

Facility

$1,679.00

Hospital Charge Code	270335148
Hospital Revenue Code	272
Min. Negotiated Rate	$251.85
Max. Negotiated Rate	$251.85
Rate for Payer: Qualcare PPO/HMO/WC	$251.85

SURGIPRO 3-0 18

Facility

$16.48

Hospital Charge Code	270651322
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$2.47
Rate for Payer: Qualcare PPO/HMO/WC	$2.47

SURGIPRO 3-0 18

Facility

$16.48

Hospital Charge Code	270651322
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna Commercial	$6.26
Rate for Payer: Aetna Medicare Advantage	$4.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.20
Rate for Payer: Cigna Commercial	$8.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.28
Rate for Payer: Oxford Commercial	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.47
Rate for Payer: UnitedHealthcare Commercial	$3.30
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

SURGIPRO 3 X 5

Facility

$167.00

Hospital Charge Code	270335119
Hospital Revenue Code	278
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$83.50
Rate for Payer: Aetna Commercial	$63.46
Rate for Payer: Aetna Medicare Advantage	$50.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.59
Rate for Payer: Cigna Commercial	$83.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.41
Rate for Payer: Qualcare PPO/HMO/WC	$25.05
Rate for Payer: UnitedHealthcare Community & State	$5.28
Rate for Payer: Wellpoint Medicaid Managed Care	$4.74

SURGIPRO 3 X 5

Facility

$167.00

Hospital Charge Code	270335119
Hospital Revenue Code	278
Min. Negotiated Rate	$25.05
Max. Negotiated Rate	$40.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.41
Rate for Payer: Qualcare PPO/HMO/WC	$25.05

SURG OV EP MINIMAL VISIT 5MINS

Facility

$260.00

Service Code	HCPCS 99211
Hospital Charge Code	75190200
Hospital Revenue Code	510
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$98.80
Rate for Payer: Aetna Medicare Advantage	$78.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.30
Rate for Payer: Cigna Commercial	$130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.60
Rate for Payer: Qualcare PPO/HMO/WC	$39.00
Rate for Payer: UnitedHealthcare Community & State	$8.22
Rate for Payer: Wellpoint Medicaid Managed Care	$7.38

SURG OV EP MINIMAL VISIT 5MINS

Facility

$260.00

Service Code	HCPCS 99211
Hospital Charge Code	75190200
Hospital Revenue Code	510
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.00

SURG OV NP EXPANDED FOCUSED

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	75190175
Hospital Revenue Code	510
Min. Negotiated Rate	$11.42
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$152.76
Rate for Payer: Aetna Medicare Advantage	$120.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.51
Rate for Payer: Cigna Commercial	$201.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.52
Rate for Payer: Qualcare PPO/HMO/WC	$60.30
Rate for Payer: UnitedHealthcare Community & State	$12.70
Rate for Payer: Wellpoint Medicaid Managed Care	$11.42

SURG OV NP EXPANDED FOCUSED

Facility

$402.00

Service Code	HCPCS 99202
Hospital Charge Code	75190175
Hospital Revenue Code	510
Min. Negotiated Rate	$60.30
Max. Negotiated Rate	$60.30
Rate for Payer: Qualcare PPO/HMO/WC	$60.30

SURG PATH, GROSS EXAM ONLY

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	38474040
Hospital Revenue Code	310
Min. Negotiated Rate	$69.75
Max. Negotiated Rate	$69.75
Rate for Payer: Qualcare PPO/HMO/WC	$69.75

SURG PATH, GROSS EXAM ONLY

Facility

$465.00

Service Code	HCPCS 88300
Hospital Charge Code	38474040
Hospital Revenue Code	310
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.90
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$69.75
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$13.21

SURG TX ECT PREG,TUB/OV REQ

Facility

$9,050.20

Service Code	HCPCS 59120
Hospital Charge Code	16000522
Hospital Revenue Code	360
Min. Negotiated Rate	$1,357.53
Max. Negotiated Rate	$1,357.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.53

SURG TX ECT PREG,TUB/OV REQ

Facility

$9,050.20

Service Code	HCPCS 59120
Hospital Charge Code	16000522
Hospital Revenue Code	360
Min. Negotiated Rate	$257.03
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,439.08
Rate for Payer: Aetna Medicare Advantage	$2,715.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,307.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,307.80
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	$2,307.80
Rate for Payer: Cigna Commercial	$4,525.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,353.05
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,357.53
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$285.99
Rate for Payer: Wellpoint Medicaid Managed Care	$257.03

Know your out-of-pocket cost for care.

All Charges