Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SWWLK SP 5.5X 24.5MM

Facility

$420.00

Hospital Charge Code	270687031
Hospital Revenue Code	272
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$159.60
Rate for Payer: Aetna Medicare Advantage	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$107.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$107.10
Rate for Payer: Cigna Commercial	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.20
Rate for Payer: Oxford Commercial	$84.00
Rate for Payer: Qualcare PPO/HMO/WC	$63.00
Rate for Payer: UnitedHealthcare Commercial	$84.00
Rate for Payer: UnitedHealthcare Community & State	$13.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.93

SYMBOTEX COMPOSIT MESH 30 X 20

Facility

$9,144.05

Service Code	HCPCS C1781
Hospital Charge Code	270678857
Hospital Revenue Code	278
Min. Negotiated Rate	$259.69
Max. Negotiated Rate	$4,572.02
Rate for Payer: Aetna Commercial	$3,474.74
Rate for Payer: Aetna Medicare Advantage	$2,743.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,331.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,331.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,828.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,331.73
Rate for Payer: Cigna Commercial	$4,572.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.61
Rate for Payer: UnitedHealthcare Community & State	$288.95
Rate for Payer: Wellpoint Medicaid Managed Care	$259.69

SYMBOTEX COMPOSIT MESH 30 X 20

Facility

$9,144.05

Service Code	HCPCS C1781
Hospital Charge Code	270678857
Hospital Revenue Code	278
Min. Negotiated Rate	$1,371.61
Max. Negotiated Rate	$2,212.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,828.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,212.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,371.61

SYMBOTEX COMPOSIT MESH 37 BY 2

Facility

$10,701.90

Service Code	HCPCS C1781
Hospital Charge Code	270678858
Hospital Revenue Code	278
Min. Negotiated Rate	$303.93
Max. Negotiated Rate	$5,350.95
Rate for Payer: Aetna Commercial	$4,066.72
Rate for Payer: Aetna Medicare Advantage	$3,210.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,728.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,728.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,140.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,728.98
Rate for Payer: Cigna Commercial	$5,350.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.29
Rate for Payer: UnitedHealthcare Community & State	$338.18
Rate for Payer: Wellpoint Medicaid Managed Care	$303.93

SYMBOTEX COMPOSIT MESH 37 BY 2

Facility

$10,701.90

Service Code	HCPCS C1781
Hospital Charge Code	270678858
Hospital Revenue Code	278
Min. Negotiated Rate	$1,605.29
Max. Negotiated Rate	$2,589.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,140.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,589.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,605.29

SYMBOTEX COMPOSIT MESH 42 X 32

Facility

$12,844.10

Service Code	HCPCS C1781
Hospital Charge Code	270678859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,926.62
Max. Negotiated Rate	$3,108.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,108.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.62

SYMBOTEX COMPOSIT MESH 42 X 32

Facility

$12,844.10

Service Code	HCPCS C1781
Hospital Charge Code	270678859
Hospital Revenue Code	278
Min. Negotiated Rate	$364.77
Max. Negotiated Rate	$6,422.05
Rate for Payer: Aetna Commercial	$4,880.76
Rate for Payer: Aetna Medicare Advantage	$3,853.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,275.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,568.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,275.25
Rate for Payer: Cigna Commercial	$6,422.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,108.27
Rate for Payer: Qualcare PPO/HMO/WC	$1,926.62
Rate for Payer: UnitedHealthcare Community & State	$405.87
Rate for Payer: Wellpoint Medicaid Managed Care	$364.77

SYMMETREL LIQUID/16OZ

Facility

$4.00

Service Code	NDC 121064616
Hospital Charge Code	60634589
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

SYMMETREL LIQUID/16OZ

Facility

$4.00

Service Code	NDC 121064616
Hospital Charge Code	60634589
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

SYMPHONY GRAFT DELIVERY SYS

Facility

$1,050.00

Hospital Charge Code	270657922
Hospital Revenue Code	272
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$273.00
Rate for Payer: Oxford Commercial	$210.00
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Commercial	$210.00
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

SYMPHONY GRAFT DELIVERY SYS

Facility

$1,050.00

Hospital Charge Code	270657922
Hospital Revenue Code	272
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$157.50
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

SYNALAR 0.1% CREAM/15GM

Facility

$298.62

Service Code	NDC 168005815
Hospital Charge Code	60634441
Hospital Revenue Code	250
Min. Negotiated Rate	$44.79
Max. Negotiated Rate	$44.79
Rate for Payer: Qualcare PPO/HMO/WC	$44.79

SYNALAR 0.1% CREAM/15GM

Facility

$298.62

Service Code	NDC 168005815
Hospital Charge Code	60634441
Hospital Revenue Code	250
Min. Negotiated Rate	$8.48
Max. Negotiated Rate	$149.31
Rate for Payer: Aetna Commercial	$113.48
Rate for Payer: Aetna Medicare Advantage	$89.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.15
Rate for Payer: Cigna Commercial	$149.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.64
Rate for Payer: Oxford Commercial	$59.72
Rate for Payer: Qualcare PPO/HMO/WC	$44.79
Rate for Payer: UnitedHealthcare Commercial	$59.72
Rate for Payer: UnitedHealthcare Community & State	$9.44
Rate for Payer: Wellpoint Medicaid Managed Care	$8.48

SYNALAR OINTMENT/15GM

Facility

$226.26

Service Code	NDC 168006415
Hospital Charge Code	60634443
Hospital Revenue Code	250
Min. Negotiated Rate	$33.94
Max. Negotiated Rate	$33.94
Rate for Payer: Qualcare PPO/HMO/WC	$33.94

SYNALAR OINTMENT/15GM

Facility

$226.26

Service Code	NDC 168006415
Hospital Charge Code	60634443
Hospital Revenue Code	250
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$113.13
Rate for Payer: Aetna Commercial	$85.98
Rate for Payer: Aetna Medicare Advantage	$67.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.70
Rate for Payer: Cigna Commercial	$113.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.83
Rate for Payer: Oxford Commercial	$45.25
Rate for Payer: Qualcare PPO/HMO/WC	$33.94
Rate for Payer: UnitedHealthcare Commercial	$45.25
Rate for Payer: UnitedHealthcare Community & State	$7.15
Rate for Payer: Wellpoint Medicaid Managed Care	$6.43

Synchro 200cm soft

Facility

$3,000.00

Hospital Charge Code	270685069N
Hospital Revenue Code	272
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

Synchro 200cm soft

Facility

$3,000.00

Hospital Charge Code	270685069N
Hospital Revenue Code	272
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$780.00
Rate for Payer: Oxford Commercial	$600.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Commercial	$600.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

Synchro 300cm soft

Facility

$3,750.00

Hospital Charge Code	270685070N
Hospital Revenue Code	272
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

Synchro 300cm soft

Facility

$3,750.00

Hospital Charge Code	270685070N
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

Synchro 300cm Stand

Facility

$3,750.00

Hospital Charge Code	270685071N
Hospital Revenue Code	272
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

Synchro 300cm Stand

Facility

$3,750.00

Hospital Charge Code	270685071N
Hospital Revenue Code	272
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

SYNCHROSEAL 8MM

Facility

$3,450.00

Service Code	HCPCS A4649
Hospital Charge Code	270693939
Hospital Revenue Code	272
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$517.50
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

SYNCHROSEAL 8MM

Facility

$3,450.00

Service Code	HCPCS A4649
Hospital Charge Code	270693939
Hospital Revenue Code	272
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,311.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$897.00
Rate for Payer: Oxford Commercial	$690.00
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Commercial	$690.00
Rate for Payer: UnitedHealthcare Community & State	$109.02
Rate for Payer: Wellpoint Medicaid Managed Care	$97.98

SYNCOPE AND COLLAPSE

Facility

$8,881.33

Service Code	APR-DRG 2042
Min. Negotiated Rate	$8,707.19
Max. Negotiated Rate	$8,881.33
Rate for Payer: UnitedHealthcare Community & State	$8,707.19
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$8,881.33
Rate for Payer: Wellpoint Medicaid Managed Care	$8,707.19

SYNCOPE AND COLLAPSE

Facility

$7,530.31

Service Code	APR-DRG 2041
Min. Negotiated Rate	$7,382.66
Max. Negotiated Rate	$7,530.31
Rate for Payer: UnitedHealthcare Community & State	$7,382.66
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,530.31
Rate for Payer: Wellpoint Medicaid Managed Care	$7,382.66

Know your out-of-pocket cost for care.

All Charges