Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SYPHILIS AB CASCADE REFL

Facility

$91.00

Service Code	HCPCS 86780
Hospital Charge Code	39900257
Hospital Revenue Code	302
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Qualcare PPO/HMO/WC	$13.65

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825S
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825
Hospital Revenue Code	278
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25
Rate for Payer: UnitedHealthcare Community & State	$38.39
Rate for Payer: Wellpoint Medicaid Managed Care	$34.51

SYR EMBOSPHERE YELLOW S220GH

Facility

$1,215.00

Service Code	HCPCS L8699
Hospital Charge Code	270638825S
Hospital Revenue Code	278
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25
Rate for Payer: UnitedHealthcare Community & State	$38.39
Rate for Payer: Wellpoint Medicaid Managed Care	$34.51

SYRGE BASX CMPK INFLTN IN4130

Facility

$130.70

Hospital Charge Code	270636814C
Hospital Revenue Code	272
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$19.61
Rate for Payer: Qualcare PPO/HMO/WC	$19.61

SYRGE BASX CMPK INFLTN IN4130

Facility

$130.70

Hospital Charge Code	270636814C
Hospital Revenue Code	272
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$65.35
Rate for Payer: Aetna Commercial	$49.67
Rate for Payer: Aetna Medicare Advantage	$39.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.33
Rate for Payer: Cigna Commercial	$65.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.98
Rate for Payer: Oxford Commercial	$26.14
Rate for Payer: Qualcare PPO/HMO/WC	$19.61
Rate for Payer: UnitedHealthcare Commercial	$26.14
Rate for Payer: UnitedHealthcare Community & State	$4.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

SYRINGE 10ML W LUER LOCK

Facility

$213.90

Hospital Charge Code	270020080
Hospital Revenue Code	272
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$106.95
Rate for Payer: Aetna Commercial	$81.28
Rate for Payer: Aetna Medicare Advantage	$64.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.54
Rate for Payer: Cigna Commercial	$106.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.61
Rate for Payer: Oxford Commercial	$42.78
Rate for Payer: Qualcare PPO/HMO/WC	$32.09
Rate for Payer: UnitedHealthcare Commercial	$42.78
Rate for Payer: UnitedHealthcare Community & State	$6.76
Rate for Payer: Wellpoint Medicaid Managed Care	$6.07

SYRINGE 10ML W LUER LOCK

Facility

$213.90

Hospital Charge Code	270020080
Hospital Revenue Code	272
Min. Negotiated Rate	$32.09
Max. Negotiated Rate	$32.09
Rate for Payer: Qualcare PPO/HMO/WC	$32.09

SYRINGE 30CC W/LUER LOCK

Facility

$1.05

Hospital Charge Code	270020095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna Commercial	$0.40
Rate for Payer: Aetna Medicare Advantage	$0.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.27
Rate for Payer: Cigna Commercial	$0.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.27
Rate for Payer: Oxford Commercial	$0.21
Rate for Payer: Qualcare PPO/HMO/WC	$0.16
Rate for Payer: UnitedHealthcare Commercial	$0.21
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

SYRINGE 30CC W/LUER LOCK

Facility

$1.05

Hospital Charge Code	270020095
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.16

SYRINGE 3cc W/ LUER LOCK

Facility

$0.20

Hospital Charge Code	270020070
Hospital Revenue Code	272
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.10
Rate for Payer: Aetna Commercial	$0.08
Rate for Payer: Aetna Medicare Advantage	$0.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.05
Rate for Payer: Cigna Commercial	$0.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.05
Rate for Payer: Oxford Commercial	$0.04
Rate for Payer: Qualcare PPO/HMO/WC	$0.03
Rate for Payer: UnitedHealthcare Commercial	$0.04
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

SYRINGE 3cc W/ LUER LOCK

Facility

$0.20

Hospital Charge Code	270020070
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.03

SYRINGE ACP ANTICOAGULENT

Facility

$5,980.00

Hospital Charge Code	270656580
Hospital Revenue Code	278
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$1,447.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00

SYRINGE ACP ANTICOAGULENT

Facility

$5,980.00

Hospital Charge Code	270656580
Hospital Revenue Code	278
Min. Negotiated Rate	$169.83
Max. Negotiated Rate	$2,990.00
Rate for Payer: Aetna Commercial	$2,272.40
Rate for Payer: Aetna Medicare Advantage	$1,794.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,524.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,524.90
Rate for Payer: Cigna Commercial	$2,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,447.16
Rate for Payer: Qualcare PPO/HMO/WC	$897.00
Rate for Payer: UnitedHealthcare Community & State	$188.97
Rate for Payer: Wellpoint Medicaid Managed Care	$169.83

SYRINGE ALLIANCE INFLATION

Facility

$160.00

Hospital Charge Code	270608079
Hospital Revenue Code	272
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$24.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00

SYRINGE ALLIANCE INFLATION

Facility

$160.00

Hospital Charge Code	270608079
Hospital Revenue Code	272
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$60.80
Rate for Payer: Aetna Medicare Advantage	$48.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.80
Rate for Payer: Cigna Commercial	$80.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.60
Rate for Payer: Oxford Commercial	$32.00
Rate for Payer: Qualcare PPO/HMO/WC	$24.00
Rate for Payer: UnitedHealthcare Commercial	$32.00
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$4.54

SYRINGE ANGIOGRAPHY MEDALLION

Facility

$9.70

Hospital Charge Code	270685209
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Qualcare PPO/HMO/WC	$1.46

SYRINGE ANGIOGRAPHY MEDALLION

Facility

$9.70

Hospital Charge Code	270685209
Hospital Revenue Code	272
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$4.85
Rate for Payer: Aetna Commercial	$3.69
Rate for Payer: Aetna Medicare Advantage	$2.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.47
Rate for Payer: Cigna Commercial	$4.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.52
Rate for Payer: Oxford Commercial	$1.94
Rate for Payer: Qualcare PPO/HMO/WC	$1.46
Rate for Payer: UnitedHealthcare Commercial	$1.94
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.28

SYRINGE BASIX COMPAK INFLATION

Facility

$130.70

Hospital Charge Code	270636814
Hospital Revenue Code	272
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$65.35
Rate for Payer: Aetna Commercial	$49.67
Rate for Payer: Aetna Medicare Advantage	$39.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.33
Rate for Payer: Cigna Commercial	$65.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.98
Rate for Payer: Oxford Commercial	$26.14
Rate for Payer: Qualcare PPO/HMO/WC	$19.61
Rate for Payer: UnitedHealthcare Commercial	$26.14
Rate for Payer: UnitedHealthcare Community & State	$4.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

SYRINGE BASIX COMPAK INFLATION

Facility

$130.70

Hospital Charge Code	270636814
Hospital Revenue Code	272
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$19.61
Rate for Payer: Qualcare PPO/HMO/WC	$19.61

SYRINGE BASIX COMPAK INFLATION

Facility

$130.70

Hospital Charge Code	270636814A
Hospital Revenue Code	272
Min. Negotiated Rate	$19.61
Max. Negotiated Rate	$19.61
Rate for Payer: Qualcare PPO/HMO/WC	$19.61

SYRINGE BASIX COMPAK INFLATION

Facility

$130.70

Hospital Charge Code	270636814A
Hospital Revenue Code	272
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$65.35
Rate for Payer: Aetna Commercial	$49.67
Rate for Payer: Aetna Medicare Advantage	$39.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.33
Rate for Payer: Cigna Commercial	$65.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.98
Rate for Payer: Oxford Commercial	$26.14
Rate for Payer: Qualcare PPO/HMO/WC	$19.61
Rate for Payer: UnitedHealthcare Commercial	$26.14
Rate for Payer: UnitedHealthcare Community & State	$4.13
Rate for Payer: Wellpoint Medicaid Managed Care	$3.71

SYRINGE BULB IRRIGATION 60cc

Facility

$0.46

Hospital Charge Code	270649112
Hospital Revenue Code	271
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.23
Rate for Payer: Aetna Commercial	$0.17
Rate for Payer: Aetna Medicare Advantage	$0.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.12
Rate for Payer: Cigna Commercial	$0.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.12
Rate for Payer: Oxford Commercial	$0.09
Rate for Payer: Qualcare PPO/HMO/WC	$0.07
Rate for Payer: UnitedHealthcare Commercial	$0.09
Rate for Payer: UnitedHealthcare Community & State	$0.01
Rate for Payer: Wellpoint Medicaid Managed Care	$0.01

SYRINGE BULB IRRIGATION 60cc

Facility

$0.46

Hospital Charge Code	270649112
Hospital Revenue Code	271
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Qualcare PPO/HMO/WC	$0.07

Know your out-of-pocket cost for care.

All Charges