Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DRSG DUODERM EXTRA THIN 187955

Facility

$9.39

Hospital Charge Code	270350289
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.70
Rate for Payer: Aetna Commercial	$3.57
Rate for Payer: Aetna Medicare Advantage	$2.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.39
Rate for Payer: Cigna Commercial	$4.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.44
Rate for Payer: Oxford Commercial	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.41
Rate for Payer: UnitedHealthcare Commercial	$1.88
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

DRSG FOAM OVAL HEEL 3x3 90619

Facility

$23.20

Hospital Charge Code	270641300W
Hospital Revenue Code	272
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$3.48
Rate for Payer: Qualcare PPO/HMO/WC	$3.48

DRSG FOAM OVAL HEEL 3x3 90619

Facility

$23.20

Hospital Charge Code	270641300W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$11.60
Rate for Payer: Aetna Commercial	$8.82
Rate for Payer: Aetna Medicare Advantage	$6.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.92
Rate for Payer: Cigna Commercial	$11.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.03
Rate for Payer: Oxford Commercial	$4.64
Rate for Payer: Qualcare PPO/HMO/WC	$3.48
Rate for Payer: UnitedHealthcare Commercial	$4.64
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.66

DRSG MATRIX WOUND 2x2CM/SQCMJW

Facility

$2,605.90

Hospital Charge Code	270636500W
Hospital Revenue Code	636
Min. Negotiated Rate	$390.88
Max. Negotiated Rate	$630.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.63
Rate for Payer: Qualcare PPO/HMO/WC	$390.88

DRSG MATRIX WOUND 2x2CM/SQCMJW

Facility

$2,605.90

Hospital Charge Code	270636500W
Hospital Revenue Code	636
Min. Negotiated Rate	$74.01
Max. Negotiated Rate	$1,302.95
Rate for Payer: Aetna Commercial	$990.24
Rate for Payer: Aetna Medicare Advantage	$781.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$664.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$664.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$664.50
Rate for Payer: Cigna Commercial	$1,302.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$630.63
Rate for Payer: Qualcare PPO/HMO/WC	$390.88
Rate for Payer: UnitedHealthcare Community & State	$82.35
Rate for Payer: Wellpoint Medicaid Managed Care	$74.01

DRSG MATRIX WOUND 2x2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270636500
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,764.18
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50
Rate for Payer: UnitedHealthcare Community & State	$230.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$207.04

DRSG MATRIX WOUND 2x2IN

Facility

$7,290.00

Service Code	HCPCS Q4108
Hospital Charge Code	270636500
Hospital Revenue Code	278
Min. Negotiated Rate	$1,093.50
Max. Negotiated Rate	$1,764.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,458.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,764.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,093.50

DRSG OD ABOSOB 4X43 3158519904

Facility

$15.67

Hospital Charge Code	270641733W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$7.83
Rate for Payer: Aetna Commercial	$5.95
Rate for Payer: Aetna Medicare Advantage	$4.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.00
Rate for Payer: Cigna Commercial	$7.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.07
Rate for Payer: Oxford Commercial	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$2.35
Rate for Payer: UnitedHealthcare Commercial	$3.13
Rate for Payer: UnitedHealthcare Community & State	$0.50
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

DRSG OD ABOSOB 4X43 3158519904

Facility

$15.67

Hospital Charge Code	270641733W
Hospital Revenue Code	272
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$2.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.35

DRSG OPTIFOAM OVAL 6X5.6

Facility

$35.92

Hospital Charge Code	270641299W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$17.96
Rate for Payer: Aetna Commercial	$13.65
Rate for Payer: Aetna Medicare Advantage	$10.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.16
Rate for Payer: Cigna Commercial	$17.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.34
Rate for Payer: Oxford Commercial	$7.18
Rate for Payer: Qualcare PPO/HMO/WC	$5.39
Rate for Payer: UnitedHealthcare Commercial	$7.18
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

DRSG OPTIFOAM OVAL 6X5.6

Facility

$35.92

Hospital Charge Code	270641299W
Hospital Revenue Code	272
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$5.39
Rate for Payer: Qualcare PPO/HMO/WC	$5.39

DRSG REST ALGT 1X12 3158529969

Facility

$39.63

Hospital Charge Code	270641732W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$19.82
Rate for Payer: Aetna Commercial	$15.06
Rate for Payer: Aetna Medicare Advantage	$11.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.11
Rate for Payer: Cigna Commercial	$19.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.30
Rate for Payer: Oxford Commercial	$7.93
Rate for Payer: Qualcare PPO/HMO/WC	$5.94
Rate for Payer: UnitedHealthcare Commercial	$7.93
Rate for Payer: UnitedHealthcare Community & State	$1.25
Rate for Payer: Wellpoint Medicaid Managed Care	$1.13

DRSG REST ALGT 1X12 3158529969

Facility

$39.63

Hospital Charge Code	270641732W
Hospital Revenue Code	272
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Qualcare PPO/HMO/WC	$5.94

DRSG REST CONT 6X8 3158509342

Facility

$168.50

Hospital Charge Code	270641731W
Hospital Revenue Code	272
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$84.25
Rate for Payer: Aetna Commercial	$64.03
Rate for Payer: Aetna Medicare Advantage	$50.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.97
Rate for Payer: Cigna Commercial	$84.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.81
Rate for Payer: Oxford Commercial	$33.70
Rate for Payer: Qualcare PPO/HMO/WC	$25.27
Rate for Payer: UnitedHealthcare Commercial	$33.70
Rate for Payer: UnitedHealthcare Community & State	$5.32
Rate for Payer: Wellpoint Medicaid Managed Care	$4.79

DRSG REST CONT 6X8 3158509342

Facility

$168.50

Hospital Charge Code	270641731W
Hospital Revenue Code	272
Min. Negotiated Rate	$25.27
Max. Negotiated Rate	$25.27
Rate for Payer: Qualcare PPO/HMO/WC	$25.27

DRSG SIL CON LYR4x5 3158509341

Facility

$42.97

Hospital Charge Code	270641730W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$21.48
Rate for Payer: Aetna Commercial	$16.33
Rate for Payer: Aetna Medicare Advantage	$12.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.96
Rate for Payer: Cigna Commercial	$21.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.17
Rate for Payer: Oxford Commercial	$8.59
Rate for Payer: Qualcare PPO/HMO/WC	$6.45
Rate for Payer: UnitedHealthcare Commercial	$8.59
Rate for Payer: UnitedHealthcare Community & State	$1.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.22

DRSG SIL CON LYR4x5 3158509341

Facility

$42.97

Hospital Charge Code	270641730W
Hospital Revenue Code	272
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$6.45
Rate for Payer: Qualcare PPO/HMO/WC	$6.45

DRSG SYS THREEFLEX MSC4300

Facility

$48.58

Service Code	HCPCS A6449
Hospital Charge Code	270639039
Hospital Revenue Code	272
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$7.29
Rate for Payer: Qualcare PPO/HMO/WC	$7.29

DRSG SYS THREEFLEX MSC4300

Facility

$48.58

Service Code	HCPCS A6449
Hospital Charge Code	270639039
Hospital Revenue Code	272
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$24.29
Rate for Payer: Aetna Commercial	$18.46
Rate for Payer: Aetna Medicare Advantage	$14.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.39
Rate for Payer: Cigna Commercial	$24.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.63
Rate for Payer: Oxford Commercial	$9.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.29
Rate for Payer: UnitedHealthcare Commercial	$9.72
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

DRSG TEGADRM FOAM SQ 2x2 90610

Facility

$12.24

Hospital Charge Code	270641295W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.12
Rate for Payer: Aetna Commercial	$4.65
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.12
Rate for Payer: Cigna Commercial	$6.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.18
Rate for Payer: Oxford Commercial	$2.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.84
Rate for Payer: UnitedHealthcare Commercial	$2.45
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

DRSG TEGADRM FOAM SQ 2x2 90610

Facility

$12.24

Hospital Charge Code	270641295W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$1.84
Rate for Payer: Qualcare PPO/HMO/WC	$1.84

DRSG TEGADRM FOAM SQ 4x4 90612

Facility

$20.00

Hospital Charge Code	270641297W
Hospital Revenue Code	272
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00

DRSG TEGADRM FOAM SQ 4x4 90612

Facility

$20.00

Hospital Charge Code	270641297W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna Commercial	$7.60
Rate for Payer: Aetna Medicare Advantage	$6.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.10
Rate for Payer: Cigna Commercial	$10.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.20
Rate for Payer: Oxford Commercial	$4.00
Rate for Payer: Qualcare PPO/HMO/WC	$3.00
Rate for Payer: UnitedHealthcare Commercial	$4.00
Rate for Payer: UnitedHealthcare Community & State	$0.63
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

DRUG ABUSE PANEL 9,SERUM I

Facility

$499.75

Hospital Charge Code	39990001A
Hospital Revenue Code	301
Min. Negotiated Rate	$74.96
Max. Negotiated Rate	$74.96
Rate for Payer: Qualcare PPO/HMO/WC	$74.96

DRUG ABUSE PANEL 9,SERUM I

Facility

$499.75

Hospital Charge Code	39990001A
Hospital Revenue Code	301
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$249.88
Rate for Payer: Aetna Commercial	$189.91
Rate for Payer: Aetna Medicare Advantage	$149.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.44
Rate for Payer: Cigna Commercial	$249.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$129.94
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$74.96
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$15.79
Rate for Payer: Wellpoint Medicaid Managed Care	$14.19

Know your out-of-pocket cost for care.

All Charges