Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FNA BX W/CT GDN 1ST LES

Facility

$2,714.04

Service Code	HCPCS 10009
Hospital Charge Code	16000529
Hospital Revenue Code	360
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.65
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.11
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$85.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$77.08

FNA BX W/CT GDN EA ADDL

Facility

$1,785.95

Service Code	HCPCS 10010
Hospital Charge Code	16000775
Hospital Revenue Code	360
Min. Negotiated Rate	$50.72
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$678.66
Rate for Payer: Aetna Medicare Advantage	$535.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.42
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	$455.42
Rate for Payer: Cigna Commercial	$892.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$464.35
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$267.89
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$56.44
Rate for Payer: Wellpoint Medicaid Managed Care	$50.72

FNA BX W/CT GDN EA ADDL

Facility

$1,785.95

Service Code	HCPCS 10010
Hospital Charge Code	16000775
Hospital Revenue Code	360
Min. Negotiated Rate	$267.89
Max. Negotiated Rate	$267.89
Rate for Payer: Qualcare PPO/HMO/WC	$267.89

FNA BX W/US GND 1ST LES

Facility

$2,714.04

Service Code	HCPCS 10005
Hospital Charge Code	16000174
Hospital Revenue Code	360
Min. Negotiated Rate	$407.11
Max. Negotiated Rate	$407.11
Rate for Payer: Qualcare PPO/HMO/WC	$407.11

FNA BX W/US GND 1ST LES

Facility

$2,714.04

Service Code	HCPCS 10005
Hospital Charge Code	16000174
Hospital Revenue Code	360
Min. Negotiated Rate	$77.08
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$705.65
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$407.11
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$85.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$77.08

FNA W/O IMAGE

Facility

$1,838.13

Service Code	HCPCS 10021
Hospital Charge Code	1600000560
Hospital Revenue Code	360
Min. Negotiated Rate	$275.72
Max. Negotiated Rate	$275.72
Rate for Payer: Qualcare PPO/HMO/WC	$275.72

FNA W/O IMAGE

Facility

$1,838.13

Service Code	HCPCS 10021
Hospital Charge Code	1600000560
Hospital Revenue Code	360
Min. Negotiated Rate	$52.20
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
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	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$477.91
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$275.72
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$58.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$52.20

FOAM DBM LG STRIP 100x25x5MM

Facility

$7,875.00

Hospital Charge Code	270671260
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

FOAM DBM LG STRIP 100x25x5MM

Facility

$7,875.00

Hospital Charge Code	270671260
Hospital Revenue Code	278
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$248.85
Rate for Payer: Wellpoint Medicaid Managed Care	$223.65

FOAM DBM MED STRIP 50x25x5MM

Facility

$5,065.00

Hospital Charge Code	270671261
Hospital Revenue Code	278
Min. Negotiated Rate	$143.85
Max. Negotiated Rate	$2,532.50
Rate for Payer: Aetna Commercial	$1,924.70
Rate for Payer: Aetna Medicare Advantage	$1,519.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,291.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,291.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,013.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,291.58
Rate for Payer: Cigna Commercial	$2,532.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.73
Rate for Payer: Qualcare PPO/HMO/WC	$759.75
Rate for Payer: UnitedHealthcare Community & State	$160.05
Rate for Payer: Wellpoint Medicaid Managed Care	$143.85

FOAM DBM MED STRIP 50x25x5MM

Facility

$5,065.00

Hospital Charge Code	270671261
Hospital Revenue Code	278
Min. Negotiated Rate	$759.75
Max. Negotiated Rate	$1,225.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,013.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,225.73
Rate for Payer: Qualcare PPO/HMO/WC	$759.75

FOAM DBM SKINNY STP 100x10x8MM

Facility

$8,550.00

Hospital Charge Code	270671259
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$2,069.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50

FOAM DBM SKINNY STP 100x10x8MM

Facility

$8,550.00

Hospital Charge Code	270671259
Hospital Revenue Code	278
Min. Negotiated Rate	$242.82
Max. Negotiated Rate	$4,275.00
Rate for Payer: Aetna Commercial	$3,249.00
Rate for Payer: Aetna Medicare Advantage	$2,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,180.25
Rate for Payer: Cigna Commercial	$4,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50
Rate for Payer: UnitedHealthcare Community & State	$270.18
Rate for Payer: Wellpoint Medicaid Managed Care	$242.82

FOAM DBM SM STRIP 15x15x8MM

Facility

$1,575.00

Hospital Charge Code	270671262
Hospital Revenue Code	278
Min. Negotiated Rate	$44.73
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$598.50
Rate for Payer: Aetna Medicare Advantage	$472.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.62
Rate for Payer: Cigna Commercial	$787.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$236.25
Rate for Payer: UnitedHealthcare Community & State	$49.77
Rate for Payer: Wellpoint Medicaid Managed Care	$44.73

FOAM DBM SM STRIP 15x15x8MM

Facility

$1,575.00

Hospital Charge Code	270671262
Hospital Revenue Code	278
Min. Negotiated Rate	$236.25
Max. Negotiated Rate	$381.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$381.15
Rate for Payer: Qualcare PPO/HMO/WC	$236.25

FOAM DRESSING DISC 4 IN

Facility

$7.74

Hospital Charge Code	270689724
Hospital Revenue Code	272
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$3.87
Rate for Payer: Aetna Commercial	$2.94
Rate for Payer: Aetna Medicare Advantage	$2.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.97
Rate for Payer: Cigna Commercial	$3.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.01
Rate for Payer: Oxford Commercial	$1.55
Rate for Payer: Qualcare PPO/HMO/WC	$1.16
Rate for Payer: UnitedHealthcare Commercial	$1.55
Rate for Payer: UnitedHealthcare Community & State	$0.24
Rate for Payer: Wellpoint Medicaid Managed Care	$0.22

FOAM DRESSING DISC 4 IN

Facility

$7.74

Hospital Charge Code	270689724
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$1.16

FOAM FINGER SPLINT 1 X 18

Facility

$33.00

Hospital Charge Code	270331640
Hospital Revenue Code	270
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

FOAM FINGER SPLINT 1 X 18

Facility

$33.00

Hospital Charge Code	270331640
Hospital Revenue Code	270
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

FOAM SELF AD 3/16 4x196 M1563L

Facility

$42.08

Hospital Charge Code	270640897W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$21.04
Rate for Payer: Aetna Commercial	$15.99
Rate for Payer: Aetna Medicare Advantage	$12.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.73
Rate for Payer: Cigna Commercial	$21.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.94
Rate for Payer: Oxford Commercial	$8.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.31
Rate for Payer: UnitedHealthcare Commercial	$8.42
Rate for Payer: UnitedHealthcare Community & State	$1.33
Rate for Payer: Wellpoint Medicaid Managed Care	$1.20

FOAM SELF AD 3/16 4x196 M1563L

Facility

$42.08

Hospital Charge Code	270640897W
Hospital Revenue Code	272
Min. Negotiated Rate	$6.31
Max. Negotiated Rate	$6.31
Rate for Payer: Qualcare PPO/HMO/WC	$6.31

FOAM VITOSS BA2X 5CC

Facility

$10,674.30

Service Code	HCPCS C1713
Hospital Charge Code	270667773
Hospital Revenue Code	278
Min. Negotiated Rate	$303.15
Max. Negotiated Rate	$5,337.15
Rate for Payer: Aetna Commercial	$4,056.23
Rate for Payer: Aetna Medicare Advantage	$3,202.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,721.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,721.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,134.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,721.95
Rate for Payer: Cigna Commercial	$5,337.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.14
Rate for Payer: UnitedHealthcare Community & State	$337.31
Rate for Payer: Wellpoint Medicaid Managed Care	$303.15

FOAM VITOSS BA2X 5CC

Facility

$10,674.30

Service Code	HCPCS C1713
Hospital Charge Code	270667773
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.14
Max. Negotiated Rate	$2,583.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,134.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,583.18
Rate for Payer: Qualcare PPO/HMO/WC	$1,601.14

FOGARTY ART EMBO CATH 3FR 80CM

Facility

$308.00

Hospital Charge Code	270330913
Hospital Revenue Code	278
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$74.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.54
Rate for Payer: Qualcare PPO/HMO/WC	$46.20

FOGARTY ART EMBO CATH 3FR 80CM

Facility

$308.00

Hospital Charge Code	270330913
Hospital Revenue Code	278
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$154.00
Rate for Payer: Aetna Commercial	$117.04
Rate for Payer: Aetna Medicare Advantage	$92.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$61.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.54
Rate for Payer: Cigna Commercial	$154.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.54
Rate for Payer: Qualcare PPO/HMO/WC	$46.20
Rate for Payer: UnitedHealthcare Community & State	$9.73
Rate for Payer: Wellpoint Medicaid Managed Care	$8.75

Know your out-of-pocket cost for care.

All Charges