Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GAUZE NU IODO 1/5YD

Facility

$11.65

Hospital Charge Code	270300960W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$4.43
Rate for Payer: Aetna Medicare Advantage	$3.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.97
Rate for Payer: Cigna Commercial	$5.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.03
Rate for Payer: Oxford Commercial	$2.33
Rate for Payer: Qualcare PPO/HMO/WC	$1.75
Rate for Payer: UnitedHealthcare Commercial	$2.33
Rate for Payer: UnitedHealthcare Community & State	$0.37
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

GAUZE NU IODO 2/5YD

Facility

$16.99

Hospital Charge Code	270300965
Hospital Revenue Code	272
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.55
Rate for Payer: Qualcare PPO/HMO/WC	$2.55

GAUZE NU IODO 2/5YD

Facility

$16.99

Hospital Charge Code	270300965
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.49
Rate for Payer: Aetna Commercial	$6.46
Rate for Payer: Aetna Medicare Advantage	$5.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.33
Rate for Payer: Cigna Commercial	$8.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.42
Rate for Payer: Oxford Commercial	$3.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.55
Rate for Payer: UnitedHealthcare Commercial	$3.40
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

GAUZE NU PLAIN 2/5YD

Facility

$20.85

Hospital Charge Code	270300945
Hospital Revenue Code	272
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$10.43
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare Advantage	$6.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.32
Rate for Payer: Cigna Commercial	$10.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.42
Rate for Payer: Oxford Commercial	$4.17
Rate for Payer: Qualcare PPO/HMO/WC	$3.13
Rate for Payer: UnitedHealthcare Commercial	$4.17
Rate for Payer: UnitedHealthcare Community & State	$0.66
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

GAUZE NU PLAIN 2/5YD

Facility

$20.85

Hospital Charge Code	270300945
Hospital Revenue Code	272
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.13

GAUZE SPONGE 4X8 12-PLY STRL

Facility

$12.10

Hospital Charge Code	270655984
Hospital Revenue Code	271
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$1.81
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

GAUZE SPONGE 4X8 12-PLY STRL

Facility

$12.10

Hospital Charge Code	270655984
Hospital Revenue Code	271
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$6.05
Rate for Payer: Aetna Commercial	$4.60
Rate for Payer: Aetna Medicare Advantage	$3.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.09
Rate for Payer: Cigna Commercial	$6.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.15
Rate for Payer: Oxford Commercial	$2.42
Rate for Payer: Qualcare PPO/HMO/WC	$1.81
Rate for Payer: UnitedHealthcare Commercial	$2.42
Rate for Payer: UnitedHealthcare Community & State	$0.38
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

GAUZE VASELINE 1/2/72

Facility

$13.65

Hospital Charge Code	270300995
Hospital Revenue Code	272
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$5.19
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.55
Rate for Payer: Oxford Commercial	$2.73
Rate for Payer: Qualcare PPO/HMO/WC	$2.05
Rate for Payer: UnitedHealthcare Commercial	$2.73
Rate for Payer: UnitedHealthcare Community & State	$0.43
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

GAUZE VASELINE 1/2/72

Facility

$13.65

Hospital Charge Code	270300995
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

GAUZE VASELINE 3/1

Facility

$9.65

Hospital Charge Code	270301000
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

GAUZE VASELINE 3/1

Facility

$9.65

Hospital Charge Code	270301000
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

GAUZE VASELINE STR WRAP 1/2X72

Facility

$3.90

Hospital Charge Code	270649205
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Qualcare PPO/HMO/WC	$0.59

GAUZE VASELINE STR WRAP 1/2X72

Facility

$3.90

Hospital Charge Code	270649205
Hospital Revenue Code	270
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Commercial	$1.48
Rate for Payer: Aetna Medicare Advantage	$1.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.99
Rate for Payer: Cigna Commercial	$1.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.01
Rate for Payer: Oxford Commercial	$0.78
Rate for Payer: Qualcare PPO/HMO/WC	$0.59
Rate for Payer: UnitedHealthcare Commercial	$0.78
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

GAUZE VASELINE STR WRAP 1X8

Facility

$1.74

Hospital Charge Code	270649204
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.87
Rate for Payer: Aetna Commercial	$0.66
Rate for Payer: Aetna Medicare Advantage	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.44
Rate for Payer: Cigna Commercial	$0.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.45
Rate for Payer: Oxford Commercial	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.26
Rate for Payer: UnitedHealthcare Commercial	$0.35
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

GAUZE VASELINE STR WRAP 1X8

Facility

$1.74

Hospital Charge Code	270649204
Hospital Revenue Code	270
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Qualcare PPO/HMO/WC	$0.26

GAUZE VERSALON 2x2 GAUZE

Facility

$5.00

Hospital Charge Code	270350115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE VERSALON 2x2 GAUZE

Facility

$5.00

Hospital Charge Code	270350115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

GAUZE VERSALON 4x4 GAUZE

Facility

$5.00

Hospital Charge Code	270350120
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAUZE VERSALON 4x4 GAUZE

Facility

$5.00

Hospital Charge Code	270350120
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

GAUZE XEROFORM 5X9

Facility

$5.00

Hospital Charge Code	270301010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

GAUZE XEROFORM 5X9

Facility

$5.00

Hospital Charge Code	270301010
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

GAYZE XEROFORM STR WRAP 1X8

Facility

$1.60

Hospital Charge Code	270649206
Hospital Revenue Code	270
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.24
Rate for Payer: Qualcare PPO/HMO/WC	$0.24

GAYZE XEROFORM STR WRAP 1X8

Facility

$1.60

Hospital Charge Code	270649206
Hospital Revenue Code	270
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.80
Rate for Payer: Aetna Commercial	$0.61
Rate for Payer: Aetna Medicare Advantage	$0.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.41
Rate for Payer: Cigna Commercial	$0.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.42
Rate for Payer: Oxford Commercial	$0.32
Rate for Payer: Qualcare PPO/HMO/WC	$0.24
Rate for Payer: UnitedHealthcare Commercial	$0.32
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.05

GBM AB IGG

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900098
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$46.97
Rate for Payer: Aetna Medicare Advantage	$55.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.65
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$17.27
Rate for Payer: Clover Medicare Advantage	$16.41
Rate for Payer: EmblemHealth Commercial	$51.81
Rate for Payer: Humana Medicare Advantage	$17.79
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$13.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.27
Rate for Payer: Wellcare Medicare Advantage	$17.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GBM AB IGG

Facility

$390.00

Service Code	HCPCS 83520
Hospital Charge Code	39900098
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges