Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GCT 1 HR

Facility

$390.00

Service Code	HCPCS 82950
Hospital Charge Code	3008498
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GCT 1 HR

Facility

$390.00

Service Code	HCPCS 82950
Hospital Charge Code	3008498
Hospital Revenue Code	301
Min. Negotiated Rate	$3.80
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$12.92
Rate for Payer: Aetna Medicare Advantage	$15.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.23
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.75
Rate for Payer: Clover Medicare Advantage	$4.51
Rate for Payer: EmblemHealth Commercial	$14.25
Rate for Payer: Humana Medicare Advantage	$4.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.75
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	$3.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.75
Rate for Payer: Wellcare Medicare Advantage	$4.75
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GD CALC FRAC PERCPLT

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686776
Hospital Revenue Code	278
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) NJ Health	$600.00
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	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

GD CALC FRAC PERCPLT

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686776
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

GDE PIN DRL TIP 2.8X300MM STE

Facility

$1,500.00

Hospital Charge Code	270704598
Hospital Revenue Code	279
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.00
Rate for Payer: Oxford Commercial	$300.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Commercial	$300.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

GDE PIN DRL TIP 2.8X300MM STE

Facility

$1,500.00

Hospital Charge Code	270704598
Hospital Revenue Code	279
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

GD PIN SHRT THRD 3.2MM X 14 3P

Facility

$475.00

Hospital Charge Code	270685089
Hospital Revenue Code	272
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$123.50
Rate for Payer: Oxford Commercial	$95.00
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Commercial	$95.00
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

GD PIN SHRT THRD 3.2MM X 14 3P

Facility

$475.00

Hospital Charge Code	270685089
Hospital Revenue Code	272
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$71.25
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

GD PIN THD TIP 3.2X 35.5CM

Facility

$288.00

Hospital Charge Code	270624835
Hospital Revenue Code	272
Min. Negotiated Rate	$8.18
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Commercial	$109.44
Rate for Payer: Aetna Medicare Advantage	$86.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.44
Rate for Payer: Cigna Commercial	$144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.88
Rate for Payer: Oxford Commercial	$57.60
Rate for Payer: Qualcare PPO/HMO/WC	$43.20
Rate for Payer: UnitedHealthcare Commercial	$57.60
Rate for Payer: UnitedHealthcare Community & State	$9.10
Rate for Payer: Wellpoint Medicaid Managed Care	$8.18

GD PIN THD TIP 3.2X 35.5CM

Facility

$288.00

Hospital Charge Code	270624835
Hospital Revenue Code	272
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$43.20
Rate for Payer: Qualcare PPO/HMO/WC	$43.20

GEL AQUASONIC 100 ULTRASOUND

Facility

$161.00

Hospital Charge Code	270331309
Hospital Revenue Code	272
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$80.50
Rate for Payer: Aetna Commercial	$61.18
Rate for Payer: Aetna Medicare Advantage	$48.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.05
Rate for Payer: Cigna Commercial	$80.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.86
Rate for Payer: Oxford Commercial	$32.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.15
Rate for Payer: UnitedHealthcare Commercial	$32.20
Rate for Payer: UnitedHealthcare Community & State	$5.09
Rate for Payer: Wellpoint Medicaid Managed Care	$4.57

GEL AQUASONIC 100 ULTRASOUND

Facility

$161.00

Hospital Charge Code	270331309
Hospital Revenue Code	272
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$24.15
Rate for Payer: Qualcare PPO/HMO/WC	$24.15

GELATIN SPONGE 1 SPG SPG

Facility

$334.93

Service Code	NDC 9034201
Hospital Charge Code	60627525
Hospital Revenue Code	250
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$50.24
Rate for Payer: Qualcare PPO/HMO/WC	$50.24

GELATIN SPONGE 1 SPG SPG

Facility

$334.93

Service Code	NDC 9034201
Hospital Charge Code	60627525
Hospital Revenue Code	250
Min. Negotiated Rate	$9.51
Max. Negotiated Rate	$167.47
Rate for Payer: Aetna Commercial	$127.27
Rate for Payer: Aetna Medicare Advantage	$100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$85.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$85.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$85.41
Rate for Payer: Cigna Commercial	$167.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$87.08
Rate for Payer: Oxford Commercial	$66.99
Rate for Payer: Qualcare PPO/HMO/WC	$50.24
Rate for Payer: UnitedHealthcare Commercial	$66.99
Rate for Payer: UnitedHealthcare Community & State	$10.58
Rate for Payer: Wellpoint Medicaid Managed Care	$9.51

GELATIN SURGIFLO HEMO 8ML

Facility

$910.00

Service Code	HCPCS C1765
Hospital Charge Code	270688738
Hospital Revenue Code	278
Min. Negotiated Rate	$25.84
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial	$345.80
Rate for Payer: Aetna Medicare Advantage	$273.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$232.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$232.05
Rate for Payer: Cigna Commercial	$455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: Qualcare PPO/HMO/WC	$136.50
Rate for Payer: UnitedHealthcare Community & State	$28.76
Rate for Payer: Wellpoint Medicaid Managed Care	$25.84

GELATIN SURGIFLO HEMO 8ML

Facility

$910.00

Service Code	HCPCS C1765
Hospital Charge Code	270688738
Hospital Revenue Code	278
Min. Negotiated Rate	$136.50
Max. Negotiated Rate	$220.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$220.22
Rate for Payer: Qualcare PPO/HMO/WC	$136.50

GELFILM NON OPHT 10 X 12.5 CM

Facility

$265.59

Service Code	NDC 9029703
Hospital Charge Code	606350995
Hospital Revenue Code	250
Min. Negotiated Rate	$39.84
Max. Negotiated Rate	$39.84
Rate for Payer: Qualcare PPO/HMO/WC	$39.84

GELFILM NON OPHT 10 X 12.5 CM

Facility

$265.59

Service Code	NDC 9029703
Hospital Charge Code	606350995
Hospital Revenue Code	250
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$132.79
Rate for Payer: Aetna Commercial	$100.92
Rate for Payer: Aetna Medicare Advantage	$79.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.73
Rate for Payer: Cigna Commercial	$132.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$69.05
Rate for Payer: Oxford Commercial	$53.12
Rate for Payer: Qualcare PPO/HMO/WC	$39.84
Rate for Payer: UnitedHealthcare Commercial	$53.12
Rate for Payer: UnitedHealthcare Community & State	$8.39
Rate for Payer: Wellpoint Medicaid Managed Care	$7.54

GELFILM OPHTH 25 X 50MM

Facility

$1,045.20

Service Code	NDC 9029703
Hospital Charge Code	60635623
Hospital Revenue Code	250
Min. Negotiated Rate	$29.68
Max. Negotiated Rate	$522.60
Rate for Payer: Aetna Commercial	$397.18
Rate for Payer: Aetna Medicare Advantage	$313.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$266.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$266.53
Rate for Payer: Cigna Commercial	$522.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$271.75
Rate for Payer: Oxford Commercial	$209.04
Rate for Payer: Qualcare PPO/HMO/WC	$156.78
Rate for Payer: UnitedHealthcare Commercial	$209.04
Rate for Payer: UnitedHealthcare Community & State	$33.03
Rate for Payer: Wellpoint Medicaid Managed Care	$29.68

GELFILM OPHTH 25 X 50MM

Facility

$1,045.20

Service Code	NDC 9029703
Hospital Charge Code	60635623
Hospital Revenue Code	250
Min. Negotiated Rate	$156.78
Max. Negotiated Rate	$156.78
Rate for Payer: Qualcare PPO/HMO/WC	$156.78

GELFOAM

Facility

$145.00

Hospital Charge Code	270335261
Hospital Revenue Code	272
Min. Negotiated Rate	$21.75
Max. Negotiated Rate	$21.75
Rate for Payer: Qualcare PPO/HMO/WC	$21.75

GELFOAM

Facility

$145.00

Hospital Charge Code	270335261
Hospital Revenue Code	272
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$72.50
Rate for Payer: Aetna Commercial	$55.10
Rate for Payer: Aetna Medicare Advantage	$43.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.98
Rate for Payer: Cigna Commercial	$72.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.70
Rate for Payer: Oxford Commercial	$29.00
Rate for Payer: Qualcare PPO/HMO/WC	$21.75
Rate for Payer: UnitedHealthcare Commercial	$29.00
Rate for Payer: UnitedHealthcare Community & State	$4.58
Rate for Payer: Wellpoint Medicaid Managed Care	$4.12

GELFOAM SPONGE 50 SQ CM

Facility

$224.05

Service Code	NDC 9032301
Hospital Charge Code	606390182
Hospital Revenue Code	250
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$112.03
Rate for Payer: Aetna Commercial	$85.14
Rate for Payer: Aetna Medicare Advantage	$67.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.13
Rate for Payer: Cigna Commercial	$112.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.25
Rate for Payer: Oxford Commercial	$44.81
Rate for Payer: Qualcare PPO/HMO/WC	$33.61
Rate for Payer: UnitedHealthcare Commercial	$44.81
Rate for Payer: UnitedHealthcare Community & State	$7.08
Rate for Payer: Wellpoint Medicaid Managed Care	$6.36

GELFOAM SPONGE 50 SQ CM

Facility

$224.05

Service Code	NDC 9032301
Hospital Charge Code	606390182
Hospital Revenue Code	250
Min. Negotiated Rate	$33.61
Max. Negotiated Rate	$33.61
Rate for Payer: Qualcare PPO/HMO/WC	$33.61

GEL GRAFTON 1CC 121120

Facility

$950.00

Service Code	HCPCS C1713
Hospital Charge Code	270601115
Hospital Revenue Code	278
Min. Negotiated Rate	$26.98
Max. Negotiated Rate	$475.00
Rate for Payer: Aetna Commercial	$361.00
Rate for Payer: Aetna Medicare Advantage	$285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.25
Rate for Payer: Cigna Commercial	$475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$229.90
Rate for Payer: Qualcare PPO/HMO/WC	$142.50
Rate for Payer: UnitedHealthcare Community & State	$30.02
Rate for Payer: Wellpoint Medicaid Managed Care	$26.98

Know your out-of-pocket cost for care.

All Charges