Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT WOUND MATRIX 5X5CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696726
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,535.49
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	$1,269.00
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	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75
Rate for Payer: UnitedHealthcare Community & State	$200.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

GRAFT XENMATRIX AB 4 X 8 CM

Facility

$30,300.00

Service Code	HCPCS C1781
Hospital Charge Code	270684825
Hospital Revenue Code	278
Min. Negotiated Rate	$860.52
Max. Negotiated Rate	$15,150.00
Rate for Payer: Aetna Commercial	$11,514.00
Rate for Payer: Aetna Medicare Advantage	$9,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,726.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,726.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,726.50
Rate for Payer: Cigna Commercial	$15,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,332.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,545.00
Rate for Payer: UnitedHealthcare Community & State	$957.48
Rate for Payer: Wellpoint Medicaid Managed Care	$860.52

GRAFT XENMATRIX AB 4 X 8 CM

Facility

$30,300.00

Service Code	HCPCS C1781
Hospital Charge Code	270684825
Hospital Revenue Code	278
Min. Negotiated Rate	$4,545.00
Max. Negotiated Rate	$7,332.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,332.60
Rate for Payer: Qualcare PPO/HMO/WC	$4,545.00

GRAFT ZENITH ALPHA 30MM

Facility

$77,500.00

Hospital Charge Code	270677133
Hospital Revenue Code	278
Min. Negotiated Rate	$11,625.00
Max. Negotiated Rate	$18,755.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,755.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,625.00

GRAFT ZENITH ALPHA 30MM

Facility

$77,500.00

Hospital Charge Code	270677133
Hospital Revenue Code	278
Min. Negotiated Rate	$2,201.00
Max. Negotiated Rate	$38,750.00
Rate for Payer: Aetna Commercial	$29,450.00
Rate for Payer: Aetna Medicare Advantage	$23,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19,762.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$15,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19,762.50
Rate for Payer: Cigna Commercial	$38,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,755.00
Rate for Payer: Qualcare PPO/HMO/WC	$11,625.00
Rate for Payer: UnitedHealthcare Community & State	$2,449.00
Rate for Payer: Wellpoint Medicaid Managed Care	$2,201.00

GRAMS STAIN

Facility

$390.00

Service Code	HCPCS 88312
Hospital Charge Code	3005277
Hospital Revenue Code	310
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GRAMS STAIN

Facility

$390.00

Service Code	HCPCS 88312
Hospital Charge Code	3005277
Hospital Revenue Code	310
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$224.58
Rate for Payer: Aetna Commercial	$168.40
Rate for Payer: Aetna Medicare Advantage	$200.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.58
Rate for Payer: Cigna Commercial	$124.10
Rate for Payer: Cigna Medicare Advantage	$61.91
Rate for Payer: Clover Medicare Advantage	$58.81
Rate for Payer: EmblemHealth Commercial	$185.73
Rate for Payer: Humana Medicare Advantage	$63.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.91
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	$92.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.91
Rate for Payer: Wellcare Medicare Advantage	$61.91
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GRAM STAIN

Facility

$390.00

Service Code	HCPCS 87205
Hospital Charge Code	3003530
Hospital Revenue Code	309
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
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	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GRAM STAIN

Facility

$390.00

Service Code	HCPCS 87205
Hospital Charge Code	3003530
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GRAM STAIN

Facility

$390.00

Service Code	HCPCS 87205
Hospital Charge Code	38475059
Hospital Revenue Code	309
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

GRAM STAIN

Facility

$390.00

Service Code	HCPCS 87205
Hospital Charge Code	38475059
Hospital Revenue Code	309
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
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	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

GRANISETRON HYDROCHLORIDE 1 MG

Facility

$395.43

Service Code	HCPCS Q0166
Hospital Charge Code	6063943201
Hospital Revenue Code	636
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$197.72
Rate for Payer: Aetna Commercial	$150.26
Rate for Payer: Aetna Medicare Advantage	$118.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.83
Rate for Payer: Cigna Commercial	$197.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.69
Rate for Payer: Qualcare PPO/HMO/WC	$59.31
Rate for Payer: UnitedHealthcare Community & State	$12.50
Rate for Payer: Wellpoint Medicaid Managed Care	$11.23

GRANISETRON HYDROCHLORIDE 1 MG

Facility

$395.43

Service Code	HCPCS Q0166
Hospital Charge Code	6063943201
Hospital Revenue Code	636
Min. Negotiated Rate	$59.31
Max. Negotiated Rate	$95.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.69
Rate for Payer: Qualcare PPO/HMO/WC	$59.31

GRANULES <2MM 15CC

Facility

$11,310.00

Service Code	HCPCS C1889
Hospital Charge Code	270704065
Hospital Revenue Code	278
Min. Negotiated Rate	$1,696.50
Max. Negotiated Rate	$2,737.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,262.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,737.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,696.50

GRANULES <2MM 15CC

Facility

$11,310.00

Service Code	HCPCS C1889
Hospital Charge Code	270704065
Hospital Revenue Code	278
Min. Negotiated Rate	$321.20
Max. Negotiated Rate	$5,655.00
Rate for Payer: Aetna Commercial	$4,297.80
Rate for Payer: Aetna Medicare Advantage	$3,393.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,884.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,262.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,884.05
Rate for Payer: Cigna Commercial	$5,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,737.02
Rate for Payer: Qualcare PPO/HMO/WC	$1,696.50
Rate for Payer: UnitedHealthcare Community & State	$357.40
Rate for Payer: Wellpoint Medicaid Managed Care	$321.20

GRANULES CHRONOS 2.8 5 6M/10CC

Facility

$2,874.00

Service Code	HCPCS C1713
Hospital Charge Code	270673440
Hospital Revenue Code	278
Min. Negotiated Rate	$431.10
Max. Negotiated Rate	$695.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.51
Rate for Payer: Qualcare PPO/HMO/WC	$431.10

GRANULES CHRONOS 2.8 5 6M/10CC

Facility

$2,874.00

Service Code	HCPCS C1713
Hospital Charge Code	270673440
Hospital Revenue Code	278
Min. Negotiated Rate	$81.62
Max. Negotiated Rate	$1,437.00
Rate for Payer: Aetna Commercial	$1,092.12
Rate for Payer: Aetna Medicare Advantage	$862.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$732.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$732.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$574.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$732.87
Rate for Payer: Cigna Commercial	$1,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$695.51
Rate for Payer: Qualcare PPO/HMO/WC	$431.10
Rate for Payer: UnitedHealthcare Community & State	$90.82
Rate for Payer: Wellpoint Medicaid Managed Care	$81.62

GRANULOCYTES PHERESIS EACH

Facility

$8,954.00

Service Code	HCPCS P9060
Hospital Charge Code	38477230
Hospital Revenue Code	390
Min. Negotiated Rate	$1,343.10
Max. Negotiated Rate	$1,343.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,343.10

GRANULOCYTES PHERESIS EACH

Facility

$8,954.00

Service Code	HCPCS P9060
Hospital Charge Code	38477230
Hospital Revenue Code	390
Min. Negotiated Rate	$58.82
Max. Negotiated Rate	$2,328.04
Rate for Payer: Aetna Commercial	$168.42
Rate for Payer: Aetna Medicare Advantage	$200.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$224.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$224.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$61.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$224.61
Rate for Payer: Cigna Commercial	$124.12
Rate for Payer: Cigna Medicare Advantage	$61.92
Rate for Payer: Clover Medicare Advantage	$58.82
Rate for Payer: EmblemHealth Commercial	$185.76
Rate for Payer: Humana Medicare Advantage	$63.78
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$61.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,328.04
Rate for Payer: Oxford Commercial	$1,028.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,343.10
Rate for Payer: UnitedHealthcare Commercial	$1,167.00
Rate for Payer: UnitedHealthcare Community & State	$282.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.92
Rate for Payer: Wellcare Medicare Advantage	$61.92
Rate for Payer: Wellpoint Medicaid Managed Care	$254.29

GRASPER W/RATCHET HANDLE 5MM

Facility

$296.20

Hospital Charge Code	270671541
Hospital Revenue Code	272
Min. Negotiated Rate	$44.43
Max. Negotiated Rate	$44.43
Rate for Payer: Qualcare PPO/HMO/WC	$44.43

GRASPER W/RATCHET HANDLE 5MM

Facility

$296.20

Hospital Charge Code	270671541
Hospital Revenue Code	272
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$148.10
Rate for Payer: Aetna Commercial	$112.56
Rate for Payer: Aetna Medicare Advantage	$88.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.53
Rate for Payer: Cigna Commercial	$148.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.01
Rate for Payer: Oxford Commercial	$59.24
Rate for Payer: Qualcare PPO/HMO/WC	$44.43
Rate for Payer: UnitedHealthcare Commercial	$59.24
Rate for Payer: UnitedHealthcare Community & State	$9.36
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

GRASP NDL OPEN LOOP DISP 10165

Facility

$270.00

Hospital Charge Code	270641145
Hospital Revenue Code	272
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.67

GRASP NDL OPEN LOOP DISP 10165

Facility

$270.00

Hospital Charge Code	270641145
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

GREAT RELEASE MTP RELEASE INST

Facility

$2,750.00

Hospital Charge Code	270704035
Hospital Revenue Code	272
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$715.00
Rate for Payer: Oxford Commercial	$550.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Commercial	$550.00
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

GREAT RELEASE MTP RELEASE INST

Facility

$2,750.00

Hospital Charge Code	270704035
Hospital Revenue Code	272
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50

Know your out-of-pocket cost for care.

All Charges