Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRFG AUTO FAT LIPO CC/<

Facility

$10,771.05

Service Code	HCPCS 15773
Hospital Charge Code	1600000358
Hospital Revenue Code	360
Min. Negotiated Rate	$305.90
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
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	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,800.47
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,615.66
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$340.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$305.90

GRFG AUTOL FAT LIPO 50 CC/<

Facility

$13,957.04

Service Code	HCPCS 15771
Hospital Charge Code	16000494
Hospital Revenue Code	360
Min. Negotiated Rate	$396.38
Max. Negotiated Rate	$15,271.92
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,271.92
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,628.83
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,093.56
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$441.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$396.38

GRFG AUTOL FAT LIPO 50 CC/<

Facility

$13,957.04

Service Code	HCPCS 15771
Hospital Charge Code	16000494
Hospital Revenue Code	360
Min. Negotiated Rate	$2,093.56
Max. Negotiated Rate	$2,093.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,093.56

GRFG AUTOL FAT LIPO EA ADDL

Facility

$5,402.61

Service Code	HCPCS 15772
Hospital Charge Code	16000309
Hospital Revenue Code	360
Min. Negotiated Rate	$810.39
Max. Negotiated Rate	$810.39
Rate for Payer: Qualcare PPO/HMO/WC	$810.39

GRFG AUTOL FAT LIPO EA ADDL

Facility

$5,402.61

Service Code	HCPCS 15772
Hospital Charge Code	16000309
Hospital Revenue Code	360
Min. Negotiated Rate	$153.43
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$2,052.99
Rate for Payer: Aetna Medicare Advantage	$1,620.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,377.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,377.67
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	$1,377.67
Rate for Payer: Cigna Commercial	$2,701.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,404.68
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$810.39
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$170.72
Rate for Payer: Wellpoint Medicaid Managed Care	$153.43

GRF MATRX IQ DERM 5X4CM/SQCMJW

Facility

$300.00

Hospital Charge Code	270676216W
Hospital Revenue Code	636
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$72.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GRF MATRX IQ DERM 5X4CM/SQCMJW

Facility

$300.00

Hospital Charge Code	270676216W
Hospital Revenue Code	636
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.60
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

GRF MATRX IQ DERMIS 5X4CM

Facility

$6,000.00

Hospital Charge Code	270676216
Hospital Revenue Code	636
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GRF MATRX IQ DERMIS 5X4CM

Facility

$6,000.00

Hospital Charge Code	270676216
Hospital Revenue Code	636
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

GRF NEOX CORD 1K 3x3CM/SQCM JW

Facility

$1,244.31

Hospital Charge Code	270675812W
Hospital Revenue Code	636
Min. Negotiated Rate	$35.34
Max. Negotiated Rate	$622.15
Rate for Payer: Aetna Commercial	$472.84
Rate for Payer: Aetna Medicare Advantage	$373.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$317.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$317.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$317.30
Rate for Payer: Cigna Commercial	$622.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.12
Rate for Payer: Qualcare PPO/HMO/WC	$186.65
Rate for Payer: UnitedHealthcare Community & State	$39.32
Rate for Payer: Wellpoint Medicaid Managed Care	$35.34

GRF NEOX CORD 1K 3x3CM/SQCM JW

Facility

$1,244.31

Hospital Charge Code	270675812W
Hospital Revenue Code	636
Min. Negotiated Rate	$186.65
Max. Negotiated Rate	$301.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$301.12
Rate for Payer: Qualcare PPO/HMO/WC	$186.65

GRFT FULL FACE/HF </= 20 SQCM

Facility

$9,070.55

Service Code	HCPCS 15240
Hospital Charge Code	323015240
Hospital Revenue Code	450
Min. Negotiated Rate	$1,360.58
Max. Negotiated Rate	$1,360.58
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58

GRFT FULL FACE/HF </= 20 SQCM

Facility

$9,070.55

Service Code	HCPCS 15240
Hospital Charge Code	323015240
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$348.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,358.34
Rate for Payer: Qualcare PPO/HMO/WC	$1,360.58
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$257.60

GRFT VASC STRD FIX R 6CM 5-45

Facility

$2,022.00

Hospital Charge Code	270339062
Hospital Revenue Code	278
Min. Negotiated Rate	$303.30
Max. Negotiated Rate	$489.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$404.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$489.32
Rate for Payer: Qualcare PPO/HMO/WC	$303.30

GRFT VASC STRD FIX R 6CM 5-45

Facility

$2,022.00

Hospital Charge Code	270339062
Hospital Revenue Code	278
Min. Negotiated Rate	$57.42
Max. Negotiated Rate	$1,011.00
Rate for Payer: Aetna Commercial	$768.36
Rate for Payer: Aetna Medicare Advantage	$606.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$515.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$515.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$404.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$515.61
Rate for Payer: Cigna Commercial	$1,011.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$489.32
Rate for Payer: Qualcare PPO/HMO/WC	$303.30
Rate for Payer: UnitedHealthcare Community & State	$63.90
Rate for Payer: Wellpoint Medicaid Managed Care	$57.42

GRFT VAS STDRD-W 6MM 10-80CM

Facility

$2,888.00

Hospital Charge Code	270339061
Hospital Revenue Code	278
Min. Negotiated Rate	$82.02
Max. Negotiated Rate	$1,444.00
Rate for Payer: Aetna Commercial	$1,097.44
Rate for Payer: Aetna Medicare Advantage	$866.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$736.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$736.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$577.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$736.44
Rate for Payer: Cigna Commercial	$1,444.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$698.90
Rate for Payer: Qualcare PPO/HMO/WC	$433.20
Rate for Payer: UnitedHealthcare Community & State	$91.26
Rate for Payer: Wellpoint Medicaid Managed Care	$82.02

GRFT VAS STDRD-W 6MM 10-80CM

Facility

$2,888.00

Hospital Charge Code	270339061
Hospital Revenue Code	278
Min. Negotiated Rate	$433.20
Max. Negotiated Rate	$698.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$577.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$698.90
Rate for Payer: Qualcare PPO/HMO/WC	$433.20

GRISEOFULVIN, MICROCRYSTALLI 250 MG TAB

Facility

$49.18

Service Code	NDC 64980018501
Hospital Charge Code	6063943202
Hospital Revenue Code	250
Min. Negotiated Rate	$7.38
Max. Negotiated Rate	$7.38
Rate for Payer: Qualcare PPO/HMO/WC	$7.38

GRISEOFULVIN, MICROCRYSTALLI 250 MG TAB

Facility

$49.18

Service Code	NDC 64980018501
Hospital Charge Code	6063943202
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$24.59
Rate for Payer: Aetna Commercial	$18.69
Rate for Payer: Aetna Medicare Advantage	$14.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.54
Rate for Payer: Cigna Commercial	$24.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.79
Rate for Payer: Oxford Commercial	$9.84
Rate for Payer: Qualcare PPO/HMO/WC	$7.38
Rate for Payer: UnitedHealthcare Commercial	$9.84
Rate for Payer: UnitedHealthcare Community & State	$1.55
Rate for Payer: Wellpoint Medicaid Managed Care	$1.40

GROUNDING PAD

Facility

$100.00

Hospital Charge Code	270680887
Hospital Revenue Code	272
Min. Negotiated Rate	$15.00
Max. Negotiated Rate	$15.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00

GROUNDING PAD

Facility

$100.00

Hospital Charge Code	270680887
Hospital Revenue Code	272
Min. Negotiated Rate	$2.84
Max. Negotiated Rate	$50.00
Rate for Payer: Aetna Commercial	$38.00
Rate for Payer: Aetna Medicare Advantage	$30.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.50
Rate for Payer: Cigna Commercial	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.00
Rate for Payer: Oxford Commercial	$20.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.00
Rate for Payer: UnitedHealthcare Commercial	$20.00
Rate for Payer: UnitedHealthcare Community & State	$3.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.84

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4818607
Hospital Revenue Code	915
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4818607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4832607
Hospital Revenue Code	915
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

GROUP ADULT OP Medicaid

Facility

$750.00

Service Code	HCPCS 90853
Hospital Charge Code	4504607
Hospital Revenue Code	915
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$437.80
Rate for Payer: Aetna Commercial	$328.28
Rate for Payer: Aetna Medicare Advantage	$391.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$437.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$120.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$437.80
Rate for Payer: Cigna Commercial	$241.93
Rate for Payer: Cigna Medicare Advantage	$120.69
Rate for Payer: Clover Medicare Advantage	$114.66
Rate for Payer: EmblemHealth Commercial	$362.07
Rate for Payer: Humana Medicare Advantage	$124.31
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$120.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.69
Rate for Payer: Wellcare Medicare Advantage	$120.69
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$27.48
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

Know your out-of-pocket cost for care.

All Charges