Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

HEMOSPLIT 27CM

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270637768
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

HEMOSPLIT 31cm 5733313

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270637885
Hospital Revenue Code	278
Min. Negotiated Rate	$49.84
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Community & State	$55.46
Rate for Payer: Wellpoint Medicaid Managed Care	$49.84

HEMOSPLIT 31cm 5733313

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270637885
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

HEMOSPRAY HEMOSTAT HEMO7

Facility

$12,250.00

Service Code	HCPCS C1052
Hospital Charge Code	270687359
Hospital Revenue Code	272
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$1,837.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

HEMOSPRAY HEMOSTAT HEMO7

Facility

$12,250.00

Service Code	HCPCS C1052
Hospital Charge Code	270687359
Hospital Revenue Code	272
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,185.00
Rate for Payer: Oxford Commercial	$2,450.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Commercial	$2,450.00
Rate for Payer: UnitedHealthcare Community & State	$387.10
Rate for Payer: Wellpoint Medicaid Managed Care	$347.90

HEMOSTAT D-STAT FLOWABLE 4000

Facility

$625.00

Hospital Charge Code	270638461
Hospital Revenue Code	272
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.50
Rate for Payer: Oxford Commercial	$125.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Commercial	$125.00
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

HEMOSTAT D-STAT FLOWABLE 4000

Facility

$625.00

Hospital Charge Code	270638461
Hospital Revenue Code	272
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$93.75
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

HEMOSTAT OSTENE 1GM

Facility

$249.05

Hospital Charge Code	270697396
Hospital Revenue Code	272
Min. Negotiated Rate	$7.07
Max. Negotiated Rate	$124.53
Rate for Payer: Aetna Commercial	$94.64
Rate for Payer: Aetna Medicare Advantage	$74.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.51
Rate for Payer: Cigna Commercial	$124.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.75
Rate for Payer: Oxford Commercial	$49.81
Rate for Payer: Qualcare PPO/HMO/WC	$37.36
Rate for Payer: UnitedHealthcare Commercial	$49.81
Rate for Payer: UnitedHealthcare Community & State	$7.87
Rate for Payer: Wellpoint Medicaid Managed Care	$7.07

HEMOSTAT OSTENE 1GM

Facility

$249.05

Hospital Charge Code	270697396
Hospital Revenue Code	272
Min. Negotiated Rate	$37.36
Max. Negotiated Rate	$37.36
Rate for Payer: Qualcare PPO/HMO/WC	$37.36

HEMOSTAT SRGICL ABSRBABL 2x14

Facility

$596.60

Hospital Charge Code	270641925
Hospital Revenue Code	272
Min. Negotiated Rate	$16.94
Max. Negotiated Rate	$298.30
Rate for Payer: Aetna Commercial	$226.71
Rate for Payer: Aetna Medicare Advantage	$178.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.13
Rate for Payer: Cigna Commercial	$298.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.12
Rate for Payer: Oxford Commercial	$119.32
Rate for Payer: Qualcare PPO/HMO/WC	$89.49
Rate for Payer: UnitedHealthcare Commercial	$119.32
Rate for Payer: UnitedHealthcare Community & State	$18.85
Rate for Payer: Wellpoint Medicaid Managed Care	$16.94

HEMOSTAT SRGICL ABSRBABL 2x14

Facility

$596.60

Hospital Charge Code	270641925
Hospital Revenue Code	272
Min. Negotiated Rate	$89.49
Max. Negotiated Rate	$89.49
Rate for Payer: Qualcare PPO/HMO/WC	$89.49

HEMOSTAT SURGICEL 4x8in 1952

Facility

$383.25

Hospital Charge Code	270641926
Hospital Revenue Code	272
Min. Negotiated Rate	$10.88
Max. Negotiated Rate	$191.62
Rate for Payer: Aetna Commercial	$145.63
Rate for Payer: Aetna Medicare Advantage	$114.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.73
Rate for Payer: Cigna Commercial	$191.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.64
Rate for Payer: Oxford Commercial	$76.65
Rate for Payer: Qualcare PPO/HMO/WC	$57.49
Rate for Payer: UnitedHealthcare Commercial	$76.65
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.88

HEMOSTAT SURGICEL 4x8in 1952

Facility

$383.25

Hospital Charge Code	270641926
Hospital Revenue Code	272
Min. Negotiated Rate	$57.49
Max. Negotiated Rate	$57.49
Rate for Payer: Qualcare PPO/HMO/WC	$57.49

HEMOTALIC INTRODUCER SYS 6F

Facility

$275.00

Hospital Charge Code	270671255
Hospital Revenue Code	272
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$8.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

HEMOTALIC INTRODUCER SYS 6F

Facility

$275.00

Hospital Charge Code	270671255
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

HEMOTALIC INTRODUCER SYS 8F

Facility

$275.00

Hospital Charge Code	270671253
Hospital Revenue Code	272
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$41.25
Rate for Payer: Qualcare PPO/HMO/WC	$41.25

HEMOTALIC INTRODUCER SYS 8F

Facility

$275.00

Hospital Charge Code	270671253
Hospital Revenue Code	272
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$137.50
Rate for Payer: Aetna Commercial	$104.50
Rate for Payer: Aetna Medicare Advantage	$82.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$70.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$70.12
Rate for Payer: Cigna Commercial	$137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.50
Rate for Payer: Oxford Commercial	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$41.25
Rate for Payer: UnitedHealthcare Commercial	$55.00
Rate for Payer: UnitedHealthcare Community & State	$8.69
Rate for Payer: Wellpoint Medicaid Managed Care	$7.81

HEMOVAC MED

Facility

$46.82

Hospital Charge Code	270649525
Hospital Revenue Code	272
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$7.02
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

HEMOVAC MED

Facility

$46.82

Hospital Charge Code	270649525
Hospital Revenue Code	272
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$23.41
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Aetna Medicare Advantage	$14.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.94
Rate for Payer: Cigna Commercial	$23.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.17
Rate for Payer: Oxford Commercial	$9.36
Rate for Payer: Qualcare PPO/HMO/WC	$7.02
Rate for Payer: UnitedHealthcare Commercial	$9.36
Rate for Payer: UnitedHealthcare Community & State	$1.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

HEMO WET FIELD ERASER 18G

Facility

$62.00

Hospital Charge Code	270332253
Hospital Revenue Code	272
Min. Negotiated Rate	$9.30
Max. Negotiated Rate	$9.30
Rate for Payer: Qualcare PPO/HMO/WC	$9.30

HEMO WET FIELD ERASER 18G

Facility

$62.00

Hospital Charge Code	270332253
Hospital Revenue Code	272
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$31.00
Rate for Payer: Aetna Commercial	$23.56
Rate for Payer: Aetna Medicare Advantage	$18.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.81
Rate for Payer: Cigna Commercial	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.12
Rate for Payer: Oxford Commercial	$12.40
Rate for Payer: Qualcare PPO/HMO/WC	$9.30
Rate for Payer: UnitedHealthcare Commercial	$12.40
Rate for Payer: UnitedHealthcare Community & State	$1.96
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

HEP A ANTIBODY

Facility

$410.00

Service Code	HCPCS 86709
Hospital Charge Code	38479444
Hospital Revenue Code	302
Min. Negotiated Rate	$61.50
Max. Negotiated Rate	$61.50
Rate for Payer: Qualcare PPO/HMO/WC	$61.50

HEP A ANTIBODY

Facility

$410.00

Service Code	HCPCS 86709
Hospital Charge Code	38479444
Hospital Revenue Code	302
Min. Negotiated Rate	$9.01
Max. Negotiated Rate	$205.00
Rate for Payer: Aetna Commercial	$30.63
Rate for Payer: Aetna Medicare Advantage	$36.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$40.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$40.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$40.85
Rate for Payer: Cigna Commercial	$205.00
Rate for Payer: Cigna Medicare Advantage	$11.26
Rate for Payer: Clover Medicare Advantage	$10.70
Rate for Payer: EmblemHealth Commercial	$33.78
Rate for Payer: Humana Medicare Advantage	$11.60
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$106.60
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$61.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.26
Rate for Payer: Wellcare Medicare Advantage	$11.26
Rate for Payer: Wellpoint Medicaid Managed Care	$11.64

HEP A PEDS

Facility

$50.00

Service Code	HCPCS 90633
Hospital Charge Code	83652597
Hospital Revenue Code	636
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$12.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.50

HEP A PEDS

Facility

$50.00

Service Code	HCPCS 90633
Hospital Charge Code	83652597
Hospital Revenue Code	636
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$45.03
Rate for Payer: Aetna Commercial	$19.00
Rate for Payer: Aetna Medicare Advantage	$15.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.75
Rate for Payer: Cigna Commercial	$25.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.50
Rate for Payer: UnitedHealthcare Community & State	$1.58
Rate for Payer: Wellpoint Medicaid Managed Care	$1.42

Know your out-of-pocket cost for care.

All Charges