Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

INTEGRA FLOWABLE WOUND MATRIX

Facility

$14,105.00

Service Code	HCPCS Q4114
Hospital Charge Code	270646968
Hospital Revenue Code	278
Min. Negotiated Rate	$2,115.75
Max. Negotiated Rate	$3,413.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,821.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,413.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,115.75

INTEGRAL PRIMARY/REV 13X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270688618
Hospital Revenue Code	278
Min. Negotiated Rate	$7,558.20
Max. Negotiated Rate	$12,193.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20

INTEGRAL PRIMARY/REV 13X180

Facility

$38,760.00

Service Code	HCPCS C1776
Hospital Charge Code	270686318
Hospital Revenue Code	278
Min. Negotiated Rate	$5,814.00
Max. Negotiated Rate	$9,379.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,379.92
Rate for Payer: Qualcare PPO/HMO/WC	$5,814.00

INTEGRAL PRIMARY/REV 13X180

Facility

$50,388.00

Service Code	HCPCS C1776
Hospital Charge Code	270688618
Hospital Revenue Code	278
Min. Negotiated Rate	$1,431.02
Max. Negotiated Rate	$25,194.00
Rate for Payer: Aetna Commercial	$19,147.44
Rate for Payer: Aetna Medicare Advantage	$15,116.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,848.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$10,077.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,848.94
Rate for Payer: Cigna Commercial	$25,194.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,193.90
Rate for Payer: Qualcare PPO/HMO/WC	$7,558.20
Rate for Payer: UnitedHealthcare Community & State	$1,592.26
Rate for Payer: Wellpoint Medicaid Managed Care	$1,431.02

INTEGRAL PRIMARY/REV 13X180

Facility

$38,760.00

Service Code	HCPCS C1776
Hospital Charge Code	270686318
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.78
Max. Negotiated Rate	$19,380.00
Rate for Payer: Aetna Commercial	$14,728.80
Rate for Payer: Aetna Medicare Advantage	$11,628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,883.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,883.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,883.80
Rate for Payer: Cigna Commercial	$19,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,379.92
Rate for Payer: Qualcare PPO/HMO/WC	$5,814.00
Rate for Payer: UnitedHealthcare Community & State	$1,224.82
Rate for Payer: Wellpoint Medicaid Managed Care	$1,100.78

INTEGRA POR STAND SZ8 120MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694498
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

INTEGRA POR STAND SZ8 120MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694498
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

INTEGRA SINGLE LAYER 2X2IN

Facility

$9,890.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657179
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.50
Max. Negotiated Rate	$2,393.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,978.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,393.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50

INTEGRA SINGLE LAYER 2X2IN

Facility

$9,890.00

Service Code	HCPCS Q4108
Hospital Charge Code	270657179
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,393.38
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	$1,978.00
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	$2,393.38
Rate for Payer: Qualcare PPO/HMO/WC	$1,483.50
Rate for Payer: UnitedHealthcare Community & State	$312.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$280.88

INTEGRATED PLATE 24MM 1 HOLE

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695935
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

INTEGRATED PLATE 24MM 1 HOLE

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695935
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

INTEGRATOR STRIPS CLASS 5

Facility

$0.64

Hospital Charge Code	270645806
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.32
Rate for Payer: Aetna Commercial	$0.24
Rate for Payer: Aetna Medicare Advantage	$0.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.16
Rate for Payer: Cigna Commercial	$0.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.10
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.02

INTEGRATOR STRIPS CLASS 5

Facility

$0.64

Hospital Charge Code	270645806
Hospital Revenue Code	278
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.10

INTEGRA WND DRSG 2X2CM

Facility

$2,273.00

Hospital Charge Code	270332613
Hospital Revenue Code	636
Min. Negotiated Rate	$64.55
Max. Negotiated Rate	$1,136.50
Rate for Payer: Aetna Commercial	$863.74
Rate for Payer: Aetna Medicare Advantage	$681.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$579.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$579.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$579.62
Rate for Payer: Cigna Commercial	$1,136.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.07
Rate for Payer: Qualcare PPO/HMO/WC	$340.95
Rate for Payer: UnitedHealthcare Community & State	$71.83
Rate for Payer: Wellpoint Medicaid Managed Care	$64.55

INTEGRA WND DRSG 2X2CM

Facility

$2,273.00

Hospital Charge Code	270332613
Hospital Revenue Code	636
Min. Negotiated Rate	$340.95
Max. Negotiated Rate	$550.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$550.07
Rate for Payer: Qualcare PPO/HMO/WC	$340.95

INTEGRA WND DRSG 2X2/SQ CMJW

Facility

$568.25

Hospital Charge Code	270332613W
Hospital Revenue Code	636
Min. Negotiated Rate	$85.24
Max. Negotiated Rate	$137.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.52
Rate for Payer: Qualcare PPO/HMO/WC	$85.24

INTEGRA WND DRSG 2X2/SQ CMJW

Facility

$568.25

Hospital Charge Code	270332613W
Hospital Revenue Code	636
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$284.12
Rate for Payer: Aetna Commercial	$215.94
Rate for Payer: Aetna Medicare Advantage	$170.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$144.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$144.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$144.90
Rate for Payer: Cigna Commercial	$284.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$137.52
Rate for Payer: Qualcare PPO/HMO/WC	$85.24
Rate for Payer: UnitedHealthcare Community & State	$17.96
Rate for Payer: Wellpoint Medicaid Managed Care	$16.14

INTEGRA WND DRSG 4X10CM/SQCMJW

Facility

$66.28

Hospital Charge Code	270332610W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$33.14
Rate for Payer: Aetna Commercial	$25.19
Rate for Payer: Aetna Medicare Advantage	$19.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.90
Rate for Payer: Cigna Commercial	$33.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.94
Rate for Payer: UnitedHealthcare Community & State	$2.09
Rate for Payer: Wellpoint Medicaid Managed Care	$1.88

INTEGRA WND DRSG 4X10CM/SQCMJW

Facility

$66.28

Hospital Charge Code	270332610W
Hospital Revenue Code	636
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$16.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.04
Rate for Payer: Qualcare PPO/HMO/WC	$9.94

INTEGRA WND DRSG 8X10CM

Facility

$3,743.00

Hospital Charge Code	270332612
Hospital Revenue Code	636
Min. Negotiated Rate	$561.45
Max. Negotiated Rate	$905.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45

INTEGRA WND DRSG 8X10CM

Facility

$3,743.00

Hospital Charge Code	270332612
Hospital Revenue Code	636
Min. Negotiated Rate	$106.30
Max. Negotiated Rate	$1,871.50
Rate for Payer: Aetna Commercial	$1,422.34
Rate for Payer: Aetna Medicare Advantage	$1,122.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$954.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$954.47
Rate for Payer: Cigna Commercial	$1,871.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$905.81
Rate for Payer: Qualcare PPO/HMO/WC	$561.45
Rate for Payer: UnitedHealthcare Community & State	$118.28
Rate for Payer: Wellpoint Medicaid Managed Care	$106.30

INTEGRA WND DRSG 8X10/SQCMJW

Facility

$46.79

Hospital Charge Code	270332612W
Hospital Revenue Code	636
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$11.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02

INTEGRA WND DRSG 8X10/SQCMJW

Facility

$46.79

Hospital Charge Code	270332612W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$23.39
Rate for Payer: Aetna Commercial	$17.78
Rate for Payer: Aetna Medicare Advantage	$14.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.93
Rate for Payer: Cigna Commercial	$23.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.32
Rate for Payer: Qualcare PPO/HMO/WC	$7.02
Rate for Payer: UnitedHealthcare Community & State	$1.48
Rate for Payer: Wellpoint Medicaid Managed Care	$1.33

INTEGRA WOUND DRSG 4X10CM

Facility

$2,651.00

Hospital Charge Code	270332610
Hospital Revenue Code	636
Min. Negotiated Rate	$397.65
Max. Negotiated Rate	$641.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.54
Rate for Payer: Qualcare PPO/HMO/WC	$397.65

INTEGRA WOUND DRSG 4X10CM

Facility

$2,651.00

Hospital Charge Code	270332610
Hospital Revenue Code	636
Min. Negotiated Rate	$75.29
Max. Negotiated Rate	$1,325.50
Rate for Payer: Aetna Commercial	$1,007.38
Rate for Payer: Aetna Medicare Advantage	$795.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$676.00
Rate for Payer: Cigna Commercial	$1,325.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$641.54
Rate for Payer: Qualcare PPO/HMO/WC	$397.65
Rate for Payer: UnitedHealthcare Community & State	$83.77
Rate for Payer: Wellpoint Medicaid Managed Care	$75.29

Know your out-of-pocket cost for care.

All Charges