Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MATRIX HD WOUND COV 2CM X 14CM

Facility

$2,400.00

Hospital Charge Code	270339111
Hospital Revenue Code	636
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

MATRIX HD WOUND COV 2CMX3CM

Facility

$1,125.00

Hospital Charge Code	270339108
Hospital Revenue Code	636
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

MATRIX HD WOUND COV 2CMX3CM

Facility

$1,125.00

Hospital Charge Code	270339108
Hospital Revenue Code	636
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

MATRIX HD WOUND COV 4CM X 5CM

Facility

$3,000.00

Hospital Charge Code	270339109
Hospital Revenue Code	636
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) 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

MATRIX HD WOUND COV 4CM X 5CM

Facility

$3,000.00

Hospital Charge Code	270339109
Hospital Revenue Code	636
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

MATRIX HD WOUND COV 5CM X 8CM

Facility

$3,450.00

Hospital Charge Code	270339110
Hospital Revenue Code	636
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$834.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

MATRIX HD WOUND COV 5CM X 8CM

Facility

$3,450.00

Hospital Charge Code	270339110
Hospital Revenue Code	636
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,311.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Community & State	$109.02
Rate for Payer: Wellpoint Medicaid Managed Care	$97.98

MATRIX MICRONIZD PARTCLE 100mg

Facility

$1,504.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651181
Hospital Revenue Code	278
Min. Negotiated Rate	$225.60
Max. Negotiated Rate	$363.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.97
Rate for Payer: Qualcare PPO/HMO/WC	$225.60

MATRIX MICRONIZD PARTCLE 100mg

Facility

$1,504.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651181
Hospital Revenue Code	278
Min. Negotiated Rate	$42.71
Max. Negotiated Rate	$752.00
Rate for Payer: Aetna Commercial	$571.52
Rate for Payer: Aetna Medicare Advantage	$451.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$383.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$383.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$383.52
Rate for Payer: Cigna Commercial	$752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.97
Rate for Payer: Qualcare PPO/HMO/WC	$225.60
Rate for Payer: UnitedHealthcare Community & State	$47.53
Rate for Payer: Wellpoint Medicaid Managed Care	$42.71

MATRIX MICRONIZD PARTCLE 50

Facility

$7,375.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651028
Hospital Revenue Code	636
Min. Negotiated Rate	$209.45
Max. Negotiated Rate	$3,687.50
Rate for Payer: Aetna Commercial	$2,802.50
Rate for Payer: Aetna Medicare Advantage	$2,212.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,880.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,880.62
Rate for Payer: Cigna Commercial	$3,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25
Rate for Payer: UnitedHealthcare Community & State	$233.05
Rate for Payer: Wellpoint Medicaid Managed Care	$209.45

MATRIX MICRONIZD PARTCLE 50

Facility

$7,375.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651028
Hospital Revenue Code	636
Min. Negotiated Rate	$1,106.25
Max. Negotiated Rate	$1,784.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,784.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,106.25

MATRIX MICRONIZED FINE 200 MG

Facility

$3,200.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651179
Hospital Revenue Code	278
Min. Negotiated Rate	$90.88
Max. Negotiated Rate	$1,600.00
Rate for Payer: Aetna Commercial	$1,216.00
Rate for Payer: Aetna Medicare Advantage	$960.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$816.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$816.00
Rate for Payer: Cigna Commercial	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00
Rate for Payer: UnitedHealthcare Community & State	$101.12
Rate for Payer: Wellpoint Medicaid Managed Care	$90.88

MATRIX MICRONIZED FINE 200 MG

Facility

$3,200.00

Service Code	HCPCS Q4118
Hospital Charge Code	270651179
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$774.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$774.40
Rate for Payer: Qualcare PPO/HMO/WC	$480.00

MATRIX PROTEIN

Facility

$15,000.00

Hospital Charge Code	270703297
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

MATRIX PROTEIN

Facility

$15,000.00

Hospital Charge Code	270703297
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

MATRIX STIMULAN RAP CURE 10CC

Facility

$8,975.00

Hospital Charge Code	270668279
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

MATRIX STIMULAN RAP CURE 10CC

Facility

$8,975.00

Hospital Charge Code	270668279
Hospital Revenue Code	278
Min. Negotiated Rate	$254.89
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$283.61
Rate for Payer: Wellpoint Medicaid Managed Care	$254.89

MATRIX STIMULAN RAPIDCURE 20CC

Facility

$14,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694567
Hospital Revenue Code	278
Min. Negotiated Rate	$411.80
Max. Negotiated Rate	$7,250.00
Rate for Payer: Aetna Commercial	$5,510.00
Rate for Payer: Aetna Medicare Advantage	$4,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,697.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,697.50
Rate for Payer: Cigna Commercial	$7,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00
Rate for Payer: UnitedHealthcare Community & State	$458.20
Rate for Payer: Wellpoint Medicaid Managed Care	$411.80

MATRIX STIMULAN RAPIDCURE 20CC

Facility

$14,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270694567
Hospital Revenue Code	278
Min. Negotiated Rate	$2,175.00
Max. Negotiated Rate	$3,509.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,509.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,175.00

MATRIX SURGICAL MATRIX PLUS

Facility

$4,935.00

Service Code	HCPCS C1781
Hospital Charge Code	270677085
Hospital Revenue Code	278
Min. Negotiated Rate	$140.15
Max. Negotiated Rate	$2,467.50
Rate for Payer: Aetna Commercial	$1,875.30
Rate for Payer: Aetna Medicare Advantage	$1,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,258.42
Rate for Payer: Cigna Commercial	$2,467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: Qualcare PPO/HMO/WC	$740.25
Rate for Payer: UnitedHealthcare Community & State	$155.95
Rate for Payer: Wellpoint Medicaid Managed Care	$140.15

MATRIX SURGICAL MATRIX PLUS

Facility

$4,935.00

Service Code	HCPCS C1781
Hospital Charge Code	270677085
Hospital Revenue Code	278
Min. Negotiated Rate	$740.25
Max. Negotiated Rate	$1,194.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: Qualcare PPO/HMO/WC	$740.25

MATRIX V92 CELLULAR BN 2.5CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270699358
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$296.25
Rate for Payer: Wellpoint Medicaid Managed Care	$266.25

MATRIX V92 CELLULAR BN 2.5CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270699358
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

MATRIX WOUND 10X15CM

Facility

$3,712.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662124
Hospital Revenue Code	278
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$898.42
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	$742.50
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	$898.42
Rate for Payer: Qualcare PPO/HMO/WC	$556.88
Rate for Payer: UnitedHealthcare Community & State	$117.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$105.44

MATRIX WOUND 10X15CM

Facility

$3,712.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662124
Hospital Revenue Code	278
Min. Negotiated Rate	$556.88
Max. Negotiated Rate	$898.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$742.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$898.42
Rate for Payer: Qualcare PPO/HMO/WC	$556.88

Know your out-of-pocket cost for care.

All Charges