Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MATRIX WOUND 10X15CM/SQCMJW

Facility

$24.75

Hospital Charge Code	270662124W
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$9.40
Rate for Payer: Aetna Medicare Advantage	$7.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.31
Rate for Payer: Cigna Commercial	$12.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.71
Rate for Payer: UnitedHealthcare Community & State	$0.78
Rate for Payer: Wellpoint Medicaid Managed Care	$0.70

MATRIX WOUND 10X15CM/SQCMJW

Facility

$24.75

Hospital Charge Code	270662124W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$5.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.71

MATRIX WOUND 1-LAYER 3x3.5CM

Facility

$352.50

Service Code	HCPCS Q4166
Hospital Charge Code	270651027
Hospital Revenue Code	278
Min. Negotiated Rate	$52.88
Max. Negotiated Rate	$85.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$85.31
Rate for Payer: Qualcare PPO/HMO/WC	$52.88

MATRIX WOUND 1-LAYER 3x3.5CM

Facility

$352.50

Service Code	HCPCS Q4166
Hospital Charge Code	270651027
Hospital Revenue Code	278
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$536.29
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	$70.50
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	$85.31
Rate for Payer: Qualcare PPO/HMO/WC	$52.88
Rate for Payer: UnitedHealthcare Community & State	$11.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$10.01

MATRIX WOUND 3 LAYER

Facility

$10,465.00

Service Code	HCPCS Q4166
Hospital Charge Code	270680147
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,532.53
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	$2,093.00
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	$2,532.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75
Rate for Payer: UnitedHealthcare Community & State	$330.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$297.21

MATRIX WOUND 3 LAYER

Facility

$10,465.00

Service Code	HCPCS Q4166
Hospital Charge Code	270680147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.75
Max. Negotiated Rate	$2,532.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,093.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,532.53
Rate for Payer: Qualcare PPO/HMO/WC	$1,569.75

MATRIX WOUND 6X3CM

Facility

$15,966.50

Hospital Charge Code	270673886
Hospital Revenue Code	636
Min. Negotiated Rate	$2,394.97
Max. Negotiated Rate	$3,863.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,863.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,394.97

MATRIX WOUND 6X3CM

Facility

$15,966.50

Hospital Charge Code	270673886
Hospital Revenue Code	636
Min. Negotiated Rate	$453.45
Max. Negotiated Rate	$7,983.25
Rate for Payer: Aetna Commercial	$6,067.27
Rate for Payer: Aetna Medicare Advantage	$4,789.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,071.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,071.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,071.46
Rate for Payer: Cigna Commercial	$7,983.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,863.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,394.97
Rate for Payer: UnitedHealthcare Community & State	$504.54
Rate for Payer: Wellpoint Medicaid Managed Care	$453.45

MATRIX WOUND 6X3CM/SQCM JW

Facility

$887.03

Hospital Charge Code	270673886W
Hospital Revenue Code	636
Min. Negotiated Rate	$25.19
Max. Negotiated Rate	$443.51
Rate for Payer: Aetna Commercial	$337.07
Rate for Payer: Aetna Medicare Advantage	$266.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.19
Rate for Payer: Cigna Commercial	$443.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.66
Rate for Payer: Qualcare PPO/HMO/WC	$133.05
Rate for Payer: UnitedHealthcare Community & State	$28.03
Rate for Payer: Wellpoint Medicaid Managed Care	$25.19

MATRIX WOUND 6X3CM/SQCM JW

Facility

$887.03

Hospital Charge Code	270673886W
Hospital Revenue Code	636
Min. Negotiated Rate	$133.05
Max. Negotiated Rate	$214.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.66
Rate for Payer: Qualcare PPO/HMO/WC	$133.05

MATRIX WOUND 7CM X 10CM

Facility

$1,732.50

Service Code	HCPCS C1762
Hospital Charge Code	270662126
Hospital Revenue Code	278
Min. Negotiated Rate	$259.88
Max. Negotiated Rate	$419.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.26
Rate for Payer: Qualcare PPO/HMO/WC	$259.88

MATRIX WOUND 7CM X 10CM

Facility

$1,732.50

Service Code	HCPCS C1762
Hospital Charge Code	270662126
Hospital Revenue Code	278
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$866.25
Rate for Payer: Aetna Commercial	$658.35
Rate for Payer: Aetna Medicare Advantage	$519.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$441.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$441.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$346.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$441.79
Rate for Payer: Cigna Commercial	$866.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$419.26
Rate for Payer: Qualcare PPO/HMO/WC	$259.88
Rate for Payer: UnitedHealthcare Community & State	$54.75
Rate for Payer: Wellpoint Medicaid Managed Care	$49.20

MATRIX WOUND FENESTR 7x10CM

Facility

$6,730.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662125
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,628.78
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	$1,346.10
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	$1,628.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.58
Rate for Payer: UnitedHealthcare Community & State	$212.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$191.15

MATRIX WOUND FENESTR 7x10CM

Facility

$6,730.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662125
Hospital Revenue Code	278
Min. Negotiated Rate	$1,009.58
Max. Negotiated Rate	$1,628.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,346.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,628.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.58

MAXBRD#5 MO-6-NDL

Facility

$600.00

Hospital Charge Code	270688617
Hospital Revenue Code	272
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

MAXBRD#5 MO-6-NDL

Facility

$600.00

Hospital Charge Code	270688617
Hospital Revenue Code	272
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Oxford Commercial	$120.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Commercial	$120.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

MAXCESS KIT 4

Facility

$17,310.00

Hospital Charge Code	270659707
Hospital Revenue Code	272
Min. Negotiated Rate	$2,596.50
Max. Negotiated Rate	$2,596.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50

MAXCESS KIT 4

Facility

$17,310.00

Hospital Charge Code	270659707
Hospital Revenue Code	272
Min. Negotiated Rate	$491.60
Max. Negotiated Rate	$8,655.00
Rate for Payer: Aetna Commercial	$6,577.80
Rate for Payer: Aetna Medicare Advantage	$5,193.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,414.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,414.05
Rate for Payer: Cigna Commercial	$8,655.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,500.60
Rate for Payer: Oxford Commercial	$3,462.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,596.50
Rate for Payer: UnitedHealthcare Commercial	$3,462.00
Rate for Payer: UnitedHealthcare Community & State	$547.00
Rate for Payer: Wellpoint Medicaid Managed Care	$491.60

MAXCESS MAS PLIF USAGE

Facility

$10,965.00

Hospital Charge Code	270663763
Hospital Revenue Code	270
Min. Negotiated Rate	$311.41
Max. Negotiated Rate	$5,482.50
Rate for Payer: Aetna Commercial	$4,166.70
Rate for Payer: Aetna Medicare Advantage	$3,289.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,796.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,796.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,796.07
Rate for Payer: Cigna Commercial	$5,482.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,850.90
Rate for Payer: Oxford Commercial	$2,193.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.75
Rate for Payer: UnitedHealthcare Commercial	$2,193.00
Rate for Payer: UnitedHealthcare Community & State	$346.49
Rate for Payer: Wellpoint Medicaid Managed Care	$311.41

MAXCESS MAS PLIF USAGE

Facility

$10,965.00

Hospital Charge Code	270663763
Hospital Revenue Code	270
Min. Negotiated Rate	$1,644.75
Max. Negotiated Rate	$1,644.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,644.75

MAXCESS MAS TLIF 2 KIT ACCESS

Facility

$18,375.00

Hospital Charge Code	270693335
Hospital Revenue Code	272
Min. Negotiated Rate	$2,756.25
Max. Negotiated Rate	$2,756.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,756.25

MAXCESS MAS TLIF 2 KIT ACCESS

Facility

$18,375.00

Hospital Charge Code	270693335
Hospital Revenue Code	272
Min. Negotiated Rate	$521.85
Max. Negotiated Rate	$9,187.50
Rate for Payer: Aetna Commercial	$6,982.50
Rate for Payer: Aetna Medicare Advantage	$5,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,685.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,685.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,685.62
Rate for Payer: Cigna Commercial	$9,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,777.50
Rate for Payer: Oxford Commercial	$3,675.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,756.25
Rate for Payer: UnitedHealthcare Commercial	$3,675.00
Rate for Payer: UnitedHealthcare Community & State	$580.65
Rate for Payer: Wellpoint Medicaid Managed Care	$521.85

MAXCESSMASTLIF2KITLATRETRACT

Facility

$13,750.00

Hospital Charge Code	270697195
Hospital Revenue Code	272
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$2,062.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

MAXCESSMASTLIF2KITLATRETRACT

Facility

$13,750.00

Hospital Charge Code	270697195
Hospital Revenue Code	272
Min. Negotiated Rate	$390.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,575.00
Rate for Payer: Oxford Commercial	$2,750.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Commercial	$2,750.00
Rate for Payer: UnitedHealthcare Community & State	$434.50
Rate for Payer: Wellpoint Medicaid Managed Care	$390.50

MAXFORCE PLATE LEFT

Facility

$10,274.25

Service Code	HCPCS C1713
Hospital Charge Code	270705523
Hospital Revenue Code	278
Min. Negotiated Rate	$291.79
Max. Negotiated Rate	$5,137.12
Rate for Payer: Aetna Commercial	$3,904.22
Rate for Payer: Aetna Medicare Advantage	$3,082.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,619.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,054.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,619.93
Rate for Payer: Cigna Commercial	$5,137.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,486.37
Rate for Payer: Qualcare PPO/HMO/WC	$1,541.14
Rate for Payer: UnitedHealthcare Community & State	$324.67
Rate for Payer: Wellpoint Medicaid Managed Care	$291.79

Know your out-of-pocket cost for care.

All Charges