Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PASTE REME CALAZ 4OZ MSC094544

Facility

$25.00

Hospital Charge Code	270640977W
Hospital Revenue Code	272
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$3.75
Rate for Payer: Qualcare PPO/HMO/WC	$3.75

PASTE REME CALAZ 4OZ MSC094544

Facility

$21.75

Hospital Charge Code	270640977
Hospital Revenue Code	272
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$10.88
Rate for Payer: Aetna Commercial	$8.27
Rate for Payer: Aetna Medicare Advantage	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.55
Rate for Payer: Cigna Commercial	$10.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.66
Rate for Payer: Oxford Commercial	$4.35
Rate for Payer: Qualcare PPO/HMO/WC	$3.26
Rate for Payer: UnitedHealthcare Commercial	$4.35
Rate for Payer: UnitedHealthcare Community & State	$0.69
Rate for Payer: Wellpoint Medicaid Managed Care	$0.62

PASTE REME CALAZ 4OZ MSC094544

Facility

$21.75

Hospital Charge Code	270640977
Hospital Revenue Code	272
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$3.26
Rate for Payer: Qualcare PPO/HMO/WC	$3.26

PATCH BIO-GUIDE 40x50MM

Facility

$2,375.00

Hospital Charge Code	270669571
Hospital Revenue Code	272
Min. Negotiated Rate	$356.25
Max. Negotiated Rate	$356.25
Rate for Payer: Qualcare PPO/HMO/WC	$356.25

PATCH BIO-GUIDE 40x50MM

Facility

$2,375.00

Hospital Charge Code	270669571
Hospital Revenue Code	272
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$1,187.50
Rate for Payer: Aetna Commercial	$902.50
Rate for Payer: Aetna Medicare Advantage	$712.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$605.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$605.62
Rate for Payer: Cigna Commercial	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$617.50
Rate for Payer: Oxford Commercial	$475.00
Rate for Payer: Qualcare PPO/HMO/WC	$356.25
Rate for Payer: UnitedHealthcare Commercial	$475.00
Rate for Payer: UnitedHealthcare Community & State	$75.05
Rate for Payer: Wellpoint Medicaid Managed Care	$67.45

PATCH BIOLOGICAL XENOSURE

Facility

$1,030.00

Service Code	HCPCS C1768
Hospital Charge Code	270660278
Hospital Revenue Code	278
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$515.00
Rate for Payer: Aetna Commercial	$391.40
Rate for Payer: Aetna Medicare Advantage	$309.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.65
Rate for Payer: Cigna Commercial	$515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.26
Rate for Payer: Qualcare PPO/HMO/WC	$154.50
Rate for Payer: UnitedHealthcare Community & State	$32.55
Rate for Payer: Wellpoint Medicaid Managed Care	$29.25

PATCH BIOLOGICAL XENOSURE

Facility

$1,030.00

Service Code	HCPCS C1768
Hospital Charge Code	270660278
Hospital Revenue Code	278
Min. Negotiated Rate	$154.50
Max. Negotiated Rate	$249.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$206.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.26
Rate for Payer: Qualcare PPO/HMO/WC	$154.50

PATCH BIOLOGICAL XENOSURE

Facility

$925.00

Service Code	HCPCS C1768
Hospital Charge Code	2706602778
Hospital Revenue Code	278
Min. Negotiated Rate	$138.75
Max. Negotiated Rate	$223.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.75

PATCH BIOLOGICAL XENOSURE

Facility

$925.00

Service Code	HCPCS C1768
Hospital Charge Code	2706602778
Hospital Revenue Code	278
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$462.50
Rate for Payer: Aetna Commercial	$351.50
Rate for Payer: Aetna Medicare Advantage	$277.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.88
Rate for Payer: Cigna Commercial	$462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.85
Rate for Payer: Qualcare PPO/HMO/WC	$138.75
Rate for Payer: UnitedHealthcare Community & State	$29.23
Rate for Payer: Wellpoint Medicaid Managed Care	$26.27

PATCH DURA GUARD 10X16

Facility

$3,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270668442
Hospital Revenue Code	278
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Community & State	$106.65
Rate for Payer: Wellpoint Medicaid Managed Care	$95.85

PATCH DURA GUARD 10X16

Facility

$3,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270668442
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$816.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.75
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

PATCH HEMASHLD FINESSE 8x75mm

Facility

$500.30

Service Code	HCPCS C1768
Hospital Charge Code	270630314
Hospital Revenue Code	272
Min. Negotiated Rate	$14.21
Max. Negotiated Rate	$250.15
Rate for Payer: Aetna Commercial	$190.11
Rate for Payer: Aetna Medicare Advantage	$150.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.58
Rate for Payer: Cigna Commercial	$250.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.08
Rate for Payer: Oxford Commercial	$100.06
Rate for Payer: Qualcare PPO/HMO/WC	$75.05
Rate for Payer: UnitedHealthcare Commercial	$100.06
Rate for Payer: UnitedHealthcare Community & State	$15.81
Rate for Payer: Wellpoint Medicaid Managed Care	$14.21

PATCH HEMASHLD FINESSE 8x75mm

Facility

$500.30

Service Code	HCPCS C1768
Hospital Charge Code	270630314
Hospital Revenue Code	272
Min. Negotiated Rate	$75.05
Max. Negotiated Rate	$75.05
Rate for Payer: Qualcare PPO/HMO/WC	$75.05

PATCH PLUG MARLEX BARD

Facility

$1,362.50

Service Code	HCPCS C1781
Hospital Charge Code	270601199
Hospital Revenue Code	278
Min. Negotiated Rate	$204.38
Max. Negotiated Rate	$329.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.73
Rate for Payer: Qualcare PPO/HMO/WC	$204.38

PATCH PLUG MARLEX BARD

Facility

$1,362.50

Service Code	HCPCS C1781
Hospital Charge Code	270601199
Hospital Revenue Code	278
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$681.25
Rate for Payer: Aetna Commercial	$517.75
Rate for Payer: Aetna Medicare Advantage	$408.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$347.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$347.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$272.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$347.44
Rate for Payer: Cigna Commercial	$681.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$329.73
Rate for Payer: Qualcare PPO/HMO/WC	$204.38
Rate for Payer: UnitedHealthcare Community & State	$43.05
Rate for Payer: Wellpoint Medicaid Managed Care	$38.70

PATCH PLUG MARLEX MEDIUM

Facility

$1,213.50

Hospital Charge Code	270621075
Hospital Revenue Code	272
Min. Negotiated Rate	$182.03
Max. Negotiated Rate	$182.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.03

PATCH PLUG MARLEX MEDIUM

Facility

$1,213.50

Hospital Charge Code	270621075
Hospital Revenue Code	272
Min. Negotiated Rate	$34.46
Max. Negotiated Rate	$606.75
Rate for Payer: Aetna Commercial	$461.13
Rate for Payer: Aetna Medicare Advantage	$364.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.44
Rate for Payer: Cigna Commercial	$606.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.51
Rate for Payer: Oxford Commercial	$242.70
Rate for Payer: Qualcare PPO/HMO/WC	$182.03
Rate for Payer: UnitedHealthcare Commercial	$242.70
Rate for Payer: UnitedHealthcare Community & State	$38.35
Rate for Payer: Wellpoint Medicaid Managed Care	$34.46

PATCH TISSUE 10.CM X 15.0CM

Facility

$2,060.00

Hospital Charge Code	270650766
Hospital Revenue Code	272
Min. Negotiated Rate	$309.00
Max. Negotiated Rate	$309.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.00

PATCH TISSUE 10.CM X 15.0CM

Facility

$2,060.00

Hospital Charge Code	270650766
Hospital Revenue Code	272
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$1,030.00
Rate for Payer: Aetna Commercial	$782.80
Rate for Payer: Aetna Medicare Advantage	$618.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$525.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$525.30
Rate for Payer: Cigna Commercial	$1,030.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$535.60
Rate for Payer: Oxford Commercial	$412.00
Rate for Payer: Qualcare PPO/HMO/WC	$309.00
Rate for Payer: UnitedHealthcare Commercial	$412.00
Rate for Payer: UnitedHealthcare Community & State	$65.10
Rate for Payer: Wellpoint Medicaid Managed Care	$58.50

PATCH VASCGARD 0.8 8CM VG0108N

Facility

$915.65

Service Code	HCPCS C1768
Hospital Charge Code	270619788
Hospital Revenue Code	278
Min. Negotiated Rate	$137.35
Max. Negotiated Rate	$221.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$183.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.59
Rate for Payer: Qualcare PPO/HMO/WC	$137.35

PATCH VASCGARD 0.8 8CM VG0108N

Facility

$915.65

Service Code	HCPCS C1768
Hospital Charge Code	270619788
Hospital Revenue Code	278
Min. Negotiated Rate	$26.00
Max. Negotiated Rate	$457.82
Rate for Payer: Aetna Commercial	$347.95
Rate for Payer: Aetna Medicare Advantage	$274.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$233.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$233.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$183.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$233.49
Rate for Payer: Cigna Commercial	$457.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$221.59
Rate for Payer: Qualcare PPO/HMO/WC	$137.35
Rate for Payer: UnitedHealthcare Community & State	$28.93
Rate for Payer: Wellpoint Medicaid Managed Care	$26.00

PATCH VASCULAR 0.4MM 2x9CM

Facility

$1,255.00

Service Code	HCPCS C1768
Hospital Charge Code	270601201
Hospital Revenue Code	278
Min. Negotiated Rate	$35.64
Max. Negotiated Rate	$627.50
Rate for Payer: Aetna Commercial	$476.90
Rate for Payer: Aetna Medicare Advantage	$376.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.02
Rate for Payer: Cigna Commercial	$627.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: Qualcare PPO/HMO/WC	$188.25
Rate for Payer: UnitedHealthcare Community & State	$39.66
Rate for Payer: Wellpoint Medicaid Managed Care	$35.64

PATCH VASCULAR 0.4MM 2x9CM

Facility

$1,255.00

Service Code	HCPCS C1768
Hospital Charge Code	270601201
Hospital Revenue Code	278
Min. Negotiated Rate	$188.25
Max. Negotiated Rate	$303.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$251.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$303.71
Rate for Payer: Qualcare PPO/HMO/WC	$188.25

PATCH VASCULAR 0.6MM 2.5x15CM

Facility

$1,530.00

Service Code	HCPCS C1768
Hospital Charge Code	270650847
Hospital Revenue Code	278
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$765.00
Rate for Payer: Aetna Commercial	$581.40
Rate for Payer: Aetna Medicare Advantage	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$390.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$390.15
Rate for Payer: Cigna Commercial	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.26
Rate for Payer: Qualcare PPO/HMO/WC	$229.50
Rate for Payer: UnitedHealthcare Community & State	$48.35
Rate for Payer: Wellpoint Medicaid Managed Care	$43.45

PATCH VASCULAR 0.6MM 2.5x15CM

Facility

$1,530.00

Service Code	HCPCS C1768
Hospital Charge Code	270650847
Hospital Revenue Code	278
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$370.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$370.26
Rate for Payer: Qualcare PPO/HMO/WC	$229.50

Know your out-of-pocket cost for care.

All Charges