Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

POLYMYXIN B/TRIMETHOPRIM OPTH

Facility

$442.07

Service Code	NDC 23782410
Hospital Charge Code	60632326
Hospital Revenue Code	250
Min. Negotiated Rate	$66.31
Max. Negotiated Rate	$66.31
Rate for Payer: Qualcare PPO/HMO/WC	$66.31

POLY PATELLA SZ 29MM 8.0MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696319
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

POLY PATELLA SZ 29MM 8.0MM

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696319
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

POLY PAT PLY 26 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686834
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

POLY PAT PLY 26 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686834
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

POLY PAT PLY 35 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686484
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

POLY PAT PLY 35 MM PSN

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270686484
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

POLYPECTOMY SNARE ACTIVE CORD

Facility

$258.00

Hospital Charge Code	270332254
Hospital Revenue Code	272
Min. Negotiated Rate	$38.70
Max. Negotiated Rate	$38.70
Rate for Payer: Qualcare PPO/HMO/WC	$38.70

POLYPECTOMY SNARE ACTIVE CORD

Facility

$258.00

Hospital Charge Code	270332254
Hospital Revenue Code	272
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$129.00
Rate for Payer: Aetna Commercial	$98.04
Rate for Payer: Aetna Medicare Advantage	$77.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.79
Rate for Payer: Cigna Commercial	$129.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.08
Rate for Payer: Oxford Commercial	$51.60
Rate for Payer: Qualcare PPO/HMO/WC	$38.70
Rate for Payer: UnitedHealthcare Commercial	$51.60
Rate for Payer: UnitedHealthcare Community & State	$8.15
Rate for Payer: Wellpoint Medicaid Managed Care	$7.33

POLYPLEX ECHO 22G X 21MM

Facility

$51.25

Hospital Charge Code	270684269
Hospital Revenue Code	272
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

POLYPLEX ECHO 22G X 21MM

Facility

$51.25

Hospital Charge Code	270684269
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.32
Rate for Payer: Oxford Commercial	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$10.25
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

POLYPLEX ECHO 22G X 55MM

Facility

$51.25

Hospital Charge Code	270684268
Hospital Revenue Code	272
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$7.69
Rate for Payer: Qualcare PPO/HMO/WC	$7.69

POLYPLEX ECHO 22G X 55MM

Facility

$51.25

Hospital Charge Code	270684268
Hospital Revenue Code	272
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$25.62
Rate for Payer: Aetna Commercial	$19.48
Rate for Payer: Aetna Medicare Advantage	$15.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.07
Rate for Payer: Cigna Commercial	$25.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.32
Rate for Payer: Oxford Commercial	$10.25
Rate for Payer: Qualcare PPO/HMO/WC	$7.69
Rate for Payer: UnitedHealthcare Commercial	$10.25
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

POLYPROPYLENE SUTURE

Facility

$391.00

Hospital Charge Code	270335273
Hospital Revenue Code	272
Min. Negotiated Rate	$58.65
Max. Negotiated Rate	$58.65
Rate for Payer: Qualcare PPO/HMO/WC	$58.65

POLYPROPYLENE SUTURE

Facility

$391.00

Hospital Charge Code	270335273
Hospital Revenue Code	272
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$195.50
Rate for Payer: Aetna Commercial	$148.58
Rate for Payer: Aetna Medicare Advantage	$117.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.70
Rate for Payer: Cigna Commercial	$195.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.66
Rate for Payer: Oxford Commercial	$78.20
Rate for Payer: Qualcare PPO/HMO/WC	$58.65
Rate for Payer: UnitedHealthcare Commercial	$78.20
Rate for Payer: UnitedHealthcare Community & State	$12.36
Rate for Payer: Wellpoint Medicaid Managed Care	$11.10

POLY SCREW 6.5X55MM

Facility

$3,555.00

Service Code	HCPCS C1713
Hospital Charge Code	270704458
Hospital Revenue Code	278
Min. Negotiated Rate	$100.96
Max. Negotiated Rate	$1,777.50
Rate for Payer: Aetna Commercial	$1,350.90
Rate for Payer: Aetna Medicare Advantage	$1,066.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$906.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$906.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$906.52
Rate for Payer: Cigna Commercial	$1,777.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$860.31
Rate for Payer: Qualcare PPO/HMO/WC	$533.25
Rate for Payer: UnitedHealthcare Community & State	$112.34
Rate for Payer: Wellpoint Medicaid Managed Care	$100.96

POLY SCREW 6.5X55MM

Facility

$3,555.00

Service Code	HCPCS C1713
Hospital Charge Code	270704458
Hospital Revenue Code	278
Min. Negotiated Rate	$533.25
Max. Negotiated Rate	$860.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$711.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$860.31
Rate for Payer: Qualcare PPO/HMO/WC	$533.25

POLYSORB 3-0 ENDO STITCH 48

Facility

$115.90

Hospital Charge Code	270658691
Hospital Revenue Code	272
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$57.95
Rate for Payer: Aetna Commercial	$44.04
Rate for Payer: Aetna Medicare Advantage	$34.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.55
Rate for Payer: Cigna Commercial	$57.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.13
Rate for Payer: Oxford Commercial	$23.18
Rate for Payer: Qualcare PPO/HMO/WC	$17.39
Rate for Payer: UnitedHealthcare Commercial	$23.18
Rate for Payer: UnitedHealthcare Community & State	$3.66
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

POLYSORB 3-0 ENDO STITCH 48

Facility

$115.90

Hospital Charge Code	270658691
Hospital Revenue Code	272
Min. Negotiated Rate	$17.39
Max. Negotiated Rate	$17.39
Rate for Payer: Qualcare PPO/HMO/WC	$17.39

POLYSORB 3-0 UNDYED 30 SC-2

Facility

$6.15

Hospital Charge Code	270657581
Hospital Revenue Code	270
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$0.92
Rate for Payer: Qualcare PPO/HMO/WC	$0.92

POLYSORB 3-0 UNDYED 30 SC-2

Facility

$6.15

Hospital Charge Code	270657581
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna Commercial	$2.34
Rate for Payer: Aetna Medicare Advantage	$1.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.57
Rate for Payer: Cigna Commercial	$3.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.60
Rate for Payer: Oxford Commercial	$1.23
Rate for Payer: Qualcare PPO/HMO/WC	$0.92
Rate for Payer: UnitedHealthcare Commercial	$1.23
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

POLYSPORIN POWDER 10 GM

Facility

$55.60

Hospital Charge Code	60628324W
Hospital Revenue Code	250
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$8.34
Rate for Payer: Qualcare PPO/HMO/WC	$8.34

POLYSPORIN POWDER 10 GM

Facility

$55.60

Hospital Charge Code	60628324W
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$27.80
Rate for Payer: Aetna Commercial	$21.13
Rate for Payer: Aetna Medicare Advantage	$16.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.18
Rate for Payer: Cigna Commercial	$27.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.46
Rate for Payer: Oxford Commercial	$11.12
Rate for Payer: Qualcare PPO/HMO/WC	$8.34
Rate for Payer: UnitedHealthcare Commercial	$11.12
Rate for Payer: UnitedHealthcare Community & State	$1.76
Rate for Payer: Wellpoint Medicaid Managed Care	$1.58

POLYVINYL ALCOHOL POVIDONE OPH

Facility

$29.35

Service Code	NDC 536197072
Hospital Charge Code	60628094
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.40

POLYVINYL ALCOHOL POVIDONE OPH

Facility

$29.35

Service Code	NDC 536197072
Hospital Charge Code	60628094
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$14.68
Rate for Payer: Aetna Commercial	$11.15
Rate for Payer: Aetna Medicare Advantage	$8.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.48
Rate for Payer: Cigna Commercial	$14.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.63
Rate for Payer: Oxford Commercial	$5.87
Rate for Payer: Qualcare PPO/HMO/WC	$4.40
Rate for Payer: UnitedHealthcare Commercial	$5.87
Rate for Payer: UnitedHealthcare Community & State	$0.93
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

Know your out-of-pocket cost for care.

All Charges