Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

POUCH IRRIGATION LG 19x24

Facility

$22.85

Hospital Charge Code	270676344
Hospital Revenue Code	272
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$3.43
Rate for Payer: Qualcare PPO/HMO/WC	$3.43

POUCH RETRIEVAL BAG 10MM

Facility

$211.36

Hospital Charge Code	270696224
Hospital Revenue Code	272
Min. Negotiated Rate	$31.70
Max. Negotiated Rate	$31.70
Rate for Payer: Qualcare PPO/HMO/WC	$31.70

POUCH RETRIEVAL BAG 10MM

Facility

$211.36

Hospital Charge Code	270696224
Hospital Revenue Code	272
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$105.68
Rate for Payer: Aetna Commercial	$80.32
Rate for Payer: Aetna Medicare Advantage	$63.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.90
Rate for Payer: Cigna Commercial	$105.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.95
Rate for Payer: Oxford Commercial	$42.27
Rate for Payer: Qualcare PPO/HMO/WC	$31.70
Rate for Payer: UnitedHealthcare Commercial	$42.27
Rate for Payer: UnitedHealthcare Community & State	$6.68
Rate for Payer: Wellpoint Medicaid Managed Care	$6.00

POUCH STERILE INSTRUMENT SK400

Facility

$12.50

Hospital Charge Code	270630137
Hospital Revenue Code	272
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Qualcare PPO/HMO/WC	$1.88

POUCH STERILE INSTRUMENT SK400

Facility

$12.50

Hospital Charge Code	270630137
Hospital Revenue Code	272
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$6.25
Rate for Payer: Aetna Commercial	$4.75
Rate for Payer: Aetna Medicare Advantage	$3.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.19
Rate for Payer: Cigna Commercial	$6.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.25
Rate for Payer: Oxford Commercial	$2.50
Rate for Payer: Qualcare PPO/HMO/WC	$1.88
Rate for Payer: UnitedHealthcare Commercial	$2.50
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

POUCH STOMA 4 100MM

Facility

$16.85

Hospital Charge Code	270303171
Hospital Revenue Code	272
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$2.53

POUCH STOMA 4 100MM

Facility

$16.85

Hospital Charge Code	270303171
Hospital Revenue Code	272
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$8.43
Rate for Payer: Aetna Commercial	$6.40
Rate for Payer: Aetna Medicare Advantage	$5.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.30
Rate for Payer: Cigna Commercial	$8.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.38
Rate for Payer: Oxford Commercial	$3.37
Rate for Payer: Qualcare PPO/HMO/WC	$2.53
Rate for Payer: UnitedHealthcare Commercial	$3.37
Rate for Payer: UnitedHealthcare Community & State	$0.53
Rate for Payer: Wellpoint Medicaid Managed Care	$0.48

POUCH TYRX

Facility

$4,975.00

Hospital Charge Code	270684099
Hospital Revenue Code	272
Min. Negotiated Rate	$141.29
Max. Negotiated Rate	$2,487.50
Rate for Payer: Aetna Commercial	$1,890.50
Rate for Payer: Aetna Medicare Advantage	$1,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,268.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,268.62
Rate for Payer: Cigna Commercial	$2,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,293.50
Rate for Payer: Oxford Commercial	$995.00
Rate for Payer: Qualcare PPO/HMO/WC	$746.25
Rate for Payer: UnitedHealthcare Commercial	$995.00
Rate for Payer: UnitedHealthcare Community & State	$157.21
Rate for Payer: Wellpoint Medicaid Managed Care	$141.29

POUCH TYRX

Facility

$4,975.00

Hospital Charge Code	270684099
Hospital Revenue Code	272
Min. Negotiated Rate	$746.25
Max. Negotiated Rate	$746.25
Rate for Payer: Qualcare PPO/HMO/WC	$746.25

POUCH U-DRAPE SHOULDER

Facility

$56.90

Hospital Charge Code	270676345
Hospital Revenue Code	272
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$28.45
Rate for Payer: Aetna Commercial	$21.62
Rate for Payer: Aetna Medicare Advantage	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.51
Rate for Payer: Cigna Commercial	$28.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.79
Rate for Payer: Oxford Commercial	$11.38
Rate for Payer: Qualcare PPO/HMO/WC	$8.54
Rate for Payer: UnitedHealthcare Commercial	$11.38
Rate for Payer: UnitedHealthcare Community & State	$1.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1.62

POUCH U-DRAPE SHOULDER

Facility

$56.90

Hospital Charge Code	270676345
Hospital Revenue Code	272
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$8.54
Rate for Payer: Qualcare PPO/HMO/WC	$8.54

POUCH UNIVERSAL RET 5MM INZII

Facility

$500.00

Hospital Charge Code	270679329
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

POUCH UNIVERSAL RET 5MM INZII

Facility

$500.00

Hospital Charge Code	270679329
Hospital Revenue Code	272
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) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

POVIDINE6023 IODINE SOL 237ML

Facility

$81.34

Service Code	NDC 67618015008
Hospital Charge Code	6023394
Hospital Revenue Code	251
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$40.67
Rate for Payer: Aetna Commercial	$30.91
Rate for Payer: Aetna Medicare Advantage	$24.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.74
Rate for Payer: Cigna Commercial	$40.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.15
Rate for Payer: Oxford Commercial	$16.27
Rate for Payer: Qualcare PPO/HMO/WC	$12.20
Rate for Payer: UnitedHealthcare Commercial	$16.27
Rate for Payer: UnitedHealthcare Community & State	$2.57
Rate for Payer: Wellpoint Medicaid Managed Care	$2.31

POVIDINE6023 IODINE SOL 237ML

Facility

$81.34

Service Code	NDC 67618015008
Hospital Charge Code	6023394
Hospital Revenue Code	251
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$12.20
Rate for Payer: Qualcare PPO/HMO/WC	$12.20

POVIDONE IODINE 10 % OIN

Facility

$22.11

Service Code	NDC 904110231
Hospital Charge Code	6004550
Hospital Revenue Code	250
Min. Negotiated Rate	$3.32
Max. Negotiated Rate	$3.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.32

POVIDONE IODINE 10 % OIN

Facility

$22.11

Service Code	NDC 904110231
Hospital Charge Code	6004550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.64
Rate for Payer: Cigna Commercial	$11.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.75
Rate for Payer: Oxford Commercial	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.32
Rate for Payer: UnitedHealthcare Commercial	$4.42
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

POVIDONE IODINE 1 OINT OIN

Facility

$4.00

Service Code	NDC 52380002601
Hospital Charge Code	60628355
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POVIDONE IODINE 1 OINT OIN

Facility

$4.00

Service Code	NDC 52380002601
Hospital Charge Code	60628355
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POVIDONE/IODINE 5% SPRAY

Facility

$4.00

Service Code	NDC 52380190500
Hospital Charge Code	60632235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

POVIDONE/IODINE 5% SPRAY

Facility

$4.00

Service Code	NDC 52380190500
Hospital Charge Code	60632235
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

POVIDONE-IODINE OP SOL 5% 30ML

Facility

$90.52

Service Code	NDC 65041130
Hospital Charge Code	60628976
Hospital Revenue Code	250
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$13.58
Rate for Payer: Qualcare PPO/HMO/WC	$13.58

POVIDONE-IODINE OP SOL 5% 30ML

Facility

$90.52

Service Code	NDC 65041130
Hospital Charge Code	60628976
Hospital Revenue Code	250
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$45.26
Rate for Payer: Aetna Commercial	$34.40
Rate for Payer: Aetna Medicare Advantage	$27.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.08
Rate for Payer: Cigna Commercial	$45.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.54
Rate for Payer: Oxford Commercial	$18.10
Rate for Payer: Qualcare PPO/HMO/WC	$13.58
Rate for Payer: UnitedHealthcare Commercial	$18.10
Rate for Payer: UnitedHealthcare Community & State	$2.86
Rate for Payer: Wellpoint Medicaid Managed Care	$2.57

POVIDONE-IODINE SWABSTICKS

Facility

$33.90

Service Code	NDC 52380003807
Hospital Charge Code	606390093
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$16.95
Rate for Payer: Aetna Commercial	$12.88
Rate for Payer: Aetna Medicare Advantage	$10.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.64
Rate for Payer: Cigna Commercial	$16.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.81
Rate for Payer: Oxford Commercial	$6.78
Rate for Payer: Qualcare PPO/HMO/WC	$5.08
Rate for Payer: UnitedHealthcare Commercial	$6.78
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

POVIDONE-IODINE SWABSTICKS

Facility

$33.90

Service Code	NDC 52380003807
Hospital Charge Code	606390093
Hospital Revenue Code	250
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$5.08
Rate for Payer: Qualcare PPO/HMO/WC	$5.08

Know your out-of-pocket cost for care.

All Charges