Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SIZER MOD PLUS PROFILE 457CC

Facility

$1,000.00

Hospital Charge Code	270669942
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

SIZER MOD PLUS PROFILE 575CC

Facility

$1,000.00

Hospital Charge Code	270671031
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

SIZER MOD PLUS PROFILE 575CC

Facility

$1,000.00

Hospital Charge Code	270671031
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 616CC

Facility

$1,000.00

Hospital Charge Code	270671032
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 616CC

Facility

$1,000.00

Hospital Charge Code	270671032
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

SIZER MOD PLUS PROFILE 659CC

Facility

$1,000.00

Hospital Charge Code	270671033
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

SIZER MOD PLUS PROFILE 659CC

Facility

$1,000.00

Hospital Charge Code	270671033
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

SIZER TISSUE EXPANDER 650CC

Facility

$2,000.00

Hospital Charge Code	270676082
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

SIZER TISSUE EXPANDER 650CC

Facility

$2,000.00

Hospital Charge Code	270676082
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SIZER TISSUE EXPANDER 685CC

Facility

$2,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270676081
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$484.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00

SIZER TISSUE EXPANDER 685CC

Facility

$2,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270676081
Hospital Revenue Code	278
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$1,000.00
Rate for Payer: Aetna Commercial	$760.00
Rate for Payer: Aetna Medicare Advantage	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$510.00
Rate for Payer: Cigna Commercial	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$484.00
Rate for Payer: Qualcare PPO/HMO/WC	$300.00
Rate for Payer: UnitedHealthcare Community & State	$63.20
Rate for Payer: Wellpoint Medicaid Managed Care	$56.80

SIZING CATH PIGTAIL 5F 100CM

Facility

$3,431.25

Hospital Charge Code	270670896
Hospital Revenue Code	272
Min. Negotiated Rate	$97.45
Max. Negotiated Rate	$1,715.62
Rate for Payer: Aetna Commercial	$1,303.88
Rate for Payer: Aetna Medicare Advantage	$1,029.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$874.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$874.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$874.97
Rate for Payer: Cigna Commercial	$1,715.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$892.12
Rate for Payer: Oxford Commercial	$686.25
Rate for Payer: Qualcare PPO/HMO/WC	$514.69
Rate for Payer: UnitedHealthcare Commercial	$686.25
Rate for Payer: UnitedHealthcare Community & State	$108.43
Rate for Payer: Wellpoint Medicaid Managed Care	$97.45

SIZING CATH PIGTAIL 5F 100CM

Facility

$3,431.25

Hospital Charge Code	270670896
Hospital Revenue Code	272
Min. Negotiated Rate	$514.69
Max. Negotiated Rate	$514.69
Rate for Payer: Qualcare PPO/HMO/WC	$514.69

SJOGREN'S ANTIBODIES-ANTI-SS-A

Facility

$746.00

Service Code	HCPCS 86235
Hospital Charge Code	38476155
Hospital Revenue Code	302
Min. Negotiated Rate	$111.90
Max. Negotiated Rate	$111.90
Rate for Payer: Qualcare PPO/HMO/WC	$111.90

SJOGREN'S ANTIBODIES-ANTI-SS-A

Facility

$746.00

Service Code	HCPCS 86235
Hospital Charge Code	38476155
Hospital Revenue Code	302
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$373.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.04
Rate for Payer: Cigna Commercial	$373.00
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$193.96
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.90
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$21.19

SKIN CLOSURE DERMABOND PRINEO

Facility

$1,574.28

Service Code	HCPCS A4649
Hospital Charge Code	270687929
Hospital Revenue Code	272
Min. Negotiated Rate	$44.71
Max. Negotiated Rate	$787.14
Rate for Payer: Aetna Commercial	$598.23
Rate for Payer: Aetna Medicare Advantage	$472.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$401.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$401.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$401.44
Rate for Payer: Cigna Commercial	$787.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$409.31
Rate for Payer: Oxford Commercial	$314.86
Rate for Payer: Qualcare PPO/HMO/WC	$236.14
Rate for Payer: UnitedHealthcare Commercial	$314.86
Rate for Payer: UnitedHealthcare Community & State	$49.75
Rate for Payer: Wellpoint Medicaid Managed Care	$44.71

SKIN CLOSURE DERMABOND PRINEO

Facility

$1,574.28

Service Code	HCPCS A4649
Hospital Charge Code	270687929
Hospital Revenue Code	272
Min. Negotiated Rate	$236.14
Max. Negotiated Rate	$236.14
Rate for Payer: Qualcare PPO/HMO/WC	$236.14

SKIN CLOSURE SYSTEM DERMABOND

Facility

$615.00

Hospital Charge Code	270655959
Hospital Revenue Code	271
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$233.70
Rate for Payer: Aetna Medicare Advantage	$184.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.82
Rate for Payer: Cigna Commercial	$307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.90
Rate for Payer: Oxford Commercial	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$92.25
Rate for Payer: UnitedHealthcare Commercial	$123.00
Rate for Payer: UnitedHealthcare Community & State	$19.43
Rate for Payer: Wellpoint Medicaid Managed Care	$17.47

SKIN CLOSURE SYSTEM DERMABOND

Facility

$615.00

Hospital Charge Code	270655959
Hospital Revenue Code	271
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$92.25
Rate for Payer: Qualcare PPO/HMO/WC	$92.25

SKIN CREAM

Facility

$12.99

Hospital Charge Code	270302495
Hospital Revenue Code	270
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.95

SKIN CREAM

Facility

$12.99

Hospital Charge Code	270302495
Hospital Revenue Code	270
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna Medicare Advantage	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.31
Rate for Payer: Cigna Commercial	$6.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.38
Rate for Payer: Oxford Commercial	$2.60
Rate for Payer: Qualcare PPO/HMO/WC	$1.95
Rate for Payer: UnitedHealthcare Commercial	$2.60
Rate for Payer: UnitedHealthcare Community & State	$0.41
Rate for Payer: Wellpoint Medicaid Managed Care	$0.37

SKIN DEBRIDEMENT WITH CC

Facility

$72,842.05

Service Code	MSDRG 571
Min. Negotiated Rate	$22,179.47
Max. Negotiated Rate	$72,842.05
Rate for Payer: Aetna Commercial	$53,737.44
Rate for Payer: Aetna Medicare Advantage	$72,842.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,821.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,821.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$23,346.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,821.45
Rate for Payer: Cigna Commercial	$37,664.02
Rate for Payer: Cigna Medicare Advantage	$23,346.81
Rate for Payer: Clover Medicare Advantage	$22,179.47
Rate for Payer: EmblemHealth Commercial	$70,040.43
Rate for Payer: Humana Medicare Advantage	$24,047.21
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$23,346.81
Rate for Payer: Oxford Commercial	$29,768.99
Rate for Payer: UnitedHealthcare Commercial	$39,846.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$23,346.81
Rate for Payer: Wellcare Medicare Advantage	$23,346.81

SKIN DEBRIDEMENT WITH MCC

Facility

$112,384.49

Service Code	MSDRG 570
Min. Negotiated Rate	$34,219.64
Max. Negotiated Rate	$112,384.49
Rate for Payer: Aetna Commercial	$81,900.03
Rate for Payer: Aetna Medicare Advantage	$112,384.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80,898.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80,898.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$36,020.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$80,898.60
Rate for Payer: Cigna Commercial	$65,565.94
Rate for Payer: Cigna Medicare Advantage	$36,020.67
Rate for Payer: Clover Medicare Advantage	$34,219.64
Rate for Payer: EmblemHealth Commercial	$108,062.01
Rate for Payer: Humana Medicare Advantage	$37,101.29
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$36,020.67
Rate for Payer: Oxford Commercial	$51,822.18
Rate for Payer: UnitedHealthcare Commercial	$69,365.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$36,020.67
Rate for Payer: Wellcare Medicare Advantage	$36,020.67

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$55,680.36

Service Code	MSDRG 572
Min. Negotiated Rate	$16,953.96
Max. Negotiated Rate	$55,680.36
Rate for Payer: Aetna Commercial	$41,514.71
Rate for Payer: Aetna Medicare Advantage	$55,680.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,583.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,583.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17,846.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$31,583.70
Rate for Payer: Cigna Commercial	$25,554.47
Rate for Payer: Cigna Medicare Advantage	$17,846.27
Rate for Payer: Clover Medicare Advantage	$16,953.96
Rate for Payer: EmblemHealth Commercial	$53,538.81
Rate for Payer: Humana Medicare Advantage	$18,381.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17,846.27
Rate for Payer: Oxford Commercial	$20,197.81
Rate for Payer: UnitedHealthcare Commercial	$27,035.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$17,846.27
Rate for Payer: Wellcare Medicare Advantage	$17,846.27

SKIN FULL GRAFT SCLP/ARM/LEG

Facility

$16,584.80

Service Code	HCPCS 15220
Hospital Charge Code	16000659
Hospital Revenue Code	360
Min. Negotiated Rate	$2,487.72
Max. Negotiated Rate	$2,487.72
Rate for Payer: Qualcare PPO/HMO/WC	$2,487.72

Know your out-of-pocket cost for care.

All Charges