Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3247M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	4201M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3048M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3042M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3121M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BAMLANIVIMAB INFUS & MONITOR

Facility

$1,548.00

Service Code	HCPCS M0239
Hospital Charge Code	3037M0239
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

BANANA TIT IMP 12X27X14MM 5DEG

Facility

$22,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693943
Hospital Revenue Code	278
Min. Negotiated Rate	$624.80
Max. Negotiated Rate	$11,000.00
Rate for Payer: Aetna Commercial	$8,360.00
Rate for Payer: Aetna Medicare Advantage	$6,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,610.00
Rate for Payer: Cigna Commercial	$11,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$695.20
Rate for Payer: Wellpoint Medicaid Managed Care	$624.80

BANANA TIT IMP 12X27X14MM 5DEG

Facility

$22,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270693943
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$5,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

BANDAGE ACE 2

Facility

$9.65

Hospital Charge Code	270300215
Hospital Revenue Code	272
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$4.83
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna Medicare Advantage	$2.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.46
Rate for Payer: Cigna Commercial	$4.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.51
Rate for Payer: Oxford Commercial	$1.93
Rate for Payer: Qualcare PPO/HMO/WC	$1.45
Rate for Payer: UnitedHealthcare Commercial	$1.93
Rate for Payer: UnitedHealthcare Community & State	$0.30
Rate for Payer: Wellpoint Medicaid Managed Care	$0.27

BANDAGE ACE 2

Facility

$9.65

Hospital Charge Code	270300215
Hospital Revenue Code	272
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Qualcare PPO/HMO/WC	$1.45

BANDAGE ACE 3

Facility

$5.00

Hospital Charge Code	270300220
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Qualcare PPO/HMO/WC	$0.75

BANDAGE ACE 3

Facility

$5.00

Hospital Charge Code	270300220
Hospital Revenue Code	272
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.50
Rate for Payer: Aetna Commercial	$1.90
Rate for Payer: Aetna Medicare Advantage	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.27
Rate for Payer: Cigna Commercial	$2.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.30
Rate for Payer: Oxford Commercial	$1.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.75
Rate for Payer: UnitedHealthcare Commercial	$1.00
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

BANDAGE ACE 4

Facility

$312.60

Hospital Charge Code	270300225
Hospital Revenue Code	272
Min. Negotiated Rate	$8.88
Max. Negotiated Rate	$156.30
Rate for Payer: Aetna Commercial	$118.79
Rate for Payer: Aetna Medicare Advantage	$93.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.71
Rate for Payer: Cigna Commercial	$156.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.28
Rate for Payer: Oxford Commercial	$62.52
Rate for Payer: Qualcare PPO/HMO/WC	$46.89
Rate for Payer: UnitedHealthcare Commercial	$62.52
Rate for Payer: UnitedHealthcare Community & State	$9.88
Rate for Payer: Wellpoint Medicaid Managed Care	$8.88

BANDAGE ACE 4

Facility

$312.60

Hospital Charge Code	270300225
Hospital Revenue Code	272
Min. Negotiated Rate	$46.89
Max. Negotiated Rate	$46.89
Rate for Payer: Qualcare PPO/HMO/WC	$46.89

BANDAGE ACE 6

Facility

$11.25

Hospital Charge Code	270300230W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

BANDAGE ACE 6

Facility

$11.25

Hospital Charge Code	270300230
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

BANDAGE ACE 6

Facility

$11.25

Hospital Charge Code	270300230
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

BANDAGE ACE 6

Facility

$11.25

Hospital Charge Code	270300230W
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

BANDAGE BUKLEY KERFLIX 3

Facility

$3.00

Hospital Charge Code	270649699
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.78
Rate for Payer: Oxford Commercial	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Commercial	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.09
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

BANDAGE BUKLEY KERFLIX 3

Facility

$3.00

Hospital Charge Code	270649699
Hospital Revenue Code	270
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

BANDAGE COBAN 2

Facility

$5.62

Hospital Charge Code	270300160
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

BANDAGE COBAN 2

Facility

$5.62

Hospital Charge Code	270300160
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.43
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.12
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

BANDAGE COBAN 3

Facility

$6.76

Hospital Charge Code	270300161
Hospital Revenue Code	272
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$1.01

BANDAGE COBAN 3

Facility

$6.76

Hospital Charge Code	270300161
Hospital Revenue Code	272
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$2.57
Rate for Payer: Aetna Medicare Advantage	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.72
Rate for Payer: Cigna Commercial	$3.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Oxford Commercial	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.01
Rate for Payer: UnitedHealthcare Commercial	$1.35
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

BANDAGE COBAN 4

Facility

$8.46

Hospital Charge Code	270300165W
Hospital Revenue Code	272
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$1.27
Rate for Payer: Qualcare PPO/HMO/WC	$1.27

Know your out-of-pocket cost for care.

All Charges