Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SURGI-BRA SMALL

Facility

$215.00

Hospital Charge Code	270330834
Hospital Revenue Code	270
Min. Negotiated Rate	$32.25
Max. Negotiated Rate	$32.25
Rate for Payer: Qualcare PPO/HMO/WC	$32.25

SURGI-BRA XXL

Facility

$208.70

Hospital Charge Code	270650036
Hospital Revenue Code	270
Min. Negotiated Rate	$5.93
Max. Negotiated Rate	$104.35
Rate for Payer: Aetna Commercial	$79.31
Rate for Payer: Aetna Medicare Advantage	$62.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.22
Rate for Payer: Cigna Commercial	$104.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.26
Rate for Payer: Oxford Commercial	$41.74
Rate for Payer: Qualcare PPO/HMO/WC	$31.30
Rate for Payer: UnitedHealthcare Commercial	$41.74
Rate for Payer: UnitedHealthcare Community & State	$6.59
Rate for Payer: Wellpoint Medicaid Managed Care	$5.93

SURGI-BRA XXL

Facility

$208.70

Hospital Charge Code	270650036
Hospital Revenue Code	270
Min. Negotiated Rate	$31.30
Max. Negotiated Rate	$31.30
Rate for Payer: Qualcare PPO/HMO/WC	$31.30

SURGICAL BLADES

Facility

$98.00

Hospital Charge Code	270330831
Hospital Revenue Code	272
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$49.00
Rate for Payer: Aetna Commercial	$37.24
Rate for Payer: Aetna Medicare Advantage	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.99
Rate for Payer: Cigna Commercial	$49.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.48
Rate for Payer: Oxford Commercial	$19.60
Rate for Payer: Qualcare PPO/HMO/WC	$14.70
Rate for Payer: UnitedHealthcare Commercial	$19.60
Rate for Payer: UnitedHealthcare Community & State	$3.10
Rate for Payer: Wellpoint Medicaid Managed Care	$2.78

SURGICAL BLADES

Facility

$98.00

Hospital Charge Code	270330831
Hospital Revenue Code	272
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$14.70
Rate for Payer: Qualcare PPO/HMO/WC	$14.70

SURGICAL DX EXAM ANORECTAL

Facility

$16,148.00

Service Code	HCPCS 45990
Hospital Charge Code	1600000626
Hospital Revenue Code	360
Min. Negotiated Rate	$2,422.20
Max. Negotiated Rate	$2,422.20
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.20

SURGICAL DX EXAM ANORECTAL

Facility

$16,148.00

Service Code	HCPCS 45990
Hospital Charge Code	1600000626
Hospital Revenue Code	360
Min. Negotiated Rate	$458.60
Max. Negotiated Rate	$11,961.90
Rate for Payer: Aetna Commercial	$8,969.36
Rate for Payer: Aetna Medicare Advantage	$10,684.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11,961.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11,961.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,297.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11,961.90
Rate for Payer: Cigna Commercial	$6,609.93
Rate for Payer: Cigna Medicare Advantage	$3,297.56
Rate for Payer: Clover Medicare Advantage	$3,132.68
Rate for Payer: EmblemHealth Commercial	$9,892.68
Rate for Payer: Humana Medicare Advantage	$3,396.49
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,297.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,198.48
Rate for Payer: Oxford Commercial	$5,018.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,422.20
Rate for Payer: UnitedHealthcare Commercial	$5,347.00
Rate for Payer: UnitedHealthcare Community & State	$510.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,297.56
Rate for Payer: Wellcare Medicare Advantage	$3,297.56
Rate for Payer: Wellpoint Medicaid Managed Care	$458.60

SURGICAL MATRIX 7X10CM

Facility

$9,922.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662087
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,401.24
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,984.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,401.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.38
Rate for Payer: UnitedHealthcare Community & State	$313.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$281.80

SURGICAL MATRIX 7X10CM

Facility

$9,922.50

Service Code	HCPCS Q4166
Hospital Charge Code	270662087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,488.38
Max. Negotiated Rate	$2,401.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,984.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,401.24
Rate for Payer: Qualcare PPO/HMO/WC	$1,488.38

SURGICAL MATRIX 7X10CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662087W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$34.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26

SURGICAL MATRIX 7X10CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662087W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$70.88
Rate for Payer: Aetna Commercial	$53.87
Rate for Payer: Aetna Medicare Advantage	$42.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.15
Rate for Payer: Cigna Commercial	$70.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

SURGICAL MATRIX 8X16CM

Facility

$18,144.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662094
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,390.85
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,628.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,390.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,721.60
Rate for Payer: UnitedHealthcare Community & State	$573.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$515.29

SURGICAL MATRIX 8X16CM

Facility

$18,144.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662094
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,390.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,628.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,390.85
Rate for Payer: Qualcare PPO/HMO/WC	$2,721.60

SURGICAL MATRIX 8X16CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662094W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$70.88
Rate for Payer: Aetna Commercial	$53.87
Rate for Payer: Aetna Medicare Advantage	$42.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.15
Rate for Payer: Cigna Commercial	$70.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26
Rate for Payer: UnitedHealthcare Community & State	$4.48
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

SURGICAL MATRIX 8X16CM/SQCM JW

Facility

$141.75

Hospital Charge Code	270662094W
Hospital Revenue Code	636
Min. Negotiated Rate	$21.26
Max. Negotiated Rate	$34.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.26

SURGICAL PATTI 1/2 X 1

Facility

$44.00

Hospital Charge Code	270332279
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SURGICAL PATTI 1/2 X 1

Facility

$44.00

Hospital Charge Code	270332279
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SURGICAL PATTIES 1X1

Facility

$44.00

Hospital Charge Code	270332417
Hospital Revenue Code	272
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$22.00
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare Advantage	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.22
Rate for Payer: Cigna Commercial	$22.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.44
Rate for Payer: Oxford Commercial	$8.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.60
Rate for Payer: UnitedHealthcare Commercial	$8.80
Rate for Payer: UnitedHealthcare Community & State	$1.39
Rate for Payer: Wellpoint Medicaid Managed Care	$1.25

SURGICAL PATTIES 1X1

Facility

$44.00

Hospital Charge Code	270332417
Hospital Revenue Code	272
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$6.60

SURGICEL 4X8

Facility

$597.57

Hospital Charge Code	270650484
Hospital Revenue Code	272
Min. Negotiated Rate	$16.97
Max. Negotiated Rate	$298.79
Rate for Payer: Aetna Commercial	$227.08
Rate for Payer: Aetna Medicare Advantage	$179.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.38
Rate for Payer: Cigna Commercial	$298.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$155.37
Rate for Payer: Oxford Commercial	$119.51
Rate for Payer: Qualcare PPO/HMO/WC	$89.64
Rate for Payer: UnitedHealthcare Commercial	$119.51
Rate for Payer: UnitedHealthcare Community & State	$18.88
Rate for Payer: Wellpoint Medicaid Managed Care	$16.97

SURGICEL 4X8

Facility

$597.57

Hospital Charge Code	270650484
Hospital Revenue Code	272
Min. Negotiated Rate	$89.64
Max. Negotiated Rate	$89.64
Rate for Payer: Qualcare PPO/HMO/WC	$89.64

SURGICEL FIB 2X4 HEMOSTAT 1962

Facility

$906.84

Hospital Charge Code	270632664
Hospital Revenue Code	272
Min. Negotiated Rate	$25.75
Max. Negotiated Rate	$453.42
Rate for Payer: Aetna Commercial	$344.60
Rate for Payer: Aetna Medicare Advantage	$272.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$231.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$231.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$231.24
Rate for Payer: Cigna Commercial	$453.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$235.78
Rate for Payer: Oxford Commercial	$181.37
Rate for Payer: Qualcare PPO/HMO/WC	$136.03
Rate for Payer: UnitedHealthcare Commercial	$181.37
Rate for Payer: UnitedHealthcare Community & State	$28.66
Rate for Payer: Wellpoint Medicaid Managed Care	$25.75

SURGICEL FIB 2X4 HEMOSTAT 1962

Facility

$906.84

Hospital Charge Code	270632664
Hospital Revenue Code	272
Min. Negotiated Rate	$136.03
Max. Negotiated Rate	$136.03
Rate for Payer: Qualcare PPO/HMO/WC	$136.03

SURGICEL NU-KNIT HEMOSTAT

Facility

$7,840.30

Hospital Charge Code	270661748
Hospital Revenue Code	272
Min. Negotiated Rate	$222.66
Max. Negotiated Rate	$3,920.15
Rate for Payer: Aetna Commercial	$2,979.31
Rate for Payer: Aetna Medicare Advantage	$2,352.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,999.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,999.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,999.28
Rate for Payer: Cigna Commercial	$3,920.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,038.48
Rate for Payer: Oxford Commercial	$1,568.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.05
Rate for Payer: UnitedHealthcare Commercial	$1,568.06
Rate for Payer: UnitedHealthcare Community & State	$247.75
Rate for Payer: Wellpoint Medicaid Managed Care	$222.66

SURGICEL NU-KNIT HEMOSTAT

Facility

$7,840.30

Hospital Charge Code	270661748
Hospital Revenue Code	272
Min. Negotiated Rate	$1,176.05
Max. Negotiated Rate	$1,176.05
Rate for Payer: Qualcare PPO/HMO/WC	$1,176.05

Know your out-of-pocket cost for care.

All Charges