Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SURGICEL SNOW 4X4

Facility

$1,095.71

Hospital Charge Code	270683431
Hospital Revenue Code	272
Min. Negotiated Rate	$164.36
Max. Negotiated Rate	$164.36
Rate for Payer: Qualcare PPO/HMO/WC	$164.36

SURGICEL SNOW 4X4

Facility

$1,095.71

Hospital Charge Code	270683431
Hospital Revenue Code	272
Min. Negotiated Rate	$31.12
Max. Negotiated Rate	$547.86
Rate for Payer: Aetna Commercial	$416.37
Rate for Payer: Aetna Medicare Advantage	$328.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$279.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$279.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$279.41
Rate for Payer: Cigna Commercial	$547.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$284.88
Rate for Payer: Oxford Commercial	$219.14
Rate for Payer: Qualcare PPO/HMO/WC	$164.36
Rate for Payer: UnitedHealthcare Commercial	$219.14
Rate for Payer: UnitedHealthcare Community & State	$34.62
Rate for Payer: Wellpoint Medicaid Managed Care	$31.12

SURGICEL SNOW ABSORB. HEMOSTAT

Facility

$938.66

Hospital Charge Code	270669635
Hospital Revenue Code	272
Min. Negotiated Rate	$140.80
Max. Negotiated Rate	$140.80
Rate for Payer: Qualcare PPO/HMO/WC	$140.80

SURGICEL SNOW ABSORB. HEMOSTAT

Facility

$938.66

Hospital Charge Code	270669635
Hospital Revenue Code	272
Min. Negotiated Rate	$26.66
Max. Negotiated Rate	$469.33
Rate for Payer: Aetna Commercial	$356.69
Rate for Payer: Aetna Medicare Advantage	$281.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.36
Rate for Payer: Cigna Commercial	$469.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.05
Rate for Payer: Oxford Commercial	$187.73
Rate for Payer: Qualcare PPO/HMO/WC	$140.80
Rate for Payer: UnitedHealthcare Commercial	$187.73
Rate for Payer: UnitedHealthcare Community & State	$29.66
Rate for Payer: Wellpoint Medicaid Managed Care	$26.66

SURGICLIP

Facility

$1,511.00

Hospital Charge Code	270335078
Hospital Revenue Code	272
Min. Negotiated Rate	$226.65
Max. Negotiated Rate	$226.65
Rate for Payer: Qualcare PPO/HMO/WC	$226.65

SURGICLIP

Facility

$1,511.00

Hospital Charge Code	270335078
Hospital Revenue Code	272
Min. Negotiated Rate	$42.91
Max. Negotiated Rate	$755.50
Rate for Payer: Aetna Commercial	$574.18
Rate for Payer: Aetna Medicare Advantage	$453.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$385.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$385.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$385.31
Rate for Payer: Cigna Commercial	$755.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.86
Rate for Payer: Oxford Commercial	$302.20
Rate for Payer: Qualcare PPO/HMO/WC	$226.65
Rate for Payer: UnitedHealthcare Commercial	$302.20
Rate for Payer: UnitedHealthcare Community & State	$47.75
Rate for Payer: Wellpoint Medicaid Managed Care	$42.91

SURGICLIP PERMIUM L-13.0

Facility

$1,592.07

Hospital Charge Code	270600051
Hospital Revenue Code	272
Min. Negotiated Rate	$45.21
Max. Negotiated Rate	$796.03
Rate for Payer: Aetna Commercial	$604.99
Rate for Payer: Aetna Medicare Advantage	$477.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$405.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$405.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$405.98
Rate for Payer: Cigna Commercial	$796.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$413.94
Rate for Payer: Oxford Commercial	$318.41
Rate for Payer: Qualcare PPO/HMO/WC	$238.81
Rate for Payer: UnitedHealthcare Commercial	$318.41
Rate for Payer: UnitedHealthcare Community & State	$50.31
Rate for Payer: Wellpoint Medicaid Managed Care	$45.21

SURGICLIP PERMIUM L-13.0

Facility

$1,592.07

Hospital Charge Code	270600051
Hospital Revenue Code	272
Min. Negotiated Rate	$238.81
Max. Negotiated Rate	$238.81
Rate for Payer: Qualcare PPO/HMO/WC	$238.81

SURGICLIP PERMIUM M-11.5

Facility

$285.91

Hospital Charge Code	270651807
Hospital Revenue Code	272
Min. Negotiated Rate	$8.12
Max. Negotiated Rate	$142.96
Rate for Payer: Aetna Commercial	$108.65
Rate for Payer: Aetna Medicare Advantage	$85.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$72.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$72.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$72.91
Rate for Payer: Cigna Commercial	$142.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$74.34
Rate for Payer: Oxford Commercial	$57.18
Rate for Payer: Qualcare PPO/HMO/WC	$42.89
Rate for Payer: UnitedHealthcare Commercial	$57.18
Rate for Payer: UnitedHealthcare Community & State	$9.03
Rate for Payer: Wellpoint Medicaid Managed Care	$8.12

SURGICLIP PERMIUM M-11.5

Facility

$285.91

Hospital Charge Code	270651807
Hospital Revenue Code	272
Min. Negotiated Rate	$42.89
Max. Negotiated Rate	$42.89
Rate for Payer: Qualcare PPO/HMO/WC	$42.89

SURGICLIP PERMIUM M-9.75

Facility

$249.29

Hospital Charge Code	270656248
Hospital Revenue Code	272
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$124.64
Rate for Payer: Aetna Commercial	$94.73
Rate for Payer: Aetna Medicare Advantage	$74.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.57
Rate for Payer: Cigna Commercial	$124.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.82
Rate for Payer: Oxford Commercial	$49.86
Rate for Payer: Qualcare PPO/HMO/WC	$37.39
Rate for Payer: UnitedHealthcare Commercial	$49.86
Rate for Payer: UnitedHealthcare Community & State	$7.88
Rate for Payer: Wellpoint Medicaid Managed Care	$7.08

SURGICLIP PERMIUM M-9.75

Facility

$249.29

Hospital Charge Code	270656248
Hospital Revenue Code	272
Min. Negotiated Rate	$37.39
Max. Negotiated Rate	$37.39
Rate for Payer: Qualcare PPO/HMO/WC	$37.39

SURGICLIP PERMIUM S-9.0

Facility

$1,800.21

Hospital Charge Code	270600140
Hospital Revenue Code	272
Min. Negotiated Rate	$51.13
Max. Negotiated Rate	$900.11
Rate for Payer: Aetna Commercial	$684.08
Rate for Payer: Aetna Medicare Advantage	$540.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.05
Rate for Payer: Cigna Commercial	$900.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$468.05
Rate for Payer: Oxford Commercial	$360.04
Rate for Payer: Qualcare PPO/HMO/WC	$270.03
Rate for Payer: UnitedHealthcare Commercial	$360.04
Rate for Payer: UnitedHealthcare Community & State	$56.89
Rate for Payer: Wellpoint Medicaid Managed Care	$51.13

SURGICLIP PERMIUM S-9.0

Facility

$1,800.21

Hospital Charge Code	270600140
Hospital Revenue Code	272
Min. Negotiated Rate	$270.03
Max. Negotiated Rate	$270.03
Rate for Payer: Qualcare PPO/HMO/WC	$270.03

SURGICLIP PREMIUM M-11.5

Facility

$963.98

Hospital Charge Code	270600049
Hospital Revenue Code	272
Min. Negotiated Rate	$27.38
Max. Negotiated Rate	$481.99
Rate for Payer: Aetna Commercial	$366.31
Rate for Payer: Aetna Medicare Advantage	$289.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$245.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$245.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$245.81
Rate for Payer: Cigna Commercial	$481.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$250.63
Rate for Payer: Oxford Commercial	$192.80
Rate for Payer: Qualcare PPO/HMO/WC	$144.60
Rate for Payer: UnitedHealthcare Commercial	$192.80
Rate for Payer: UnitedHealthcare Community & State	$30.46
Rate for Payer: Wellpoint Medicaid Managed Care	$27.38

SURGICLIP PREMIUM M-11.5

Facility

$963.98

Hospital Charge Code	270600049
Hospital Revenue Code	272
Min. Negotiated Rate	$144.60
Max. Negotiated Rate	$144.60
Rate for Payer: Qualcare PPO/HMO/WC	$144.60

SURGICLOSE MESHED 2:1 6X8CM

Facility

$14,550.00

Service Code	HCPCS C1781
Hospital Charge Code	270705088
Hospital Revenue Code	278
Min. Negotiated Rate	$413.22
Max. Negotiated Rate	$7,275.00
Rate for Payer: Aetna Commercial	$5,529.00
Rate for Payer: Aetna Medicare Advantage	$4,365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,710.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,710.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,910.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,710.25
Rate for Payer: Cigna Commercial	$7,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,521.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,182.50
Rate for Payer: UnitedHealthcare Community & State	$459.78
Rate for Payer: Wellpoint Medicaid Managed Care	$413.22

SURGICLOSE MESHED 2:1 6X8CM

Facility

$14,550.00

Service Code	HCPCS C1781
Hospital Charge Code	270705088
Hospital Revenue Code	278
Min. Negotiated Rate	$2,182.50
Max. Negotiated Rate	$3,521.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,910.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,521.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,182.50

SURGICLOSE MESHED 7X10CM

Facility

$19,735.00

Service Code	HCPCS C1781
Hospital Charge Code	270705089
Hospital Revenue Code	278
Min. Negotiated Rate	$560.47
Max. Negotiated Rate	$9,867.50
Rate for Payer: Aetna Commercial	$7,499.30
Rate for Payer: Aetna Medicare Advantage	$5,920.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,032.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,032.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,947.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,032.43
Rate for Payer: Cigna Commercial	$9,867.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,775.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,960.25
Rate for Payer: UnitedHealthcare Community & State	$623.63
Rate for Payer: Wellpoint Medicaid Managed Care	$560.47

SURGICLOSE MESHED 7X10CM

Facility

$19,735.00

Service Code	HCPCS C1781
Hospital Charge Code	270705089
Hospital Revenue Code	278
Min. Negotiated Rate	$2,960.25
Max. Negotiated Rate	$4,775.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,947.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,775.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,960.25

SURGICLOSE MICRO 95 SQ CM

Facility

$20,475.00

Service Code	HCPCS C1765
Hospital Charge Code	270705697
Hospital Revenue Code	278
Min. Negotiated Rate	$3,071.25
Max. Negotiated Rate	$4,954.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25

SURGICLOSE MICRO 95 SQ CM

Facility

$20,475.00

Service Code	HCPCS C1765
Hospital Charge Code	270705697
Hospital Revenue Code	278
Min. Negotiated Rate	$581.49
Max. Negotiated Rate	$10,237.50
Rate for Payer: Aetna Commercial	$7,780.50
Rate for Payer: Aetna Medicare Advantage	$6,142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,221.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,095.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,221.12
Rate for Payer: Cigna Commercial	$10,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,954.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,071.25
Rate for Payer: UnitedHealthcare Community & State	$647.01
Rate for Payer: Wellpoint Medicaid Managed Care	$581.49

SURGIFLO HEMOSTATIC 8ML

Facility

$1,200.00

Hospital Charge Code	270701429
Hospital Revenue Code	278
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$37.92
Rate for Payer: Wellpoint Medicaid Managed Care	$34.08

SURGIFLO HEMOSTATIC 8ML

Facility

$1,200.00

Hospital Charge Code	270701429
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

SURGIFOAM ABSORB GEL POWDER

Facility

$452.26

Hospital Charge Code	270644933C
Hospital Revenue Code	272
Min. Negotiated Rate	$67.84
Max. Negotiated Rate	$67.84
Rate for Payer: Qualcare PPO/HMO/WC	$67.84

Know your out-of-pocket cost for care.

All Charges