Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TAPE MEDIPORE SOFT CLOTH 3x10

Facility

$25.17

Hospital Charge Code	270649121
Hospital Revenue Code	272
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$3.78
Rate for Payer: Qualcare PPO/HMO/WC	$3.78

TAPE MEDIPORE SOFT CLOTH 3x10

Facility

$25.17

Hospital Charge Code	270649121
Hospital Revenue Code	272
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$12.59
Rate for Payer: Aetna Commercial	$9.56
Rate for Payer: Aetna Medicare Advantage	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.42
Rate for Payer: Cigna Commercial	$12.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.54
Rate for Payer: Oxford Commercial	$5.03
Rate for Payer: Qualcare PPO/HMO/WC	$3.78
Rate for Payer: UnitedHealthcare Commercial	$5.03
Rate for Payer: UnitedHealthcare Community & State	$0.80
Rate for Payer: Wellpoint Medicaid Managed Care	$0.71

TAPE MERSILENE 5MM 0S-8

Facility

$358.33

Hospital Charge Code	270655648
Hospital Revenue Code	270
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$179.16
Rate for Payer: Aetna Commercial	$136.17
Rate for Payer: Aetna Medicare Advantage	$107.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91.37
Rate for Payer: Cigna Commercial	$179.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Oxford Commercial	$71.67
Rate for Payer: Qualcare PPO/HMO/WC	$53.75
Rate for Payer: UnitedHealthcare Commercial	$71.67
Rate for Payer: UnitedHealthcare Community & State	$11.32
Rate for Payer: Wellpoint Medicaid Managed Care	$10.18

TAPE MERSILENE 5MM 0S-8

Facility

$358.33

Hospital Charge Code	270655648
Hospital Revenue Code	270
Min. Negotiated Rate	$53.75
Max. Negotiated Rate	$53.75
Rate for Payer: Qualcare PPO/HMO/WC	$53.75

TAPE MICRO FOAM 1

Facility

$30.32

Hospital Charge Code	270653207
Hospital Revenue Code	272
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$15.16
Rate for Payer: Aetna Commercial	$11.52
Rate for Payer: Aetna Medicare Advantage	$9.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.73
Rate for Payer: Cigna Commercial	$15.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.88
Rate for Payer: Oxford Commercial	$6.06
Rate for Payer: Qualcare PPO/HMO/WC	$4.55
Rate for Payer: UnitedHealthcare Commercial	$6.06
Rate for Payer: UnitedHealthcare Community & State	$0.96
Rate for Payer: Wellpoint Medicaid Managed Care	$0.86

TAPE MICRO FOAM 1

Facility

$30.32

Hospital Charge Code	270653207
Hospital Revenue Code	272
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Qualcare PPO/HMO/WC	$4.55

TAPE MICROPORE 1

Facility

$1.00

Hospital Charge Code	270350240
Hospital Revenue Code	270
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TAPE MICROPORE 1

Facility

$1.00

Hospital Charge Code	270350240
Hospital Revenue Code	270
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

TAPE MICROPORE 2

Facility

$1.00

Hospital Charge Code	270350245
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

TAPE MICROPORE 2

Facility

$1.00

Hospital Charge Code	270350245
Hospital Revenue Code	272
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.26
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.03
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

TAPER ADAPTER STD NECK

Facility

$635.00

Service Code	HCPCS C1776
Hospital Charge Code	270645467
Hospital Revenue Code	278
Min. Negotiated Rate	$95.25
Max. Negotiated Rate	$153.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: Qualcare PPO/HMO/WC	$95.25

TAPER ADAPTER STD NECK

Facility

$635.00

Service Code	HCPCS C1776
Hospital Charge Code	270645467
Hospital Revenue Code	278
Min. Negotiated Rate	$18.03
Max. Negotiated Rate	$317.50
Rate for Payer: Aetna Commercial	$241.30
Rate for Payer: Aetna Medicare Advantage	$190.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.93
Rate for Payer: Cigna Commercial	$317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: Qualcare PPO/HMO/WC	$95.25
Rate for Payer: UnitedHealthcare Community & State	$20.07
Rate for Payer: Wellpoint Medicaid Managed Care	$18.03

TAPER DELTA C 36 MM -5

Facility

$4,799.25

Service Code	HCPCS C1776
Hospital Charge Code	270691974
Hospital Revenue Code	278
Min. Negotiated Rate	$136.30
Max. Negotiated Rate	$2,399.62
Rate for Payer: Aetna Commercial	$1,823.71
Rate for Payer: Aetna Medicare Advantage	$1,439.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,223.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,223.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,223.81
Rate for Payer: Cigna Commercial	$2,399.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.42
Rate for Payer: Qualcare PPO/HMO/WC	$719.89
Rate for Payer: UnitedHealthcare Community & State	$151.66
Rate for Payer: Wellpoint Medicaid Managed Care	$136.30

TAPER DELTA C 36 MM -5

Facility

$4,799.25

Service Code	HCPCS C1776
Hospital Charge Code	270691974
Hospital Revenue Code	278
Min. Negotiated Rate	$719.89
Max. Negotiated Rate	$1,161.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$959.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,161.42
Rate for Payer: Qualcare PPO/HMO/WC	$719.89

TAPER ECCENTRICAL ADAPTOR +4MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672316
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

TAPER ECCENTRICAL ADAPTOR +4MM

Facility

$1,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270672316
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

TAPERED ROUTER 2.3X22MM

Facility

$395.00

Hospital Charge Code	270691577
Hospital Revenue Code	272
Min. Negotiated Rate	$59.25
Max. Negotiated Rate	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$59.25

TAPERED ROUTER 2.3X22MM

Facility

$395.00

Hospital Charge Code	270691577
Hospital Revenue Code	272
Min. Negotiated Rate	$11.22
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$150.10
Rate for Payer: Aetna Medicare Advantage	$118.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$100.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$100.72
Rate for Payer: Cigna Commercial	$197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.70
Rate for Payer: Oxford Commercial	$79.00
Rate for Payer: Qualcare PPO/HMO/WC	$59.25
Rate for Payer: UnitedHealthcare Commercial	$79.00
Rate for Payer: UnitedHealthcare Community & State	$12.48
Rate for Payer: Wellpoint Medicaid Managed Care	$11.22

TAPERED ROUTER D-58 1.7X16MM

Facility

$603.75

Hospital Charge Code	270676208
Hospital Revenue Code	272
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$301.88
Rate for Payer: Aetna Commercial	$229.43
Rate for Payer: Aetna Medicare Advantage	$181.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.96
Rate for Payer: Cigna Commercial	$301.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.97
Rate for Payer: Oxford Commercial	$120.75
Rate for Payer: Qualcare PPO/HMO/WC	$90.56
Rate for Payer: UnitedHealthcare Commercial	$120.75
Rate for Payer: UnitedHealthcare Community & State	$19.08
Rate for Payer: Wellpoint Medicaid Managed Care	$17.15

TAPERED ROUTER D-58 1.7X16MM

Facility

$603.75

Hospital Charge Code	270676208
Hospital Revenue Code	272
Min. Negotiated Rate	$90.56
Max. Negotiated Rate	$90.56
Rate for Payer: Qualcare PPO/HMO/WC	$90.56

TAPERLOC COMPLETE PRIMARY FEM

Facility

$10,500.00

Hospital Charge Code	270702559
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

TAPERLOC COMPLETE PRIMARY FEM

Facility

$10,500.00

Hospital Charge Code	270702559
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TAPERLOC FEM 7X134MM STD OFFST

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692886
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

TAPERLOC FEM 7X134MM STD OFFST

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270692886
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

TAPERLOC TYPE 1 PPS 9X137MM

Facility

$10,815.00

Service Code	HCPCS C1776
Hospital Charge Code	270700153
Hospital Revenue Code	278
Min. Negotiated Rate	$307.15
Max. Negotiated Rate	$5,407.50
Rate for Payer: Aetna Commercial	$4,109.70
Rate for Payer: Aetna Medicare Advantage	$3,244.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,757.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,757.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,163.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,757.82
Rate for Payer: Cigna Commercial	$5,407.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,617.23
Rate for Payer: Qualcare PPO/HMO/WC	$1,622.25
Rate for Payer: UnitedHealthcare Community & State	$341.75
Rate for Payer: Wellpoint Medicaid Managed Care	$307.15

Know your out-of-pocket cost for care.

All Charges