Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC ALLEVYN DRSNG >48SQ IN W/O

Facility

$24.00

Service Code	HCPCS A6211
Hospital Charge Code	9808130
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

WC ALLEVYN HEEL DRESSING

Facility

$37.00

Service Code	HCPCS A6210
Hospital Charge Code	9808125
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$18.50
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna Medicare Advantage	$11.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.44
Rate for Payer: Cigna Commercial	$18.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.62
Rate for Payer: Oxford Commercial	$7.40
Rate for Payer: Qualcare PPO/HMO/WC	$5.55
Rate for Payer: UnitedHealthcare Commercial	$7.40
Rate for Payer: UnitedHealthcare Community & State	$1.17
Rate for Payer: Wellpoint Medicaid Managed Care	$1.05

WC ALLEVYN HEEL DRESSING

Facility

$37.00

Service Code	HCPCS A6210
Hospital Charge Code	9808125
Hospital Revenue Code	272
Min. Negotiated Rate	$5.55
Max. Negotiated Rate	$5.55
Rate for Payer: Qualcare PPO/HMO/WC	$5.55

WC ALLEVYN ISLAND 4X4

Facility

$24.00

Service Code	HCPCS A6209
Hospital Charge Code	9808110
Hospital Revenue Code	272
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Qualcare PPO/HMO/WC	$3.60

WC ALLEVYN ISLAND 4X4

Facility

$24.00

Service Code	HCPCS A6209
Hospital Charge Code	9808110
Hospital Revenue Code	272
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$9.12
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.12
Rate for Payer: Cigna Commercial	$12.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.24
Rate for Payer: Oxford Commercial	$4.80
Rate for Payer: Qualcare PPO/HMO/WC	$3.60
Rate for Payer: UnitedHealthcare Commercial	$4.80
Rate for Payer: UnitedHealthcare Community & State	$0.76
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

WC ALLEYN AG NON ADHESIVE 4 X

Facility

$27.00

Service Code	HCPCS A6209
Hospital Charge Code	9808115
Hospital Revenue Code	272
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$4.05
Rate for Payer: Qualcare PPO/HMO/WC	$4.05

WC ALLEYN AG NON ADHESIVE 4 X

Facility

$27.00

Service Code	HCPCS A6209
Hospital Charge Code	9808115
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$10.26
Rate for Payer: Aetna Medicare Advantage	$8.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.88
Rate for Payer: Cigna Commercial	$13.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.02
Rate for Payer: Oxford Commercial	$5.40
Rate for Payer: Qualcare PPO/HMO/WC	$4.05
Rate for Payer: UnitedHealthcare Commercial	$5.40
Rate for Payer: UnitedHealthcare Community & State	$0.85
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

WC ALLOGRAFT FACE/FEET INI 100

Facility

$1,898.15

Hospital Charge Code	9800425
Hospital Revenue Code	510
Min. Negotiated Rate	$53.91
Max. Negotiated Rate	$949.08
Rate for Payer: Aetna Commercial	$721.30
Rate for Payer: Aetna Medicare Advantage	$569.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.03
Rate for Payer: Cigna Commercial	$949.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.52
Rate for Payer: Qualcare PPO/HMO/WC	$284.72
Rate for Payer: UnitedHealthcare Community & State	$59.98
Rate for Payer: Wellpoint Medicaid Managed Care	$53.91

WC ALLOGRAFT FACE/FEET INI 100

Facility

$1,898.15

Hospital Charge Code	9800425
Hospital Revenue Code	510
Min. Negotiated Rate	$284.72
Max. Negotiated Rate	$284.72
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC ALLOGRAFT TR/AR/L INI 100CM

Facility

$1,898.15

Hospital Charge Code	9800420
Hospital Revenue Code	510
Min. Negotiated Rate	$284.72
Max. Negotiated Rate	$284.72
Rate for Payer: Qualcare PPO/HMO/WC	$284.72

WC ALLOGRAFT TR/AR/L INI 100CM

Facility

$1,898.15

Hospital Charge Code	9800420
Hospital Revenue Code	510
Min. Negotiated Rate	$53.91
Max. Negotiated Rate	$949.08
Rate for Payer: Aetna Commercial	$721.30
Rate for Payer: Aetna Medicare Advantage	$569.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$484.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$484.03
Rate for Payer: Cigna Commercial	$949.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$493.52
Rate for Payer: Qualcare PPO/HMO/WC	$284.72
Rate for Payer: UnitedHealthcare Community & State	$59.98
Rate for Payer: Wellpoint Medicaid Managed Care	$53.91

WC AMP TOE/METATARSOPHALANGEAL

Facility

$8,632.45

Service Code	HCPCS 28820
Hospital Charge Code	9800145
Hospital Revenue Code	510
Min. Negotiated Rate	$97.02
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,244.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.87
Rate for Payer: UnitedHealthcare Community & State	$272.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$245.16

WC AMP TOE/METATARSOPHALANGEAL

Facility

$8,632.45

Service Code	HCPCS 28820
Hospital Charge Code	9800145
Hospital Revenue Code	510
Min. Negotiated Rate	$1,294.87
Max. Negotiated Rate	$1,294.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.87

WC AMPUTATION OF TOE - PARTIAL

Facility

$8,632.45

Service Code	HCPCS 28825
Hospital Charge Code	9800150
Hospital Revenue Code	510
Min. Negotiated Rate	$1,294.87
Max. Negotiated Rate	$1,294.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.87

WC AMPUTATION OF TOE - PARTIAL

Facility

$8,632.45

Service Code	HCPCS 28825
Hospital Charge Code	9800150
Hospital Revenue Code	510
Min. Negotiated Rate	$97.02
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$97.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,244.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.87
Rate for Payer: UnitedHealthcare Community & State	$272.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$245.16

WC AMPUTATION SGL TOE/METATSAL

Facility

$8,632.45

Service Code	HCPCS 28810
Hospital Charge Code	9800140
Hospital Revenue Code	510
Min. Negotiated Rate	$209.92
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,244.44
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.87
Rate for Payer: UnitedHealthcare Community & State	$272.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$245.16

WC AMPUTATION SGL TOE/METATSAL

Facility

$8,632.45

Service Code	HCPCS 28810
Hospital Charge Code	9800140
Hospital Revenue Code	510
Min. Negotiated Rate	$1,294.87
Max. Negotiated Rate	$1,294.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,294.87

WC ANKLE STRAPPING

Facility

$458.00

Service Code	HCPCS 29540
Hospital Charge Code	9808055
Hospital Revenue Code	361
Min. Negotiated Rate	$13.01
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$525.10
Rate for Payer: Aetna Medicare Advantage	$625.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$700.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$193.05
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	$700.29
Rate for Payer: Cigna Commercial	$386.97
Rate for Payer: Cigna Medicare Advantage	$193.05
Rate for Payer: Clover Medicare Advantage	$183.40
Rate for Payer: EmblemHealth Commercial	$579.15
Rate for Payer: Humana Medicare Advantage	$198.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$193.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$119.08
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.70
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$14.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.01

WC ANKLE STRAPPING

Facility

$458.00

Service Code	HCPCS 29540
Hospital Charge Code	9808055
Hospital Revenue Code	361
Min. Negotiated Rate	$68.70
Max. Negotiated Rate	$68.70
Rate for Payer: Qualcare PPO/HMO/WC	$68.70

WC ANTEPARTUM 4-6 VIS

Facility

$270.00

Service Code	HCPCS 59425
Hospital Charge Code	83652225
Hospital Revenue Code	514
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

WC ANTEPARTUM 4-6 VIS

Facility

$270.00

Service Code	HCPCS 59425
Hospital Charge Code	83652225
Hospital Revenue Code	514
Min. Negotiated Rate	$7.67
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare Advantage	$81.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$74.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.67

WC APLIGRAF - PER SQ CM

Facility

$205.10

Service Code	HCPCS Q4101
Hospital Charge Code	9800245
Hospital Revenue Code	636
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$49.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.63
Rate for Payer: Qualcare PPO/HMO/WC	$30.77

WC APLIGRAF - PER SQ CM

Facility

$205.10

Service Code	HCPCS Q4101
Hospital Charge Code	9800245
Hospital Revenue Code	636
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$536.29
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	$156.71
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	$49.63
Rate for Payer: Qualcare PPO/HMO/WC	$30.77
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

WC APLIGRAF - PER SQ CM JW

Facility

$205.10

Service Code	HCPCS Q4101JW
Hospital Charge Code	9800245W
Hospital Revenue Code	636
Min. Negotiated Rate	$30.77
Max. Negotiated Rate	$49.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.63
Rate for Payer: Qualcare PPO/HMO/WC	$30.77

WC APLIGRAF - PER SQ CM JW

Facility

$205.10

Service Code	HCPCS Q4101JW
Hospital Charge Code	9800245W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$102.55
Rate for Payer: Aetna Commercial	$77.94
Rate for Payer: Aetna Medicare Advantage	$61.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.30
Rate for Payer: Cigna Commercial	$102.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.63
Rate for Payer: Qualcare PPO/HMO/WC	$30.77
Rate for Payer: UnitedHealthcare Community & State	$6.48
Rate for Payer: Wellpoint Medicaid Managed Care	$5.82

Know your out-of-pocket cost for care.

All Charges