Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC DEBRIDE NAILS 1-5

Facility

$1,421.00

Service Code	HCPCS 11720
Hospital Charge Code	9800045
Hospital Revenue Code	510
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$369.46
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$369.46
Rate for Payer: Qualcare PPO/HMO/WC	$213.15
Rate for Payer: UnitedHealthcare Community & State	$44.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$40.36

WC DEBRIDE NAILS 1-5

Facility

$1,421.00

Service Code	HCPCS 11720
Hospital Charge Code	9800045
Hospital Revenue Code	510
Min. Negotiated Rate	$213.15
Max. Negotiated Rate	$213.15
Rate for Payer: Qualcare PPO/HMO/WC	$213.15

WC DEBRIDE NAILS >5

Facility

$1,550.00

Service Code	HCPCS 11721
Hospital Charge Code	9800050
Hospital Revenue Code	510
Min. Negotiated Rate	$232.50
Max. Negotiated Rate	$232.50
Rate for Payer: Qualcare PPO/HMO/WC	$232.50

WC DEBRIDE NAILS >5

Facility

$1,550.00

Service Code	HCPCS 11721
Hospital Charge Code	9800050
Hospital Revenue Code	510
Min. Negotiated Rate	$26.06
Max. Negotiated Rate	$403.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$26.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$403.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.50
Rate for Payer: UnitedHealthcare Community & State	$48.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$197.37
Rate for Payer: Wellpoint Medicaid Managed Care	$44.02

WC DEBRID GREATER THAN 20SQCM

Facility

$612.00

Service Code	HCPCS 97598
Hospital Charge Code	9800081
Hospital Revenue Code	510
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Qualcare PPO/HMO/WC	$91.80

WC DEBRID GREATER THAN 20SQCM

Facility

$612.00

Service Code	HCPCS 97598
Hospital Charge Code	9800081
Hospital Revenue Code	510
Min. Negotiated Rate	$17.38
Max. Negotiated Rate	$440.00
Rate for Payer: Aetna Commercial	$232.56
Rate for Payer: Aetna Medicare Advantage	$183.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$156.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$156.06
Rate for Payer: Cigna Commercial	$306.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.12
Rate for Payer: Qualcare PPO/HMO/WC	$91.80
Rate for Payer: UnitedHealthcare Community & State	$19.34
Rate for Payer: Wellpoint Medicaid Managed Care	$17.38

WC DEBRID MUSCLE ADD 20 SQCM

Facility

$1,142.60

Service Code	HCPCS 11046
Hospital Charge Code	9800097
Hospital Revenue Code	510
Min. Negotiated Rate	$32.45
Max. Negotiated Rate	$571.30
Rate for Payer: Aetna Commercial	$434.19
Rate for Payer: Aetna Medicare Advantage	$342.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.36
Rate for Payer: Cigna Commercial	$571.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.08
Rate for Payer: Qualcare PPO/HMO/WC	$171.39
Rate for Payer: UnitedHealthcare Community & State	$36.11
Rate for Payer: Wellpoint Medicaid Managed Care	$32.45

WC DEBRID MUSCLE ADD 20 SQCM

Facility

$1,142.60

Service Code	HCPCS 11046
Hospital Charge Code	9800097
Hospital Revenue Code	510
Min. Negotiated Rate	$171.39
Max. Negotiated Rate	$171.39
Rate for Payer: Qualcare PPO/HMO/WC	$171.39

WC DEBRID SQ ADD 20 SQCM

Facility

$1,142.60

Service Code	HCPCS 11045
Hospital Charge Code	9800096
Hospital Revenue Code	510
Min. Negotiated Rate	$171.39
Max. Negotiated Rate	$171.39
Rate for Payer: Qualcare PPO/HMO/WC	$171.39

WC DEBRID SQ ADD 20 SQCM

Facility

$1,142.60

Service Code	HCPCS 11045
Hospital Charge Code	9800096
Hospital Revenue Code	510
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$571.30
Rate for Payer: Aetna Commercial	$434.19
Rate for Payer: Aetna Medicare Advantage	$342.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.36
Rate for Payer: Cigna Commercial	$571.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.08
Rate for Payer: Qualcare PPO/HMO/WC	$171.39
Rate for Payer: UnitedHealthcare Community & State	$36.11
Rate for Payer: Wellpoint Medicaid Managed Care	$32.45

WC DEPO MEDROL 40MG VIAL

Facility

$45.00

Hospital Charge Code	9808165
Hospital Revenue Code	636
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$10.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

WC DEPO MEDROL 40MG VIAL

Facility

$45.00

Hospital Charge Code	9808165
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

WC DERMAGRAFT - PER SQ CM

Facility

$224.40

Service Code	HCPCS Q4106
Hospital Charge Code	9800275
Hospital Revenue Code	636
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$54.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.66

WC DERMAGRAFT - PER SQ CM

Facility

$224.40

Service Code	HCPCS Q4106
Hospital Charge Code	9800275
Hospital Revenue Code	636
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$112.20
Rate for Payer: Aetna Commercial	$85.27
Rate for Payer: Aetna Medicare Advantage	$67.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.22
Rate for Payer: Cigna Commercial	$112.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.66
Rate for Payer: UnitedHealthcare Community & State	$7.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.37

WC DERMAGRAFT - PER SQ CM JW

Facility

$224.40

Service Code	HCPCS Q4106JW
Hospital Charge Code	9800275W
Hospital Revenue Code	636
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$54.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.66

WC DERMAGRAFT - PER SQ CM JW

Facility

$224.40

Service Code	HCPCS Q4106JW
Hospital Charge Code	9800275W
Hospital Revenue Code	636
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$112.20
Rate for Payer: Aetna Commercial	$85.27
Rate for Payer: Aetna Medicare Advantage	$67.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.22
Rate for Payer: Cigna Commercial	$112.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.66
Rate for Payer: UnitedHealthcare Community & State	$7.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.37

WC DERMAGRAFT PER SQ CM -WASTE

Facility

$224.40

Hospital Charge Code	9800275WM
Hospital Revenue Code	636
Min. Negotiated Rate	$33.66
Max. Negotiated Rate	$54.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.66

WC DERMAGRAFT PER SQ CM -WASTE

Facility

$224.40

Hospital Charge Code	9800275WM
Hospital Revenue Code	636
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$112.20
Rate for Payer: Aetna Commercial	$85.27
Rate for Payer: Aetna Medicare Advantage	$67.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.22
Rate for Payer: Cigna Commercial	$112.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.30
Rate for Payer: Qualcare PPO/HMO/WC	$33.66
Rate for Payer: UnitedHealthcare Community & State	$7.09
Rate for Payer: Wellpoint Medicaid Managed Care	$6.37

WC DERMAL/EPID SUBS/TISS PR SQ

Facility

$200.00

Hospital Charge Code	9808170
Hospital Revenue Code	636
Min. Negotiated Rate	$5.68
Max. Negotiated Rate	$100.00
Rate for Payer: Aetna Commercial	$76.00
Rate for Payer: Aetna Medicare Advantage	$60.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$51.00
Rate for Payer: Cigna Commercial	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00
Rate for Payer: UnitedHealthcare Community & State	$6.32
Rate for Payer: Wellpoint Medicaid Managed Care	$5.68

WC DERMAL/EPID SUBS/TISS PR SQ

Facility

$200.00

Hospital Charge Code	9808170
Hospital Revenue Code	636
Min. Negotiated Rate	$30.00
Max. Negotiated Rate	$48.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$48.40
Rate for Payer: Qualcare PPO/HMO/WC	$30.00

WC DEST BENIGN LESIONS >15

Facility

$367.00

Service Code	HCPCS 17111
Hospital Charge Code	9808050
Hospital Revenue Code	361
Min. Negotiated Rate	$10.42
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.42
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.05
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$11.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.42

WC DEST BENIGN LESIONS >15

Facility

$367.00

Service Code	HCPCS 17111
Hospital Charge Code	9808050
Hospital Revenue Code	361
Min. Negotiated Rate	$55.05
Max. Negotiated Rate	$55.05
Rate for Payer: Qualcare PPO/HMO/WC	$55.05

WC DEST BENIGN LESIONS-UP TO 1

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	9808045
Hospital Revenue Code	361
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
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	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$96.72
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$55.80
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$11.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$10.56

WC DEST BENIGN LESIONS-UP TO 1

Facility

$372.00

Service Code	HCPCS 17110
Hospital Charge Code	9808045
Hospital Revenue Code	361
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$55.80
Rate for Payer: Qualcare PPO/HMO/WC	$55.80

WC DESTRUCTION VULVA LESIONS

Facility

$651.00

Service Code	HCPCS 57061
Hospital Charge Code	83652129
Hospital Revenue Code	361
Min. Negotiated Rate	$97.65
Max. Negotiated Rate	$97.65
Rate for Payer: Qualcare PPO/HMO/WC	$97.65

Know your out-of-pocket cost for care.

All Charges