Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC FETAL MONITORING INT.ONLY

Facility

$346.00

Service Code	HCPCS 59051
Hospital Charge Code	83652199
Hospital Revenue Code	761
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$220.00
Rate for Payer: Aetna Commercial	$131.48
Rate for Payer: Aetna Medicare Advantage	$103.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$88.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$88.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$220.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$88.23
Rate for Payer: Cigna Commercial	$173.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.96
Rate for Payer: Oxford Commercial	$69.20
Rate for Payer: Qualcare PPO/HMO/WC	$51.90
Rate for Payer: UnitedHealthcare Commercial	$69.20
Rate for Payer: UnitedHealthcare Community & State	$10.93
Rate for Payer: Wellpoint Medicaid Managed Care	$9.83

WC FETAL MONITORING INT.ONLY

Facility

$346.00

Service Code	HCPCS 59051
Hospital Charge Code	83652199
Hospital Revenue Code	761
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Qualcare PPO/HMO/WC	$51.90

WC FOAM DRESNG, 16 SQ IN OR<W

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808135
Hospital Revenue Code	272
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

WC FOAM DRESNG, 16 SQ IN OR<W

Facility

$33.00

Service Code	HCPCS A6212
Hospital Charge Code	9808135
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRSSING 16SQ IN < W AD

Facility

$16.00

Service Code	HCPCS A6212
Hospital Charge Code	9808140
Hospital Revenue Code	272
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna Commercial	$6.08
Rate for Payer: Aetna Medicare Advantage	$4.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.08
Rate for Payer: Cigna Commercial	$8.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.16
Rate for Payer: Oxford Commercial	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$2.40
Rate for Payer: UnitedHealthcare Commercial	$3.20
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.45

WC FOAM DRSSING 16SQ IN < W AD

Facility

$16.00

Service Code	HCPCS A6212
Hospital Charge Code	9808140
Hospital Revenue Code	272
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

WC FOAM DRSSNG 16 SQ IN OR < N

Facility

$33.00

Service Code	HCPCS A6222
Hospital Charge Code	9808105
Hospital Revenue Code	272
Min. Negotiated Rate	$4.95
Max. Negotiated Rate	$4.95
Rate for Payer: Qualcare PPO/HMO/WC	$4.95

WC FOAM DRSSNG 16 SQ IN OR < N

Facility

$33.00

Service Code	HCPCS A6222
Hospital Charge Code	9808105
Hospital Revenue Code	272
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$12.54
Rate for Payer: Aetna Medicare Advantage	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.41
Rate for Payer: Cigna Commercial	$16.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.58
Rate for Payer: Oxford Commercial	$6.60
Rate for Payer: Qualcare PPO/HMO/WC	$4.95
Rate for Payer: UnitedHealthcare Commercial	$6.60
Rate for Payer: UnitedHealthcare Community & State	$1.04
Rate for Payer: Wellpoint Medicaid Managed Care	$0.94

WC GLUCOSE,BLOOD/STRIP ACCU CH

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	83652279
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

WC GLUCOSE,BLOOD/STRIP ACCU CH

Facility

$390.00

Service Code	HCPCS 82948
Hospital Charge Code	83652279
Hospital Revenue Code	301
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$13.71
Rate for Payer: Aetna Medicare Advantage	$16.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.28
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.04
Rate for Payer: Clover Medicare Advantage	$4.79
Rate for Payer: EmblemHealth Commercial	$15.12
Rate for Payer: Humana Medicare Advantage	$5.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04
Rate for Payer: Wellcare Medicare Advantage	$5.04
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

WC GLUCOSE CAPIL FINGERSTIC+91

Facility

$401.55

Service Code	HCPCS 8294891
Hospital Charge Code	9800405
Hospital Revenue Code	301
Min. Negotiated Rate	$60.23
Max. Negotiated Rate	$60.23
Rate for Payer: Qualcare PPO/HMO/WC	$60.23

WC GLUCOSE CAPIL FINGERSTIC+91

Facility

$401.55

Service Code	HCPCS 8294891
Hospital Charge Code	9800405
Hospital Revenue Code	301
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$200.78
Rate for Payer: Aetna Commercial	$152.59
Rate for Payer: Aetna Medicare Advantage	$120.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.40
Rate for Payer: Cigna Commercial	$200.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.23
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.69
Rate for Payer: Wellpoint Medicaid Managed Care	$11.40

WC GRAFT JACKET - PER SQ CM

Facility

$504.90

Service Code	HCPCS Q4107
Hospital Charge Code	9800225
Hospital Revenue Code	636
Min. Negotiated Rate	$75.73
Max. Negotiated Rate	$122.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.19
Rate for Payer: Qualcare PPO/HMO/WC	$75.73

WC GRAFT JACKET - PER SQ CM

Facility

$504.90

Service Code	HCPCS Q4107
Hospital Charge Code	9800225
Hospital Revenue Code	636
Min. Negotiated Rate	$14.34
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	$122.19
Rate for Payer: Qualcare PPO/HMO/WC	$75.73
Rate for Payer: UnitedHealthcare Community & State	$15.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$14.34

WC GRAFT JACKET - PER SQ CM JW

Facility

$504.90

Service Code	HCPCS Q4107JW
Hospital Charge Code	9800225W
Hospital Revenue Code	636
Min. Negotiated Rate	$75.73
Max. Negotiated Rate	$122.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.19
Rate for Payer: Qualcare PPO/HMO/WC	$75.73

WC GRAFT JACKET - PER SQ CM JW

Facility

$504.90

Service Code	HCPCS Q4107JW
Hospital Charge Code	9800225W
Hospital Revenue Code	636
Min. Negotiated Rate	$14.34
Max. Negotiated Rate	$252.45
Rate for Payer: Aetna Commercial	$191.86
Rate for Payer: Aetna Medicare Advantage	$151.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$128.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$128.75
Rate for Payer: Cigna Commercial	$252.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$122.19
Rate for Payer: Qualcare PPO/HMO/WC	$75.73
Rate for Payer: UnitedHealthcare Community & State	$15.95
Rate for Payer: Wellpoint Medicaid Managed Care	$14.34

WC HEMOSTATIC AGENT-SPON-TRAUM

Facility

$314.00

Service Code	HCPCS 57180
Hospital Charge Code	83652133
Hospital Revenue Code	361
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

WC HEMOSTATIC AGENT-SPON-TRAUM

Facility

$314.00

Service Code	HCPCS 57180
Hospital Charge Code	83652133
Hospital Revenue Code	361
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$653.29
Rate for Payer: Aetna Medicare Advantage	$778.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$871.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$240.18
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	$871.25
Rate for Payer: Cigna Commercial	$481.45
Rate for Payer: Cigna Medicare Advantage	$240.18
Rate for Payer: Clover Medicare Advantage	$228.17
Rate for Payer: EmblemHealth Commercial	$720.54
Rate for Payer: Humana Medicare Advantage	$247.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$240.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.64
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$9.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.18
Rate for Payer: Wellcare Medicare Advantage	$240.18
Rate for Payer: Wellpoint Medicaid Managed Care	$8.92

WC HORIZON NJ VAGINAL DELIVERY

Professional

Both

$2,395.00

Service Code	HCPCS 59409
Hospital Charge Code	83652217
Hospital Revenue Code	960
Min. Negotiated Rate	$753.34
Max. Negotiated Rate	$2,414.25
Rate for Payer: Aetna Commercial	$978.54
Rate for Payer: Aetna Medicare Advantage	$978.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,414.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,414.25
Rate for Payer: Cigna Commercial	$1,767.33
Rate for Payer: Cigna Medicare Advantage	$1,767.33
Rate for Payer: Fidelis All Plans	$753.34
Rate for Payer: Marpai Administrators LLC Commercial	$791.82
Rate for Payer: Tricare Tricare	$1,069.04
Rate for Payer: UnitedHealthcare Commercial	$1,299.54
Rate for Payer: UnitedHealthcare Community & State	$1,299.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,299.54
Rate for Payer: Wellpoint Medicaid Managed Care	$828.79

WC HYDROCOLLOID WND DRS REPLI

Facility

$80.00

Hospital Charge Code	9808215
Hospital Revenue Code	272
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$12.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00

WC HYDROCOLLOID WND DRS REPLI

Facility

$80.00

Hospital Charge Code	9808215
Hospital Revenue Code	272
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$40.00
Rate for Payer: Aetna Commercial	$30.40
Rate for Payer: Aetna Medicare Advantage	$24.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.40
Rate for Payer: Cigna Commercial	$40.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.80
Rate for Payer: Oxford Commercial	$16.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.00
Rate for Payer: UnitedHealthcare Commercial	$16.00
Rate for Payer: UnitedHealthcare Community & State	$2.53
Rate for Payer: Wellpoint Medicaid Managed Care	$2.27

WC HYDROPOL DRESS 7 X 7

Facility

$106.00

Hospital Charge Code	9808255
Hospital Revenue Code	272
Min. Negotiated Rate	$3.01
Max. Negotiated Rate	$53.00
Rate for Payer: Aetna Commercial	$40.28
Rate for Payer: Aetna Medicare Advantage	$31.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$27.03
Rate for Payer: Cigna Commercial	$53.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.56
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$15.90
Rate for Payer: UnitedHealthcare Commercial	$21.20
Rate for Payer: UnitedHealthcare Community & State	$3.35
Rate for Payer: Wellpoint Medicaid Managed Care	$3.01

WC HYDROPOL DRESS 7 X 7

Facility

$106.00

Hospital Charge Code	9808255
Hospital Revenue Code	272
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$15.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.90

WC HYPERBARIC O2 TX PER 30MINS

Facility

$3,900.00

Service Code	HCPCS G0277
Hospital Charge Code	9800000
Hospital Revenue Code	413
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$585.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00

WC HYPERBARIC O2 TX PER 30MINS

Facility

$3,900.00

Service Code	HCPCS G0277
Hospital Charge Code	9800000
Hospital Revenue Code	413
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$3,553.00
Rate for Payer: Aetna Commercial	$444.67
Rate for Payer: Aetna Medicare Advantage	$529.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$593.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$593.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$163.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$593.02
Rate for Payer: Cigna Commercial	$327.70
Rate for Payer: Cigna Medicare Advantage	$163.48
Rate for Payer: Clover Medicare Advantage	$155.31
Rate for Payer: EmblemHealth Commercial	$490.44
Rate for Payer: Humana Medicare Advantage	$168.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$163.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,014.00
Rate for Payer: Oxford Commercial	$3,131.00
Rate for Payer: Qualcare PPO/HMO/WC	$585.00
Rate for Payer: UnitedHealthcare Commercial	$3,553.00
Rate for Payer: UnitedHealthcare Community & State	$123.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.48
Rate for Payer: Wellcare Medicare Advantage	$163.48
Rate for Payer: Wellpoint Medicaid Managed Care	$110.76

Know your out-of-pocket cost for care.

All Charges