Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC NPWT < 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97607
Hospital Charge Code	9808326
Hospital Revenue Code	510
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$244.80
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT < 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97607
Hospital Charge Code	9808326
Hospital Revenue Code	510
Min. Negotiated Rate	$27.03
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$27.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.32
Rate for Payer: Qualcare PPO/HMO/WC	$244.80
Rate for Payer: UnitedHealthcare Community & State	$51.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$46.35

WC NPWT > 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97608
Hospital Charge Code	9808327
Hospital Revenue Code	510
Min. Negotiated Rate	$32.22
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$32.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.32
Rate for Payer: Qualcare PPO/HMO/WC	$244.80
Rate for Payer: UnitedHealthcare Community & State	$51.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$46.35

WC NPWT > 50 SQ CM SNAP

Facility

$1,632.00

Service Code	HCPCS 97608
Hospital Charge Code	9808327
Hospital Revenue Code	510
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$244.80
Rate for Payer: Qualcare PPO/HMO/WC	$244.80

WC NPWT(VAC) < 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97605
Hospital Charge Code	9800410
Hospital Revenue Code	510
Min. Negotiated Rate	$46.31
Max. Negotiated Rate	$864.65
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	$240.90
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	$423.98
Rate for Payer: Qualcare PPO/HMO/WC	$244.60
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$46.31

WC NPWT(VAC) < 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97605
Hospital Charge Code	9800410
Hospital Revenue Code	510
Min. Negotiated Rate	$244.60
Max. Negotiated Rate	$244.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NPWT(VAC) > 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97606
Hospital Charge Code	9800411
Hospital Revenue Code	510
Min. Negotiated Rate	$46.31
Max. Negotiated Rate	$1,751.90
Rate for Payer: Aetna Commercial	$1,313.62
Rate for Payer: Aetna Medicare Advantage	$1,564.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,751.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$482.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,751.90
Rate for Payer: Cigna Commercial	$968.07
Rate for Payer: Cigna Medicare Advantage	$482.95
Rate for Payer: Clover Medicare Advantage	$458.80
Rate for Payer: EmblemHealth Commercial	$1,448.85
Rate for Payer: Humana Medicare Advantage	$497.44
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$482.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.98
Rate for Payer: Qualcare PPO/HMO/WC	$244.60
Rate for Payer: UnitedHealthcare Community & State	$51.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$46.31

WC NPWT(VAC) > 50 SQ CM

Facility

$1,630.70

Service Code	HCPCS 97606
Hospital Charge Code	9800411
Hospital Revenue Code	510
Min. Negotiated Rate	$244.60
Max. Negotiated Rate	$244.60
Rate for Payer: Qualcare PPO/HMO/WC	$244.60

WC NU GEL DRESSING 6X8

Facility

$15.00

Hospital Charge Code	9808230
Hospital Revenue Code	272
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$5.70
Rate for Payer: Aetna Medicare Advantage	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.83
Rate for Payer: Cigna Commercial	$7.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.90
Rate for Payer: Oxford Commercial	$3.00
Rate for Payer: Qualcare PPO/HMO/WC	$2.25
Rate for Payer: UnitedHealthcare Commercial	$3.00
Rate for Payer: UnitedHealthcare Community & State	$0.47
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

WC NU GEL DRESSING 6X8

Facility

$15.00

Hospital Charge Code	9808230
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

WC OASIS - PER SQ CM

Facility

$40.85

Service Code	HCPCS Q4102
Hospital Charge Code	9800260
Hospital Revenue Code	636
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

WC OASIS - PER SQ CM

Facility

$40.85

Service Code	HCPCS Q4102
Hospital Charge Code	9800260
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
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	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

WC OASIS - PER SQ CM JW

Facility

$40.85

Service Code	HCPCS Q4102JW
Hospital Charge Code	9800260W
Hospital Revenue Code	636
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

WC OASIS - PER SQ CM JW

Facility

$40.85

Service Code	HCPCS Q4102JW
Hospital Charge Code	9800260W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$20.43
Rate for Payer: Aetna Commercial	$15.52
Rate for Payer: Aetna Medicare Advantage	$12.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.42
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

WC OASIS - PER SQ CM- WASTE

Facility

$40.85

Hospital Charge Code	9800260WM
Hospital Revenue Code	636
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$20.43
Rate for Payer: Aetna Commercial	$15.52
Rate for Payer: Aetna Medicare Advantage	$12.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.42
Rate for Payer: Cigna Commercial	$20.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

WC OASIS - PER SQ CM- WASTE

Facility

$40.85

Hospital Charge Code	9800260WM
Hospital Revenue Code	636
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$9.89
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.89
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

WC OP VISIT

Facility

$549.50

Hospital Charge Code	9800540
Hospital Revenue Code	510
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$274.75
Rate for Payer: Aetna Commercial	$208.81
Rate for Payer: Aetna Medicare Advantage	$164.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.12
Rate for Payer: Cigna Commercial	$274.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.87
Rate for Payer: Qualcare PPO/HMO/WC	$82.42
Rate for Payer: UnitedHealthcare Community & State	$17.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.61

WC OP VISIT

Facility

$549.50

Hospital Charge Code	9800540
Hospital Revenue Code	510
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$82.42
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC OP VISIT W MOD

Facility

$549.50

Hospital Charge Code	9800545
Hospital Revenue Code	510
Min. Negotiated Rate	$82.42
Max. Negotiated Rate	$82.42
Rate for Payer: Qualcare PPO/HMO/WC	$82.42

WC OP VISIT W MOD

Facility

$549.50

Hospital Charge Code	9800545
Hospital Revenue Code	510
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$274.75
Rate for Payer: Aetna Commercial	$208.81
Rate for Payer: Aetna Medicare Advantage	$164.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.12
Rate for Payer: Cigna Commercial	$274.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$142.87
Rate for Payer: Qualcare PPO/HMO/WC	$82.42
Rate for Payer: UnitedHealthcare Community & State	$17.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.61

WC PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652617
Hospital Revenue Code	636
Min. Negotiated Rate	$26.10
Max. Negotiated Rate	$42.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10

WC PARAGARD IUD

Facility

$174.00

Service Code	HCPCS J7300
Hospital Charge Code	83652617
Hospital Revenue Code	636
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$87.00
Rate for Payer: Aetna Commercial	$66.12
Rate for Payer: Aetna Medicare Advantage	$52.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.37
Rate for Payer: Cigna Commercial	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.11
Rate for Payer: Qualcare PPO/HMO/WC	$26.10
Rate for Payer: UnitedHealthcare Community & State	$5.50
Rate for Payer: Wellpoint Medicaid Managed Care	$4.94

WC PARING 2-4 LESIONS

Facility

$752.00

Service Code	HCPCS 11056
Hospital Charge Code	9800105
Hospital Revenue Code	510
Min. Negotiated Rate	$21.36
Max. Negotiated Rate	$864.65
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	$35.00
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	$195.52
Rate for Payer: Qualcare PPO/HMO/WC	$112.80
Rate for Payer: UnitedHealthcare Community & State	$23.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$21.36

WC PARING 2-4 LESIONS

Facility

$752.00

Service Code	HCPCS 11056
Hospital Charge Code	9800105
Hospital Revenue Code	510
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$112.80
Rate for Payer: Qualcare PPO/HMO/WC	$112.80

WC PARING > 4 LESIONS

Facility

$1,291.00

Service Code	HCPCS 11057
Hospital Charge Code	9800110
Hospital Revenue Code	510
Min. Negotiated Rate	$36.66
Max. Negotiated Rate	$864.65
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	$43.28
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	$335.66
Rate for Payer: Qualcare PPO/HMO/WC	$193.65
Rate for Payer: UnitedHealthcare Community & State	$40.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$36.66

Know your out-of-pocket cost for care.

All Charges