Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WC SKIN SUB HD/FT/DG FIRST 25C

Facility

$1,370.55

Service Code	HCPCS 15275KX
Hospital Charge Code	9800510
Hospital Revenue Code	510
Min. Negotiated Rate	$205.58
Max. Negotiated Rate	$205.58
Rate for Payer: Qualcare PPO/HMO/WC	$205.58

WC SKIN SUB TR/AR/L ADD 100 CM

Facility

$1,257.40

Service Code	HCPCS 15274
Hospital Charge Code	9800205
Hospital Revenue Code	510
Min. Negotiated Rate	$188.61
Max. Negotiated Rate	$188.61
Rate for Payer: Qualcare PPO/HMO/WC	$188.61

WC SKIN SUB TR/AR/L ADD 100 CM

Facility

$1,257.40

Service Code	HCPCS 15274
Hospital Charge Code	9800205
Hospital Revenue Code	510
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$628.70
Rate for Payer: Aetna Commercial	$477.81
Rate for Payer: Aetna Medicare Advantage	$377.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$320.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$320.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$33.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$320.64
Rate for Payer: Cigna Commercial	$628.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.92
Rate for Payer: Qualcare PPO/HMO/WC	$188.61
Rate for Payer: UnitedHealthcare Community & State	$39.73
Rate for Payer: Wellpoint Medicaid Managed Care	$35.71

WC SKIN SUB TR/AR/L ADD 25CM

Facility

$467.35

Service Code	HCPCS 15272KX
Hospital Charge Code	9800505
Hospital Revenue Code	510
Min. Negotiated Rate	$13.27
Max. Negotiated Rate	$233.68
Rate for Payer: Aetna Commercial	$177.59
Rate for Payer: Aetna Medicare Advantage	$140.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.17
Rate for Payer: Cigna Commercial	$233.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.51
Rate for Payer: Qualcare PPO/HMO/WC	$70.10
Rate for Payer: UnitedHealthcare Community & State	$14.77
Rate for Payer: Wellpoint Medicaid Managed Care	$13.27

WC SKIN SUB TR/AR/L ADD 25CM

Facility

$467.35

Service Code	HCPCS 15272KX
Hospital Charge Code	9800505
Hospital Revenue Code	510
Min. Negotiated Rate	$70.10
Max. Negotiated Rate	$70.10
Rate for Payer: Qualcare PPO/HMO/WC	$70.10

WC SKIN SUB TR/AR/L FIRST 100C

Facility

$1,966.90

Service Code	HCPCS 15273
Hospital Charge Code	9800200
Hospital Revenue Code	510
Min. Negotiated Rate	$295.04
Max. Negotiated Rate	$295.04
Rate for Payer: Qualcare PPO/HMO/WC	$295.04

WC SKIN SUB TR/AR/L FIRST 100C

Facility

$1,966.90

Service Code	HCPCS 15273
Hospital Charge Code	9800200
Hospital Revenue Code	510
Min. Negotiated Rate	$55.86
Max. Negotiated Rate	$8,891.84
Rate for Payer: Aetna Commercial	$6,667.35
Rate for Payer: Aetna Medicare Advantage	$7,941.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,891.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$2,451.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$182.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,891.84
Rate for Payer: Cigna Commercial	$4,913.48
Rate for Payer: Cigna Medicare Advantage	$2,451.23
Rate for Payer: Clover Medicare Advantage	$2,328.67
Rate for Payer: EmblemHealth Commercial	$7,353.69
Rate for Payer: Humana Medicare Advantage	$2,524.77
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$2,451.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$511.39
Rate for Payer: Qualcare PPO/HMO/WC	$295.04
Rate for Payer: UnitedHealthcare Community & State	$62.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,451.23
Rate for Payer: Wellcare Medicare Advantage	$2,451.23
Rate for Payer: Wellpoint Medicaid Managed Care	$55.86

WC SKIN SUB TR/AR/L FIRST 25CM

Facility

$1,370.55

Service Code	HCPCS 15271KX
Hospital Charge Code	9800500
Hospital Revenue Code	510
Min. Negotiated Rate	$38.92
Max. Negotiated Rate	$685.27
Rate for Payer: Aetna Commercial	$520.81
Rate for Payer: Aetna Medicare Advantage	$411.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$349.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$349.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$349.49
Rate for Payer: Cigna Commercial	$685.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.34
Rate for Payer: Qualcare PPO/HMO/WC	$205.58
Rate for Payer: UnitedHealthcare Community & State	$43.31
Rate for Payer: Wellpoint Medicaid Managed Care	$38.92

WC SKIN SUB TR/AR/L FIRST 25CM

Facility

$1,370.55

Service Code	HCPCS 15271KX
Hospital Charge Code	9800500
Hospital Revenue Code	510
Min. Negotiated Rate	$205.58
Max. Negotiated Rate	$205.58
Rate for Payer: Qualcare PPO/HMO/WC	$205.58

WC SKN GRAFT TO FACE EA ADD 25

Facility

$417.00

Service Code	HCPCS 15276
Hospital Charge Code	9808040
Hospital Revenue Code	519
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

WC SKN GRAFT TO FACE EA ADD 25

Facility

$417.00

Service Code	HCPCS 15276
Hospital Charge Code	9808040
Hospital Revenue Code	519
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$208.50
Rate for Payer: Aetna Commercial	$158.46
Rate for Payer: Aetna Medicare Advantage	$125.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.33
Rate for Payer: Cigna Commercial	$208.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.42
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
Rate for Payer: UnitedHealthcare Community & State	$13.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.84

WC SKN GRAFT TO FACE INT 25 SQ

Facility

$1,133.00

Service Code	HCPCS 15275
Hospital Charge Code	9808035
Hospital Revenue Code	519
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$3,185.09
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,185.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.58
Rate for Payer: Qualcare PPO/HMO/WC	$169.95
Rate for Payer: UnitedHealthcare Community & State	$35.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$32.18

WC SKN GRAFT TO FACE INT 25 SQ

Facility

$1,133.00

Service Code	HCPCS 15275
Hospital Charge Code	9808035
Hospital Revenue Code	519
Min. Negotiated Rate	$169.95
Max. Negotiated Rate	$169.95
Rate for Payer: Qualcare PPO/HMO/WC	$169.95

WC SKN GRAFT TO TRNK EA ADD 25

Facility

$417.00

Service Code	HCPCS 15272
Hospital Charge Code	9808030
Hospital Revenue Code	519
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$208.50
Rate for Payer: Aetna Commercial	$158.46
Rate for Payer: Aetna Medicare Advantage	$125.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$106.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$106.33
Rate for Payer: Cigna Commercial	$208.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.42
Rate for Payer: Qualcare PPO/HMO/WC	$62.55
Rate for Payer: UnitedHealthcare Community & State	$13.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.84

WC SKN GRAFT TO TRNK EA ADD 25

Facility

$417.00

Service Code	HCPCS 15272
Hospital Charge Code	9808030
Hospital Revenue Code	519
Min. Negotiated Rate	$62.55
Max. Negotiated Rate	$62.55
Rate for Payer: Qualcare PPO/HMO/WC	$62.55

WC SKN GRAFT TO TRNK INT 25 SQ

Facility

$1,133.00

Service Code	HCPCS 15271
Hospital Charge Code	9808025
Hospital Revenue Code	519
Min. Negotiated Rate	$32.18
Max. Negotiated Rate	$3,185.09
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$89.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,185.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.58
Rate for Payer: Qualcare PPO/HMO/WC	$169.95
Rate for Payer: UnitedHealthcare Community & State	$35.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$32.18

WC SKN GRAFT TO TRNK INT 25 SQ

Facility

$1,133.00

Service Code	HCPCS 15271
Hospital Charge Code	9808025
Hospital Revenue Code	519
Min. Negotiated Rate	$169.95
Max. Negotiated Rate	$169.95
Rate for Payer: Qualcare PPO/HMO/WC	$169.95

WC SOF-FOAM DRESSING 3X3

Facility

$15.00

Hospital Charge Code	9808235
Hospital Revenue Code	272
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$2.25

WC SOF-FOAM DRESSING 3X3

Facility

$15.00

Hospital Charge Code	9808235
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 SPIRATION/INJ GANGLION CYST

Facility

$1,434.65

Service Code	HCPCS 20612
Hospital Charge Code	9800530
Hospital Revenue Code	510
Min. Negotiated Rate	$31.90
Max. Negotiated Rate	$1,322.84
Rate for Payer: Aetna Commercial	$991.90
Rate for Payer: Aetna Medicare Advantage	$1,181.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,322.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$364.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,322.84
Rate for Payer: Cigna Commercial	$730.97
Rate for Payer: Cigna Medicare Advantage	$364.67
Rate for Payer: Clover Medicare Advantage	$346.44
Rate for Payer: EmblemHealth Commercial	$1,094.01
Rate for Payer: Humana Medicare Advantage	$375.61
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$364.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$373.01
Rate for Payer: Qualcare PPO/HMO/WC	$215.20
Rate for Payer: UnitedHealthcare Community & State	$45.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$364.67
Rate for Payer: Wellcare Medicare Advantage	$364.67
Rate for Payer: Wellpoint Medicaid Managed Care	$40.74

WC SPIRATION/INJ GANGLION CYST

Facility

$1,434.65

Service Code	HCPCS 20612
Hospital Charge Code	9800530
Hospital Revenue Code	510
Min. Negotiated Rate	$215.20
Max. Negotiated Rate	$215.20
Rate for Payer: Qualcare PPO/HMO/WC	$215.20

WC STRAPPING FOOT

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808057
Hospital Revenue Code	361
Min. Negotiated Rate	$13.31
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	$121.88
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$70.31
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$14.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$193.05
Rate for Payer: Wellcare Medicare Advantage	$193.05
Rate for Payer: Wellpoint Medicaid Managed Care	$13.31

WC STRAPPING FOOT

Facility

$468.75

Service Code	HCPCS 29540
Hospital Charge Code	9808057
Hospital Revenue Code	361
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$70.31
Rate for Payer: Qualcare PPO/HMO/WC	$70.31

WC SURG PREP/HAND/FT/DIG<100CM

Facility

$1,257.40

Service Code	HCPCS 15004
Hospital Charge Code	9800190
Hospital Revenue Code	510
Min. Negotiated Rate	$35.71
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) 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	$326.92
Rate for Payer: Qualcare PPO/HMO/WC	$188.61
Rate for Payer: UnitedHealthcare Community & State	$39.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$35.71

WC SURG PREP/HAND/FT/DIG<100CM

Facility

$1,257.40

Service Code	HCPCS 15004
Hospital Charge Code	9800190
Hospital Revenue Code	510
Min. Negotiated Rate	$188.61
Max. Negotiated Rate	$188.61
Rate for Payer: Qualcare PPO/HMO/WC	$188.61

Know your out-of-pocket cost for care.

All Charges