Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

WOUND DRESSING PEGASUS 4 X 4CM

Facility

$2,593.00

Hospital Charge Code	270332662
Hospital Revenue Code	272
Min. Negotiated Rate	$388.95
Max. Negotiated Rate	$388.95
Rate for Payer: Qualcare PPO/HMO/WC	$388.95

WOUND DRESSN PEGASUS 2 X 12CM

Facility

$1,381.00

Hospital Charge Code	270332661
Hospital Revenue Code	272
Min. Negotiated Rate	$207.15
Max. Negotiated Rate	$207.15
Rate for Payer: Qualcare PPO/HMO/WC	$207.15

WOUND DRESSN PEGASUS 2 X 12CM

Facility

$1,381.00

Hospital Charge Code	270332661
Hospital Revenue Code	272
Min. Negotiated Rate	$39.22
Max. Negotiated Rate	$690.50
Rate for Payer: Aetna Commercial	$524.78
Rate for Payer: Aetna Medicare Advantage	$414.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$352.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$352.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$352.15
Rate for Payer: Cigna Commercial	$690.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.06
Rate for Payer: Oxford Commercial	$276.20
Rate for Payer: Qualcare PPO/HMO/WC	$207.15
Rate for Payer: UnitedHealthcare Commercial	$276.20
Rate for Payer: UnitedHealthcare Community & State	$43.64
Rate for Payer: Wellpoint Medicaid Managed Care	$39.22

WOUND MATRIX 10x15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270673217
Hospital Revenue Code	278
Min. Negotiated Rate	$1,586.25
Max. Negotiated Rate	$2,559.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,559.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25

WOUND MATRIX 10x15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270673217
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,559.15
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	$2,115.00
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	$2,559.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25
Rate for Payer: UnitedHealthcare Community & State	$334.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$300.33

WOUND MATRIX 10x15CM/SQCM JW

Facility

$70.50

Hospital Charge Code	270673217W
Hospital Revenue Code	636
Min. Negotiated Rate	$10.57
Max. Negotiated Rate	$17.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$10.57

WOUND MATRIX 10x15CM/SQCM JW

Facility

$70.50

Hospital Charge Code	270673217W
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Commercial	$26.79
Rate for Payer: Aetna Medicare Advantage	$21.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.98
Rate for Payer: Cigna Commercial	$35.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$10.57
Rate for Payer: UnitedHealthcare Community & State	$2.23
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

WOUND MATRIX CYTAL 16X35CM

Facility

$40,375.00

Service Code	HCPCS Q4166
Hospital Charge Code	270700145
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$9,770.75
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	$8,075.00
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	$9,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,056.25
Rate for Payer: UnitedHealthcare Community & State	$1,275.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,146.65

WOUND MATRIX CYTAL 16X35CM

Facility

$40,375.00

Service Code	HCPCS Q4166
Hospital Charge Code	270700145
Hospital Revenue Code	278
Min. Negotiated Rate	$6,056.25
Max. Negotiated Rate	$9,770.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,770.75
Rate for Payer: Qualcare PPO/HMO/WC	$6,056.25

WOUND MATRIX CYTAL 6L 10X15CM

Facility

$24,440.00

Service Code	HCPCS Q4166
Hospital Charge Code	270695955
Hospital Revenue Code	278
Min. Negotiated Rate	$3,666.00
Max. Negotiated Rate	$5,914.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,888.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,914.48
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.00

WOUND MATRIX CYTAL 6L 10X15CM

Facility

$24,440.00

Service Code	HCPCS Q4166
Hospital Charge Code	270695955
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$5,914.48
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	$4,888.00
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	$5,914.48
Rate for Payer: Qualcare PPO/HMO/WC	$3,666.00
Rate for Payer: UnitedHealthcare Community & State	$772.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$694.10

WOUND MATRIX MATRISTEM 7x10CM

Facility

$5,875.00

Service Code	HCPCS Q4166
Hospital Charge Code	270667326
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,421.75
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	$1,175.00
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	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25
Rate for Payer: UnitedHealthcare Community & State	$185.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$166.85

WOUND MATRIX MATRISTEM 7x10CM

Facility

$5,875.00

Service Code	HCPCS Q4166
Hospital Charge Code	270667326
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

WOUND PREP ADDL 100 CM

Facility

$1,595.33

Service Code	HCPCS 15003
Hospital Charge Code	16000597
Hospital Revenue Code	360
Min. Negotiated Rate	$239.30
Max. Negotiated Rate	$239.30
Rate for Payer: Qualcare PPO/HMO/WC	$239.30

WOUND PREP ADDL 100 CM

Facility

$1,595.33

Service Code	HCPCS 15003
Hospital Charge Code	16000597
Hospital Revenue Code	360
Min. Negotiated Rate	$50.41
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$606.23
Rate for Payer: Aetna Medicare Advantage	$478.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$406.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$406.81
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	$406.81
Rate for Payer: Cigna Commercial	$797.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$414.79
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$239.30
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$50.41

WOUND PREP F/N/HF/G 100 SQ CM/

Facility

$2,532.16

Service Code	HCPCS 15004
Hospital Charge Code	1600000567
Hospital Revenue Code	360
Min. Negotiated Rate	$71.91
Max. Negotiated Rate	$3,536.00
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	$3,536.00
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	$658.36
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$379.82
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$80.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$71.91

WOUND PREP F/N/HF/G 100 SQ CM/

Facility

$2,532.16

Service Code	HCPCS 15004
Hospital Charge Code	1600000567
Hospital Revenue Code	360
Min. Negotiated Rate	$379.82
Max. Negotiated Rate	$379.82
Rate for Payer: Qualcare PPO/HMO/WC	$379.82

WOUND PREP HAND/FT/DIG,100CM

Facility

$2,674.75

Service Code	HCPCS 15004
Hospital Charge Code	323015004
Hospital Revenue Code	450
Min. Negotiated Rate	$75.96
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	$695.43
Rate for Payer: Qualcare PPO/HMO/WC	$401.21
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.95
Rate for Payer: Wellcare Medicare Advantage	$482.95
Rate for Payer: Wellpoint Medicaid Managed Care	$75.96

WOUND PREP HAND/FT/DIG,100CM

Facility

$2,674.75

Service Code	HCPCS 15004
Hospital Charge Code	323015004
Hospital Revenue Code	450
Min. Negotiated Rate	$401.21
Max. Negotiated Rate	$401.21
Rate for Payer: Qualcare PPO/HMO/WC	$401.21

WOUND PROTECTOR

Facility

$350.00

Hospital Charge Code	270686469
Hospital Revenue Code	272
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

WOUND PROTECTOR

Facility

$350.00

Hospital Charge Code	270686469
Hospital Revenue Code	272
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Oxford Commercial	$70.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Commercial	$70.00
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

WOUND PROTECTOR RETRACTOR SM

Facility

$270.00

Hospital Charge Code	270670166
Hospital Revenue Code	272
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$40.50
Rate for Payer: Qualcare PPO/HMO/WC	$40.50

WOUND PROTECTOR RETRACTOR SM

Facility

$270.00

Hospital Charge Code	270670166
Hospital Revenue Code	272
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) PPO	$68.85
Rate for Payer: Cigna Commercial	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.20
Rate for Payer: Oxford Commercial	$54.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.50
Rate for Payer: UnitedHealthcare Commercial	$54.00
Rate for Payer: UnitedHealthcare Community & State	$8.53
Rate for Payer: Wellpoint Medicaid Managed Care	$7.67

WOUNDVAC CANISTER W/GEL 500ML

Facility

$163.68

Hospital Charge Code	270100015
Hospital Revenue Code	272
Min. Negotiated Rate	$4.65
Max. Negotiated Rate	$81.84
Rate for Payer: Aetna Commercial	$62.20
Rate for Payer: Aetna Medicare Advantage	$49.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.74
Rate for Payer: Cigna Commercial	$81.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.56
Rate for Payer: Oxford Commercial	$32.74
Rate for Payer: Qualcare PPO/HMO/WC	$24.55
Rate for Payer: UnitedHealthcare Commercial	$32.74
Rate for Payer: UnitedHealthcare Community & State	$5.17
Rate for Payer: Wellpoint Medicaid Managed Care	$4.65

WOUNDVAC CANISTER W/GEL 500ML

Facility

$163.68

Hospital Charge Code	270100015
Hospital Revenue Code	272
Min. Negotiated Rate	$24.55
Max. Negotiated Rate	$24.55
Rate for Payer: Qualcare PPO/HMO/WC	$24.55

Know your out-of-pocket cost for care.

All Charges