Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CAP MOD EPIPHYSIS SZ 1 R, HA

Facility

$25,200.00

Service Code	HCPCS C1776
Hospital Charge Code	270686437
Hospital Revenue Code	278
Min. Negotiated Rate	$715.68
Max. Negotiated Rate	$12,600.00
Rate for Payer: Aetna Commercial	$9,576.00
Rate for Payer: Aetna Medicare Advantage	$7,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,426.00
Rate for Payer: Cigna Commercial	$12,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,098.40
Rate for Payer: Qualcare PPO/HMO/WC	$3,780.00
Rate for Payer: UnitedHealthcare Community & State	$796.32
Rate for Payer: Wellpoint Medicaid Managed Care	$715.68

CAPNOLINE H 02 ADULT

Facility

$80.47

Hospital Charge Code	270668153
Hospital Revenue Code	272
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$12.07
Rate for Payer: Qualcare PPO/HMO/WC	$12.07

CAPNOLINE H 02 ADULT

Facility

$80.47

Hospital Charge Code	270668153
Hospital Revenue Code	272
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$40.23
Rate for Payer: Aetna Commercial	$30.58
Rate for Payer: Aetna Medicare Advantage	$24.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$20.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$20.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$20.52
Rate for Payer: Cigna Commercial	$40.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.92
Rate for Payer: Oxford Commercial	$16.09
Rate for Payer: Qualcare PPO/HMO/WC	$12.07
Rate for Payer: UnitedHealthcare Commercial	$16.09
Rate for Payer: UnitedHealthcare Community & State	$2.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2.29

CAP ONE SEAL REDUCR 229901SEAL

Facility

$16.40

Hospital Charge Code	270608811
Hospital Revenue Code	272
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.20
Rate for Payer: Aetna Commercial	$6.23
Rate for Payer: Aetna Medicare Advantage	$4.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.18
Rate for Payer: Cigna Commercial	$8.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.26
Rate for Payer: Oxford Commercial	$3.28
Rate for Payer: Qualcare PPO/HMO/WC	$2.46
Rate for Payer: UnitedHealthcare Commercial	$3.28
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.47

CAP ONE SEAL REDUCR 229901SEAL

Facility

$16.40

Hospital Charge Code	270608811
Hospital Revenue Code	272
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$2.46
Rate for Payer: Qualcare PPO/HMO/WC	$2.46

CAP PROTECTIVE F/4.0MM CARBON

Facility

$13.83

Hospital Charge Code	270633008
Hospital Revenue Code	278
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.92
Rate for Payer: Aetna Commercial	$5.26
Rate for Payer: Aetna Medicare Advantage	$4.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.53
Rate for Payer: Cigna Commercial	$6.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

CAP PROTECTIVE F/4.0MM CARBON

Facility

$13.83

Hospital Charge Code	270633008
Hospital Revenue Code	278
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$3.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.35
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

CAP PROTECTIVE F/4.5mm FIX PIN

Facility

$17.15

Hospital Charge Code	270639893
Hospital Revenue Code	278
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$8.57
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: Aetna Medicare Advantage	$5.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.37
Rate for Payer: Cigna Commercial	$8.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.15
Rate for Payer: Qualcare PPO/HMO/WC	$2.57
Rate for Payer: UnitedHealthcare Community & State	$0.54
Rate for Payer: Wellpoint Medicaid Managed Care	$0.49

CAP PROTECTIVE F/4.5mm FIX PIN

Facility

$17.15

Hospital Charge Code	270639893
Hospital Revenue Code	278
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$4.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.15
Rate for Payer: Qualcare PPO/HMO/WC	$2.57

CAP PSN ASF 14 MM 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690744
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

CAP PSN ASF 14 MM 6-9 EF

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270690744
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

CAP REVEAL DIS ATT O.D. 11.35

Facility

$90.00

Hospital Charge Code	270685846
Hospital Revenue Code	272
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CAP REVEAL DIS ATT O.D. 11.35

Facility

$90.00

Hospital Charge Code	270685846
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CAP REVEAL DIS ATT O.D. 11.8

Facility

$90.00

Hospital Charge Code	270685847
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CAP REVEAL DIS ATT O.D. 11.8

Facility

$90.00

Hospital Charge Code	270685847
Hospital Revenue Code	272
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CAP REVEAL DIS ATT O.D. 13.4

Facility

$90.00

Hospital Charge Code	270685848
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CAP REVEAL DIS ATT O.D. 13.4

Facility

$90.00

Hospital Charge Code	270685848
Hospital Revenue Code	272
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CAP REVEAL DIS ATT O.D. 15.0

Facility

$90.00

Hospital Charge Code	270685849
Hospital Revenue Code	272
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CAP REVEAL DIS ATT O.D. 15.0

Facility

$90.00

Hospital Charge Code	270685849
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CAPS

Facility

$875.00

Hospital Charge Code	270669468
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

CAPS

Facility

$875.00

Hospital Charge Code	270659159
Hospital Revenue Code	278
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

CAPS

Facility

$875.00

Hospital Charge Code	270669468
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CAPS

Facility

$875.00

Hospital Charge Code	270659159
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

CAPSAICIN 0.1% CREAM

Facility

$102.04

Service Code	NDC 41167075142
Hospital Charge Code	606390225
Hospital Revenue Code	250
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$51.02
Rate for Payer: Aetna Commercial	$38.78
Rate for Payer: Aetna Medicare Advantage	$30.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.02
Rate for Payer: Cigna Commercial	$51.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.53
Rate for Payer: Oxford Commercial	$20.41
Rate for Payer: Qualcare PPO/HMO/WC	$15.31
Rate for Payer: UnitedHealthcare Commercial	$20.41
Rate for Payer: UnitedHealthcare Community & State	$3.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.90

CAPSAICIN 0.1% CREAM

Facility

$102.04

Service Code	NDC 41167075142
Hospital Charge Code	606390225
Hospital Revenue Code	250
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$15.31
Rate for Payer: Qualcare PPO/HMO/WC	$15.31

Know your out-of-pocket cost for care.

All Charges