Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ACELL MICRO MATRIX 60 MG

Facility

$229.80

Hospital Charge Code	270339114
Hospital Revenue Code	278
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$55.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.61
Rate for Payer: Qualcare PPO/HMO/WC	$34.47

ACELL MICRO MATRIX 60 MG

Facility

$229.80

Hospital Charge Code	270339114
Hospital Revenue Code	278
Min. Negotiated Rate	$6.53
Max. Negotiated Rate	$114.90
Rate for Payer: Aetna Commercial	$87.32
Rate for Payer: Aetna Medicare Advantage	$68.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$45.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.60
Rate for Payer: Cigna Commercial	$114.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$55.61
Rate for Payer: Qualcare PPO/HMO/WC	$34.47
Rate for Payer: UnitedHealthcare Community & State	$7.26
Rate for Payer: Wellpoint Medicaid Managed Care	$6.53

A-CELL MICRO MATRIX MM0500

Facility

$2,250.00

Hospital Charge Code	270339429
Hospital Revenue Code	636
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

A-CELL MICRO MATRIX MM0500

Facility

$2,250.00

Hospital Charge Code	270339429
Hospital Revenue Code	636
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

A-CELL PLAST MAT PSMO715 7X 15

Facility

$3,308.00

Hospital Charge Code	270339129
Hospital Revenue Code	636
Min. Negotiated Rate	$496.20
Max. Negotiated Rate	$800.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$800.54
Rate for Payer: Qualcare PPO/HMO/WC	$496.20

A-CELL PLAST MAT PSMO715 7X 15

Facility

$3,308.00

Hospital Charge Code	270339129
Hospital Revenue Code	636
Min. Negotiated Rate	$93.95
Max. Negotiated Rate	$1,654.00
Rate for Payer: Aetna Commercial	$1,257.04
Rate for Payer: Aetna Medicare Advantage	$992.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$843.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$843.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$843.54
Rate for Payer: Cigna Commercial	$1,654.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$800.54
Rate for Payer: Qualcare PPO/HMO/WC	$496.20
Rate for Payer: UnitedHealthcare Community & State	$104.53
Rate for Payer: Wellpoint Medicaid Managed Care	$93.95

A-CELL PLAST/SURG PSMX0710

Facility

$3,600.00

Hospital Charge Code	270339430
Hospital Revenue Code	636
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$871.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

A-CELL PLAST/SURG PSMX0710

Facility

$3,600.00

Hospital Charge Code	270339430
Hospital Revenue Code	636
Min. Negotiated Rate	$102.24
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$1,368.00
Rate for Payer: Aetna Medicare Advantage	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$918.00
Rate for Payer: Cigna Commercial	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00
Rate for Payer: UnitedHealthcare Community & State	$113.76
Rate for Payer: Wellpoint Medicaid Managed Care	$102.24

A-CELL PLSTC MATX PSM0615-6X15

Facility

$2,835.00

Hospital Charge Code	270339130
Hospital Revenue Code	636
Min. Negotiated Rate	$80.51
Max. Negotiated Rate	$1,417.50
Rate for Payer: Aetna Commercial	$1,077.30
Rate for Payer: Aetna Medicare Advantage	$850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$722.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$722.92
Rate for Payer: Cigna Commercial	$1,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.07
Rate for Payer: Qualcare PPO/HMO/WC	$425.25
Rate for Payer: UnitedHealthcare Community & State	$89.59
Rate for Payer: Wellpoint Medicaid Managed Care	$80.51

A-CELL PLSTC MATX PSM0615-6X15

Facility

$2,835.00

Hospital Charge Code	270339130
Hospital Revenue Code	636
Min. Negotiated Rate	$425.25
Max. Negotiated Rate	$686.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$686.07
Rate for Payer: Qualcare PPO/HMO/WC	$425.25

ACELL PLSTC S MATRIX XS

Facility

$1,950.00

Hospital Charge Code	270339124
Hospital Revenue Code	636
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$975.00
Rate for Payer: Aetna Commercial	$741.00
Rate for Payer: Aetna Medicare Advantage	$585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.25
Rate for Payer: Cigna Commercial	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.90
Rate for Payer: Qualcare PPO/HMO/WC	$292.50
Rate for Payer: UnitedHealthcare Community & State	$61.62
Rate for Payer: Wellpoint Medicaid Managed Care	$55.38

ACELL PLSTC S MATRIX XS

Facility

$1,950.00

Hospital Charge Code	270339124
Hospital Revenue Code	636
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$471.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$471.90
Rate for Payer: Qualcare PPO/HMO/WC	$292.50

ACELL SURG MATRIX 5 X 5 CM

Facility

$1,620.00

Hospital Charge Code	270339115
Hospital Revenue Code	636
Min. Negotiated Rate	$243.00
Max. Negotiated Rate	$392.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00

ACELL SURG MATRIX 5 X 5 CM

Facility

$1,620.00

Hospital Charge Code	270339115
Hospital Revenue Code	636
Min. Negotiated Rate	$46.01
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$615.60
Rate for Payer: Aetna Medicare Advantage	$486.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$413.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$413.10
Rate for Payer: Cigna Commercial	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$392.04
Rate for Payer: Qualcare PPO/HMO/WC	$243.00
Rate for Payer: UnitedHealthcare Community & State	$51.19
Rate for Payer: Wellpoint Medicaid Managed Care	$46.01

ACELLULAR DERM MATX IMPLT

Facility

$3,254.52

Service Code	HCPCS 15777
Hospital Charge Code	16000382
Hospital Revenue Code	360
Min. Negotiated Rate	$488.18
Max. Negotiated Rate	$488.18
Rate for Payer: Qualcare PPO/HMO/WC	$488.18

ACELLULAR DERM MATX IMPLT

Facility

$3,254.52

Service Code	HCPCS 15777
Hospital Charge Code	16000382
Hospital Revenue Code	360
Min. Negotiated Rate	$92.43
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$1,236.72
Rate for Payer: Aetna Medicare Advantage	$976.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$829.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$829.90
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	$829.90
Rate for Payer: Cigna Commercial	$1,627.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$846.18
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$488.18
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$102.84
Rate for Payer: Wellpoint Medicaid Managed Care	$92.43

A-CELL WOUND SHEET WS0710

Facility

$2,400.00

Hospital Charge Code	270339428
Hospital Revenue Code	636
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$912.00
Rate for Payer: Aetna Medicare Advantage	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$612.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$612.00
Rate for Payer: Cigna Commercial	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00
Rate for Payer: UnitedHealthcare Community & State	$75.84
Rate for Payer: Wellpoint Medicaid Managed Care	$68.16

A-CELL WOUND SHEET WS0710

Facility

$2,400.00

Hospital Charge Code	270339428
Hospital Revenue Code	636
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

A-CELL WOUND SHEET WS1015

Facility

$1,023.00

Hospital Charge Code	270339431
Hospital Revenue Code	636
Min. Negotiated Rate	$153.45
Max. Negotiated Rate	$247.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.57
Rate for Payer: Qualcare PPO/HMO/WC	$153.45

A-CELL WOUND SHEET WS1015

Facility

$1,023.00

Hospital Charge Code	270339431
Hospital Revenue Code	636
Min. Negotiated Rate	$29.05
Max. Negotiated Rate	$511.50
Rate for Payer: Aetna Commercial	$388.74
Rate for Payer: Aetna Medicare Advantage	$306.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$260.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$260.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$260.87
Rate for Payer: Cigna Commercial	$511.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$247.57
Rate for Payer: Qualcare PPO/HMO/WC	$153.45
Rate for Payer: UnitedHealthcare Community & State	$32.33
Rate for Payer: Wellpoint Medicaid Managed Care	$29.05

ACELL WUND POWER 100MG

Facility

$450.00

Hospital Charge Code	270339123
Hospital Revenue Code	636
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

ACELL WUND POWER 100MG

Facility

$450.00

Hospital Charge Code	270339123
Hospital Revenue Code	636
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

ACETAB LINER LONGEVITY 28X46MM

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696625
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

ACETAB LINER LONGEVITY 28X46MM

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270696625
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

ACETABULAR 48 SZ D

Facility

$500.00

Service Code	HCPCS C1776
Hospital Charge Code	270687180
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

Know your out-of-pocket cost for care.

All Charges