Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DBM PUTTY 2CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700322
Hospital Revenue Code	278
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

DBM PUTTY 2CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700322
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

DBM PUTTY-INTEGRA XPRESS 305

Facility

$1,875.00

Hospital Charge Code	270339460
Hospital Revenue Code	278
Min. Negotiated Rate	$281.25
Max. Negotiated Rate	$453.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25

DBM PUTTY-INTEGRA XPRESS 305

Facility

$1,875.00

Hospital Charge Code	270339460
Hospital Revenue Code	278
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$712.50
Rate for Payer: Aetna Medicare Advantage	$562.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$478.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$478.12
Rate for Payer: Cigna Commercial	$937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$453.75
Rate for Payer: Qualcare PPO/HMO/WC	$281.25
Rate for Payer: UnitedHealthcare Community & State	$59.25
Rate for Payer: Wellpoint Medicaid Managed Care	$53.25

DBM PUTTY INTEGRA XPRESS 3C05

Facility

$2,100.00

Hospital Charge Code	270339461
Hospital Revenue Code	278
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$798.00
Rate for Payer: Aetna Medicare Advantage	$630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.50
Rate for Payer: Cigna Commercial	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Community & State	$66.36
Rate for Payer: Wellpoint Medicaid Managed Care	$59.64

DBM PUTTY INTEGRA XPRESS 3C05

Facility

$2,100.00

Hospital Charge Code	270339461
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

DBM PUTTY-INTEGRA XPRESS 3C25

Facility

$1,200.00

Hospital Charge Code	270339458
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00

DBM PUTTY-INTEGRA XPRESS 3C25

Facility

$1,200.00

Hospital Charge Code	270339458
Hospital Revenue Code	278
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$600.00
Rate for Payer: Aetna Commercial	$456.00
Rate for Payer: Aetna Medicare Advantage	$360.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$306.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$306.00
Rate for Payer: Cigna Commercial	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.40
Rate for Payer: Qualcare PPO/HMO/WC	$180.00
Rate for Payer: UnitedHealthcare Community & State	$37.92
Rate for Payer: Wellpoint Medicaid Managed Care	$34.08

DBM PUTTY-INTEGRA X[RESS 325

Facility

$1,050.00

Hospital Charge Code	270339459
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

DBM PUTTY-INTEGRA X[RESS 325

Facility

$1,050.00

Hospital Charge Code	270339459
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

DBM PUTTY TREL-XPRESS 300C

Facility

$14,811.25

Service Code	HCPCS C9359
Hospital Charge Code	270657169
Hospital Revenue Code	278
Min. Negotiated Rate	$2,221.69
Max. Negotiated Rate	$3,584.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,962.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,584.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,221.69

DBM PUTTY TREL-XPRESS 300C

Facility

$14,811.25

Service Code	HCPCS C9359
Hospital Charge Code	270657169
Hospital Revenue Code	278
Min. Negotiated Rate	$420.64
Max. Negotiated Rate	$7,405.62
Rate for Payer: Aetna Commercial	$5,628.27
Rate for Payer: Aetna Medicare Advantage	$4,443.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,776.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,776.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,962.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,776.87
Rate for Payer: Cigna Commercial	$7,405.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,584.32
Rate for Payer: Qualcare PPO/HMO/WC	$2,221.69
Rate for Payer: UnitedHealthcare Community & State	$468.04
Rate for Payer: Wellpoint Medicaid Managed Care	$420.64

DBM SPONGE BLOCK 10 X10 X 10MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270690557
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

DBM SPONGE BLOCK 10 X10 X 10MM

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270690557
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

DBM SPONGE STRIP 35X20X7 MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692442
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

DBM SPONGE STRIP 35X20X7 MM

Facility

$11,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270692442
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

DBRDMT SKIN ABDOMINAL WALL

Facility

$9,712.00

Service Code	HCPCS 11005
Hospital Charge Code	1600000809
Hospital Revenue Code	360
Min. Negotiated Rate	$1,456.80
Max. Negotiated Rate	$1,456.80
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.80

DBRDMT SKIN ABDOMINAL WALL

Facility

$9,712.00

Service Code	HCPCS 11005
Hospital Charge Code	1600000809
Hospital Revenue Code	360
Min. Negotiated Rate	$275.82
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$3,690.56
Rate for Payer: Aetna Medicare Advantage	$2,913.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,476.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,476.56
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	$2,476.56
Rate for Payer: Cigna Commercial	$4,856.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,525.12
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,456.80
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$306.90
Rate for Payer: Wellpoint Medicaid Managed Care	$275.82

DBRDMT SUBQ TISS EACH ADDL

Facility

$2,452.00

Service Code	HCPCS 11045
Hospital Charge Code	1600000756
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$367.80
Rate for Payer: Qualcare PPO/HMO/WC	$367.80

DBRDMT SUBQ TISS EACH ADDL

Facility

$2,452.00

Service Code	HCPCS 11045
Hospital Charge Code	1600000756
Hospital Revenue Code	360
Min. Negotiated Rate	$69.64
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$931.76
Rate for Payer: Aetna Medicare Advantage	$735.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$625.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$625.26
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	$625.26
Rate for Payer: Cigna Commercial	$1,226.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$637.52
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$367.80
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$77.48
Rate for Payer: Wellpoint Medicaid Managed Care	$69.64

DBRD SK,SQ TISS,MUSCLE,BONE OP

Facility

$13,927.00

Service Code	HCPCS 11012
Hospital Charge Code	5770050
Hospital Revenue Code	450
Min. Negotiated Rate	$2,089.05
Max. Negotiated Rate	$2,089.05
Rate for Payer: Qualcare PPO/HMO/WC	$2,089.05

DBRD SK,SQ TISS,MUSCLE,BONE OP

Facility

$13,927.00

Service Code	HCPCS 11012
Hospital Charge Code	5770050
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$12,518.07
Rate for Payer: Aetna Commercial	$9,386.39
Rate for Payer: Aetna Medicare Advantage	$11,180.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,518.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,450.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$412.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,518.07
Rate for Payer: Cigna Commercial	$6,917.28
Rate for Payer: Cigna Medicare Advantage	$3,450.88
Rate for Payer: Clover Medicare Advantage	$3,278.34
Rate for Payer: EmblemHealth Commercial	$10,352.64
Rate for Payer: Humana Medicare Advantage	$3,554.41
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,450.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,621.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,089.05
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare Medicare Advantage	$3,450.88
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$7,775.06
Rate for Payer: Wellpoint Medicaid Managed Care	$395.53

DBRID SKIN @ ADDNL 20 SQ CM

Facility

$612.30

Service Code	HCPCS 97597
Hospital Charge Code	75190160
Hospital Revenue Code	761
Min. Negotiated Rate	$91.84
Max. Negotiated Rate	$91.84
Rate for Payer: Qualcare PPO/HMO/WC	$91.84

DBRID SKIN @ ADDNL 20 SQ CM

Facility

$612.30

Service Code	HCPCS 97597
Hospital Charge Code	75190160
Hospital Revenue Code	761
Min. Negotiated Rate	$17.39
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	$357.50
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	$159.20
Rate for Payer: Oxford Commercial	$122.46
Rate for Payer: Qualcare PPO/HMO/WC	$91.84
Rate for Payer: UnitedHealthcare Commercial	$122.46
Rate for Payer: UnitedHealthcare Community & State	$19.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$17.39

DBX CONNECTIVE TISSUE,H 0.5 CC

Facility

$263.00

Hospital Charge Code	27038005
Hospital Revenue Code	278
Min. Negotiated Rate	$39.45
Max. Negotiated Rate	$63.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$52.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.65
Rate for Payer: Qualcare PPO/HMO/WC	$39.45

Know your out-of-pocket cost for care.

All Charges