Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DERMACELL GRAFT

Facility

$7,200.00

Hospital Charge Code	270339527
Hospital Revenue Code	636
Min. Negotiated Rate	$204.48
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,736.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00
Rate for Payer: UnitedHealthcare Community & State	$227.52
Rate for Payer: Wellpoint Medicaid Managed Care	$204.48

DERMACELL GRAFT ARTHREX

Facility

$7,200.00

Hospital Charge Code	270339533
Hospital Revenue Code	278
Min. Negotiated Rate	$204.48
Max. Negotiated Rate	$3,600.00
Rate for Payer: Aetna Commercial	$2,736.00
Rate for Payer: Aetna Medicare Advantage	$2,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,836.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,836.00
Rate for Payer: Cigna Commercial	$3,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00
Rate for Payer: UnitedHealthcare Community & State	$227.52
Rate for Payer: Wellpoint Medicaid Managed Care	$204.48

DERMACELL GRAFT ARTHREX

Facility

$7,200.00

Hospital Charge Code	270339533
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,742.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,742.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,080.00

DERMACLOSE KIT

Facility

$4,995.00

Hospital Charge Code	270697854
Hospital Revenue Code	272
Min. Negotiated Rate	$749.25
Max. Negotiated Rate	$749.25
Rate for Payer: Qualcare PPO/HMO/WC	$749.25

DERMACLOSE KIT

Facility

$4,995.00

Hospital Charge Code	270697854
Hospital Revenue Code	272
Min. Negotiated Rate	$141.86
Max. Negotiated Rate	$2,497.50
Rate for Payer: Aetna Commercial	$1,898.10
Rate for Payer: Aetna Medicare Advantage	$1,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.72
Rate for Payer: Cigna Commercial	$2,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,298.70
Rate for Payer: Oxford Commercial	$999.00
Rate for Payer: Qualcare PPO/HMO/WC	$749.25
Rate for Payer: UnitedHealthcare Commercial	$999.00
Rate for Payer: UnitedHealthcare Community & State	$157.84
Rate for Payer: Wellpoint Medicaid Managed Care	$141.86

DERMA FAT FASCIA GRAFT

Facility

$12,712.96

Service Code	HCPCS 15770
Hospital Charge Code	16000533
Hospital Revenue Code	360
Min. Negotiated Rate	$1,906.94
Max. Negotiated Rate	$1,906.94
Rate for Payer: Qualcare PPO/HMO/WC	$1,906.94

DERMA FAT FASCIA GRAFT

Facility

$12,712.96

Service Code	HCPCS 15770
Hospital Charge Code	16000533
Hospital Revenue Code	360
Min. Negotiated Rate	$361.05
Max. Negotiated Rate	$15,271.92
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,271.92
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,305.37
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,906.94
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$401.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$361.05

DERM AGRAFT TK/ARM/LEG 100SQCM

Facility

$26,848.40

Service Code	HCPCS 15130
Hospital Charge Code	1600000802
Hospital Revenue Code	360
Min. Negotiated Rate	$762.49
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	$3,536.00
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	$6,980.58
Rate for Payer: Oxford Commercial	$7,525.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$8,192.00
Rate for Payer: UnitedHealthcare Community & State	$848.41
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	$762.49

DERM AGRAFT TK/ARM/LEG 100SQCM

Facility

$26,848.40

Service Code	HCPCS 15130
Hospital Charge Code	1600000802
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

DERMAL MATRIX 4x4CM

Facility

$7,500.00

Hospital Charge Code	270681987
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

DERMAL MATRIX 4x4CM

Facility

$7,500.00

Hospital Charge Code	270681987
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

DERMAL MATRIX 4x8CM

Facility

$15,250.00

Hospital Charge Code	270675132
Hospital Revenue Code	278
Min. Negotiated Rate	$433.10
Max. Negotiated Rate	$7,625.00
Rate for Payer: Aetna Commercial	$5,795.00
Rate for Payer: Aetna Medicare Advantage	$4,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,888.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,888.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,888.75
Rate for Payer: Cigna Commercial	$7,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,690.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,287.50
Rate for Payer: UnitedHealthcare Community & State	$481.90
Rate for Payer: Wellpoint Medicaid Managed Care	$433.10

DERMAL MATRIX 4x8CM

Facility

$15,250.00

Hospital Charge Code	270675132
Hospital Revenue Code	278
Min. Negotiated Rate	$2,287.50
Max. Negotiated Rate	$3,690.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,690.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,287.50

DERMATONE BLADES

Facility

$116.00

Hospital Charge Code	270332562
Hospital Revenue Code	272
Min. Negotiated Rate	$3.29
Max. Negotiated Rate	$58.00
Rate for Payer: Aetna Commercial	$44.08
Rate for Payer: Aetna Medicare Advantage	$34.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.58
Rate for Payer: Cigna Commercial	$58.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.16
Rate for Payer: Oxford Commercial	$23.20
Rate for Payer: Qualcare PPO/HMO/WC	$17.40
Rate for Payer: UnitedHealthcare Commercial	$23.20
Rate for Payer: UnitedHealthcare Community & State	$3.67
Rate for Payer: Wellpoint Medicaid Managed Care	$3.29

DERMATONE BLADES

Facility

$116.00

Hospital Charge Code	270332562
Hospital Revenue Code	272
Min. Negotiated Rate	$17.40
Max. Negotiated Rate	$17.40
Rate for Payer: Qualcare PPO/HMO/WC	$17.40

DERMATRIX SURGICAL MESH

Facility

$780.00

Hospital Charge Code	270335523
Hospital Revenue Code	278
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Commercial	$296.40
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$198.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$198.90
Rate for Payer: Cigna Commercial	$390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00
Rate for Payer: UnitedHealthcare Community & State	$24.65
Rate for Payer: Wellpoint Medicaid Managed Care	$22.15

DERMATRIX SURGICAL MESH

Facility

$780.00

Hospital Charge Code	270335523
Hospital Revenue Code	278
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$188.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$188.76
Rate for Payer: Qualcare PPO/HMO/WC	$117.00

DERM AUTOFRAFT 100 SQ CM/1% BA

Facility

$16,286.20

Service Code	HCPCS 15135
Hospital Charge Code	16000532
Hospital Revenue Code	360
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

DERM AUTOFRAFT 100 SQ CM/1% BA

Facility

$16,286.20

Service Code	HCPCS 15135
Hospital Charge Code	16000532
Hospital Revenue Code	360
Min. Negotiated Rate	$462.53
Max. Negotiated Rate	$15,271.92
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,271.92
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,234.41
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$514.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$462.53

DERM AUTOFRAFT 100 SQ CM/1% BA

Facility

$16,286.20

Service Code	HCPCS 15135
Hospital Charge Code	5792299
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$15,271.92
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$537.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,271.92
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,234.41
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$462.53

DERM AUTOFRAFT 100 SQ CM/1% BA

Facility

$16,286.20

Service Code	HCPCS 15135
Hospital Charge Code	5792299
Hospital Revenue Code	450
Min. Negotiated Rate	$2,442.93
Max. Negotiated Rate	$2,442.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,442.93

DERMICELL DECELL RETIC 6X7

Facility

$5,435.00

Hospital Charge Code	270703188
Hospital Revenue Code	278
Min. Negotiated Rate	$815.25
Max. Negotiated Rate	$1,315.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,087.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,315.27
Rate for Payer: Qualcare PPO/HMO/WC	$815.25

DERMICELL DECELL RETIC 6X7

Facility

$5,435.00

Hospital Charge Code	270703188
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$2,717.50
Rate for Payer: Aetna Commercial	$2,065.30
Rate for Payer: Aetna Medicare Advantage	$1,630.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,385.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,385.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,087.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,385.92
Rate for Payer: Cigna Commercial	$2,717.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,315.27
Rate for Payer: Qualcare PPO/HMO/WC	$815.25
Rate for Payer: UnitedHealthcare Community & State	$171.75
Rate for Payer: Wellpoint Medicaid Managed Care	$154.35

DERML REPAIR MATRIX 6x6CM

Facility

$8,050.00

Hospital Charge Code	270674973
Hospital Revenue Code	636
Min. Negotiated Rate	$228.62
Max. Negotiated Rate	$4,025.00
Rate for Payer: Aetna Commercial	$3,059.00
Rate for Payer: Aetna Medicare Advantage	$2,415.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,052.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,052.75
Rate for Payer: Cigna Commercial	$4,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50
Rate for Payer: UnitedHealthcare Community & State	$254.38
Rate for Payer: Wellpoint Medicaid Managed Care	$228.62

DERML REPAIR MATRIX 6x6CM

Facility

$8,050.00

Hospital Charge Code	270674973
Hospital Revenue Code	636
Min. Negotiated Rate	$1,207.50
Max. Negotiated Rate	$1,948.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,948.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,207.50

Know your out-of-pocket cost for care.

All Charges