Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DRAIN TO PERITONEAL CAVITY

Facility

$3,005.56

Service Code	HCPCS 49062
Hospital Charge Code	1600000343
Hospital Revenue Code	360
Min. Negotiated Rate	$450.83
Max. Negotiated Rate	$450.83
Rate for Payer: Qualcare PPO/HMO/WC	$450.83

DRAIN TO PERITONEAL CAVITY

Facility

$3,005.56

Service Code	HCPCS 49062
Hospital Charge Code	1600000343
Hospital Revenue Code	360
Min. Negotiated Rate	$85.36
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$1,142.11
Rate for Payer: Aetna Medicare Advantage	$901.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.42
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	$766.42
Rate for Payer: Cigna Commercial	$1,502.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$781.45
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.83
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$94.98
Rate for Payer: Wellpoint Medicaid Managed Care	$85.36

DRAIN URET,SYSTEM STRL

Facility

$103.00

Hospital Charge Code	270331591
Hospital Revenue Code	278
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$24.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.93
Rate for Payer: Qualcare PPO/HMO/WC	$15.45

DRAIN URET,SYSTEM STRL

Facility

$103.00

Hospital Charge Code	270331591
Hospital Revenue Code	278
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.93
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

DRAIN WOUND EVAC MED 1/8

Facility

$53.35

Hospital Charge Code	270601098
Hospital Revenue Code	272
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$8.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.00

DRAIN WOUND EVAC MED 1/8

Facility

$53.35

Hospital Charge Code	270601098
Hospital Revenue Code	272
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$26.68
Rate for Payer: Aetna Commercial	$20.27
Rate for Payer: Aetna Medicare Advantage	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.60
Rate for Payer: Cigna Commercial	$26.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.87
Rate for Payer: Oxford Commercial	$10.67
Rate for Payer: Qualcare PPO/HMO/WC	$8.00
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Community & State	$1.69
Rate for Payer: Wellpoint Medicaid Managed Care	$1.52

DRAIN WOUND SHIRLEY AN-30

Facility

$51.45

Hospital Charge Code	270649145
Hospital Revenue Code	270
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$25.73
Rate for Payer: Aetna Commercial	$19.55
Rate for Payer: Aetna Medicare Advantage	$15.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.12
Rate for Payer: Cigna Commercial	$25.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.38
Rate for Payer: Oxford Commercial	$10.29
Rate for Payer: Qualcare PPO/HMO/WC	$7.72
Rate for Payer: UnitedHealthcare Commercial	$10.29
Rate for Payer: UnitedHealthcare Community & State	$1.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.46

DRAIN WOUND SHIRLEY AN-30

Facility

$51.45

Hospital Charge Code	270649145
Hospital Revenue Code	270
Min. Negotiated Rate	$7.72
Max. Negotiated Rate	$7.72
Rate for Payer: Qualcare PPO/HMO/WC	$7.72

DRAPE IOBAN 23X17 INCISE ANTI-

Facility

$26.60

Hospital Charge Code	270653225
Hospital Revenue Code	270
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$13.30
Rate for Payer: Aetna Commercial	$10.11
Rate for Payer: Aetna Medicare Advantage	$7.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.78
Rate for Payer: Cigna Commercial	$13.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.92
Rate for Payer: Oxford Commercial	$5.32
Rate for Payer: Qualcare PPO/HMO/WC	$3.99
Rate for Payer: UnitedHealthcare Commercial	$5.32
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.76

DRAPE IOBAN 23X17 INCISE ANTI-

Facility

$26.60

Hospital Charge Code	270653225
Hospital Revenue Code	270
Min. Negotiated Rate	$3.99
Max. Negotiated Rate	$3.99
Rate for Payer: Qualcare PPO/HMO/WC	$3.99

DRAPE ISO VI INTESTINE 1003M

Facility

$39.16

Hospital Charge Code	270650805
Hospital Revenue Code	270
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$19.58
Rate for Payer: Aetna Commercial	$14.88
Rate for Payer: Aetna Medicare Advantage	$11.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.99
Rate for Payer: Cigna Commercial	$19.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.18
Rate for Payer: Oxford Commercial	$7.83
Rate for Payer: Qualcare PPO/HMO/WC	$5.87
Rate for Payer: UnitedHealthcare Commercial	$7.83
Rate for Payer: UnitedHealthcare Community & State	$1.24
Rate for Payer: Wellpoint Medicaid Managed Care	$1.11

DRAPE ISO VI INTESTINE 1003M

Facility

$39.16

Hospital Charge Code	270650805
Hospital Revenue Code	270
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$5.87
Rate for Payer: Qualcare PPO/HMO/WC	$5.87

DRAPE MAGNETIC 30/CS

Facility

$20.65

Hospital Charge Code	270655944
Hospital Revenue Code	270
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.10
Rate for Payer: Qualcare PPO/HMO/WC	$3.10

DRAPE MAGNETIC 30/CS

Facility

$20.65

Hospital Charge Code	270655944
Hospital Revenue Code	270
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$10.32
Rate for Payer: Aetna Commercial	$7.85
Rate for Payer: Aetna Medicare Advantage	$6.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.27
Rate for Payer: Cigna Commercial	$10.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.37
Rate for Payer: Oxford Commercial	$4.13
Rate for Payer: Qualcare PPO/HMO/WC	$3.10
Rate for Payer: UnitedHealthcare Commercial	$4.13
Rate for Payer: UnitedHealthcare Community & State	$0.65
Rate for Payer: Wellpoint Medicaid Managed Care	$0.59

DRAPE MICROSCOPE DISP

Facility

$90.00

Hospital Charge Code	270658254
Hospital Revenue Code	270
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

DRAPE MICROSCOPE DISP

Facility

$90.00

Hospital Charge Code	270658254
Hospital Revenue Code	270
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

DRAPE NEUROLOGICAL W/XL POUCH

Facility

$97.62

Hospital Charge Code	270653749
Hospital Revenue Code	270
Min. Negotiated Rate	$14.64
Max. Negotiated Rate	$14.64
Rate for Payer: Qualcare PPO/HMO/WC	$14.64

DRAPE NEUROLOGICAL W/XL POUCH

Facility

$97.62

Hospital Charge Code	270653749
Hospital Revenue Code	270
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$48.81
Rate for Payer: Aetna Commercial	$37.10
Rate for Payer: Aetna Medicare Advantage	$29.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.89
Rate for Payer: Cigna Commercial	$48.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.38
Rate for Payer: Oxford Commercial	$19.52
Rate for Payer: Qualcare PPO/HMO/WC	$14.64
Rate for Payer: UnitedHealthcare Commercial	$19.52
Rate for Payer: UnitedHealthcare Community & State	$3.08
Rate for Payer: Wellpoint Medicaid Managed Care	$2.77

DRAPE PEDIATRIC MAJOR OPTIMA

Facility

$22.10

Hospital Charge Code	270652032
Hospital Revenue Code	270
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$11.05
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.64
Rate for Payer: Cigna Commercial	$11.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.75
Rate for Payer: Oxford Commercial	$4.42
Rate for Payer: Qualcare PPO/HMO/WC	$3.31
Rate for Payer: UnitedHealthcare Commercial	$4.42
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.63

DRAPE PEDIATRIC MAJOR OPTIMA

Facility

$22.10

Hospital Charge Code	270652032
Hospital Revenue Code	270
Min. Negotiated Rate	$3.31
Max. Negotiated Rate	$3.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.31

DRAPE SHEET HALF 9358

Facility

$12.38

Hospital Charge Code	270649149
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.19
Rate for Payer: Aetna Commercial	$4.70
Rate for Payer: Aetna Medicare Advantage	$3.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.16
Rate for Payer: Cigna Commercial	$6.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.22
Rate for Payer: Oxford Commercial	$2.48
Rate for Payer: Qualcare PPO/HMO/WC	$1.86
Rate for Payer: UnitedHealthcare Commercial	$2.48
Rate for Payer: UnitedHealthcare Community & State	$0.39
Rate for Payer: Wellpoint Medicaid Managed Care	$0.35

DRAPE SHEET HALF 9358

Facility

$12.38

Hospital Charge Code	270649149
Hospital Revenue Code	270
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Qualcare PPO/HMO/WC	$1.86

DRAPE STERI MEDIUM 1040

Facility

$10.25

Hospital Charge Code	270641460
Hospital Revenue Code	270
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$5.12
Rate for Payer: Aetna Commercial	$3.90
Rate for Payer: Aetna Medicare Advantage	$3.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.61
Rate for Payer: Cigna Commercial	$5.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.67
Rate for Payer: Oxford Commercial	$2.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.54
Rate for Payer: UnitedHealthcare Commercial	$2.05
Rate for Payer: UnitedHealthcare Community & State	$0.32
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

DRAPE STERI MEDIUM 1040

Facility

$10.25

Hospital Charge Code	270641460
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$1.54
Rate for Payer: Qualcare PPO/HMO/WC	$1.54

DRAPE SURGICAL STERI ISOLATION

Facility

$15.28

Hospital Charge Code	270643305
Hospital Revenue Code	270
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Qualcare PPO/HMO/WC	$2.29

Know your out-of-pocket cost for care.

All Charges