Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DRAPE SURGICAL STERI ISOLATION

Facility

$15.28

Hospital Charge Code	270643305
Hospital Revenue Code	270
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$7.64
Rate for Payer: Aetna Commercial	$5.81
Rate for Payer: Aetna Medicare Advantage	$4.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.90
Rate for Payer: Cigna Commercial	$7.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.97
Rate for Payer: Oxford Commercial	$3.06
Rate for Payer: Qualcare PPO/HMO/WC	$2.29
Rate for Payer: UnitedHealthcare Commercial	$3.06
Rate for Payer: UnitedHealthcare Community & State	$0.48
Rate for Payer: Wellpoint Medicaid Managed Care	$0.43

DRAPE TOWEL

Facility

$3.13

Hospital Charge Code	270654109
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.56
Rate for Payer: Aetna Commercial	$1.19
Rate for Payer: Aetna Medicare Advantage	$0.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.80
Rate for Payer: Cigna Commercial	$1.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.81
Rate for Payer: Oxford Commercial	$0.63
Rate for Payer: Qualcare PPO/HMO/WC	$0.47
Rate for Payer: UnitedHealthcare Commercial	$0.63
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

DRAPE TOWEL

Facility

$3.13

Hospital Charge Code	270654109
Hospital Revenue Code	270
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Qualcare PPO/HMO/WC	$0.47

DRAPE UNDER BTTCKS HYDROFLX HD

Facility

$1,809.00

Hospital Charge Code	270662642
Hospital Revenue Code	270
Min. Negotiated Rate	$51.38
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna Commercial	$687.42
Rate for Payer: Aetna Medicare Advantage	$542.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$461.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$461.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$461.30
Rate for Payer: Cigna Commercial	$904.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$470.34
Rate for Payer: Oxford Commercial	$361.80
Rate for Payer: Qualcare PPO/HMO/WC	$271.35
Rate for Payer: UnitedHealthcare Commercial	$361.80
Rate for Payer: UnitedHealthcare Community & State	$57.16
Rate for Payer: Wellpoint Medicaid Managed Care	$51.38

DRAPE UNDER BTTCKS HYDROFLX HD

Facility

$1,809.00

Hospital Charge Code	270662642
Hospital Revenue Code	270
Min. Negotiated Rate	$271.35
Max. Negotiated Rate	$271.35
Rate for Payer: Qualcare PPO/HMO/WC	$271.35

DRAPE UTILITY 89731

Facility

$3.34

Hospital Charge Code	270649152
Hospital Revenue Code	270
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Qualcare PPO/HMO/WC	$0.50

DRAPE UTILITY 89731

Facility

$3.34

Hospital Charge Code	270649152
Hospital Revenue Code	270
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$1.67
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare Advantage	$1.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.85
Rate for Payer: Cigna Commercial	$1.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.87
Rate for Payer: Oxford Commercial	$0.67
Rate for Payer: Qualcare PPO/HMO/WC	$0.50
Rate for Payer: UnitedHealthcare Commercial	$0.67
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.09

DRAPE X-RAY CASSETT LARGE

Facility

$35.83

Hospital Charge Code	270650754
Hospital Revenue Code	270
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$5.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.37

DRAPE X-RAY CASSETT LARGE

Facility

$35.83

Hospital Charge Code	270650754
Hospital Revenue Code	270
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$17.91
Rate for Payer: Aetna Commercial	$13.62
Rate for Payer: Aetna Medicare Advantage	$10.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.14
Rate for Payer: Cigna Commercial	$17.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.32
Rate for Payer: Oxford Commercial	$7.17
Rate for Payer: Qualcare PPO/HMO/WC	$5.37
Rate for Payer: UnitedHealthcare Commercial	$7.17
Rate for Payer: UnitedHealthcare Community & State	$1.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1.02

DRAW BLOOD ESTABLISHED LINE

Facility

$623.55

Service Code	HCPCS 36592
Hospital Charge Code	3401165
Hospital Revenue Code	361
Min. Negotiated Rate	$93.53
Max. Negotiated Rate	$93.53
Rate for Payer: Qualcare PPO/HMO/WC	$93.53

DRAW BLOOD ESTABLISHED LINE

Facility

$623.55

Service Code	HCPCS 36592
Hospital Charge Code	3401165
Hospital Revenue Code	361
Min. Negotiated Rate	$17.71
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$429.92
Rate for Payer: Aetna Medicare Advantage	$512.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$158.06
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	$573.36
Rate for Payer: Cigna Commercial	$316.85
Rate for Payer: Cigna Medicare Advantage	$158.06
Rate for Payer: Clover Medicare Advantage	$150.16
Rate for Payer: EmblemHealth Commercial	$474.18
Rate for Payer: Humana Medicare Advantage	$162.80
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$158.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.12
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$93.53
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$19.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.06
Rate for Payer: Wellcare Medicare Advantage	$158.06
Rate for Payer: Wellpoint Medicaid Managed Care	$17.71

DREAMTOME 450CM

Facility

$2,029.75

Service Code	HCPCS C1769
Hospital Charge Code	270696134
Hospital Revenue Code	272
Min. Negotiated Rate	$57.64
Max. Negotiated Rate	$1,014.88
Rate for Payer: Aetna Commercial	$771.30
Rate for Payer: Aetna Medicare Advantage	$608.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$517.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$517.59
Rate for Payer: Cigna Commercial	$1,014.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$527.74
Rate for Payer: Oxford Commercial	$405.95
Rate for Payer: Qualcare PPO/HMO/WC	$304.46
Rate for Payer: UnitedHealthcare Commercial	$405.95
Rate for Payer: UnitedHealthcare Community & State	$64.14
Rate for Payer: Wellpoint Medicaid Managed Care	$57.64

DREAMTOME 450CM

Facility

$2,029.75

Service Code	HCPCS C1769
Hospital Charge Code	270696134
Hospital Revenue Code	272
Min. Negotiated Rate	$304.46
Max. Negotiated Rate	$304.46
Rate for Payer: Qualcare PPO/HMO/WC	$304.46

DREAMTOME RX 44 SPINCTEROTOME

Facility

$2,095.85

Hospital Charge Code	270679137
Hospital Revenue Code	272
Min. Negotiated Rate	$59.52
Max. Negotiated Rate	$1,047.92
Rate for Payer: Aetna Commercial	$796.42
Rate for Payer: Aetna Medicare Advantage	$628.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.44
Rate for Payer: Cigna Commercial	$1,047.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.92
Rate for Payer: Oxford Commercial	$419.17
Rate for Payer: Qualcare PPO/HMO/WC	$314.38
Rate for Payer: UnitedHealthcare Commercial	$419.17
Rate for Payer: UnitedHealthcare Community & State	$66.23
Rate for Payer: Wellpoint Medicaid Managed Care	$59.52

DREAMTOME RX 44 SPINCTEROTOME

Facility

$2,095.85

Hospital Charge Code	270679137
Hospital Revenue Code	272
Min. Negotiated Rate	$314.38
Max. Negotiated Rate	$314.38
Rate for Payer: Qualcare PPO/HMO/WC	$314.38

DREAMWIRE F/G 0.035x260 5612

Facility

$859.98

Hospital Charge Code	270643738
Hospital Revenue Code	272
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

DREAMWIRE F/G 0.035x260 5612

Facility

$859.98

Hospital Charge Code	270643738
Hospital Revenue Code	272
Min. Negotiated Rate	$24.42
Max. Negotiated Rate	$429.99
Rate for Payer: Aetna Commercial	$326.79
Rate for Payer: Aetna Medicare Advantage	$257.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.29
Rate for Payer: Cigna Commercial	$429.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.59
Rate for Payer: Oxford Commercial	$172.00
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Commercial	$172.00
Rate for Payer: UnitedHealthcare Community & State	$27.18
Rate for Payer: Wellpoint Medicaid Managed Care	$24.42

DREAMWIRE F/G .035/260CM STR

Facility

$857.83

Service Code	HCPCS C1769
Hospital Charge Code	270676497
Hospital Revenue Code	278
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$428.92
Rate for Payer: Aetna Commercial	$325.98
Rate for Payer: Aetna Medicare Advantage	$257.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.75
Rate for Payer: Cigna Commercial	$428.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.59
Rate for Payer: Qualcare PPO/HMO/WC	$128.67
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$24.36

DREAMWIRE F/G .035/260CM STR

Facility

$857.83

Service Code	HCPCS C1769
Hospital Charge Code	270676497
Hospital Revenue Code	278
Min. Negotiated Rate	$128.67
Max. Negotiated Rate	$207.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.59
Rate for Payer: Qualcare PPO/HMO/WC	$128.67

DREAMWIRE F/G .035/450cm STR

Facility

$859.98

Service Code	HCPCS C1769
Hospital Charge Code	270643470
Hospital Revenue Code	278
Min. Negotiated Rate	$24.42
Max. Negotiated Rate	$429.99
Rate for Payer: Aetna Commercial	$326.79
Rate for Payer: Aetna Medicare Advantage	$257.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$219.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$219.29
Rate for Payer: Cigna Commercial	$429.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00
Rate for Payer: UnitedHealthcare Community & State	$27.18
Rate for Payer: Wellpoint Medicaid Managed Care	$24.42

DREAMWIRE F/G .035/450cm STR

Facility

$859.98

Service Code	HCPCS C1769
Hospital Charge Code	270643470
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$208.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$172.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.12
Rate for Payer: Qualcare PPO/HMO/WC	$129.00

DRESS BIL MATRIX WOUND BMW4101

Facility

$22,370.00

Hospital Charge Code	270636056
Hospital Revenue Code	272
Min. Negotiated Rate	$635.31
Max. Negotiated Rate	$11,185.00
Rate for Payer: Aetna Commercial	$8,500.60
Rate for Payer: Aetna Medicare Advantage	$6,711.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,704.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,704.35
Rate for Payer: Cigna Commercial	$11,185.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,816.20
Rate for Payer: Oxford Commercial	$4,474.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50
Rate for Payer: UnitedHealthcare Commercial	$4,474.00
Rate for Payer: UnitedHealthcare Community & State	$706.89
Rate for Payer: Wellpoint Medicaid Managed Care	$635.31

DRESS BIL MATRIX WOUND BMW4101

Facility

$22,370.00

Hospital Charge Code	270636056
Hospital Revenue Code	272
Min. Negotiated Rate	$3,355.50
Max. Negotiated Rate	$3,355.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.50

DRESS BILYR MTRX WOUND BMW4051

Facility

$13,625.00

Service Code	HCPCS Q4104
Hospital Charge Code	270635917
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,297.25
Rate for Payer: Aetna Commercial	$402.12
Rate for Payer: Aetna Medicare Advantage	$479.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$536.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$156.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$536.29
Rate for Payer: Cigna Commercial	$296.35
Rate for Payer: Cigna Medicare Advantage	$147.84
Rate for Payer: Clover Medicare Advantage	$140.45
Rate for Payer: EmblemHealth Commercial	$443.52
Rate for Payer: Humana Medicare Advantage	$152.28
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75
Rate for Payer: UnitedHealthcare Community & State	$430.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$386.95

DRESS BILYR MTRX WOUND BMW4051

Facility

$13,625.00

Service Code	HCPCS Q4104
Hospital Charge Code	270635917
Hospital Revenue Code	636
Min. Negotiated Rate	$2,043.75
Max. Negotiated Rate	$3,297.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,297.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,043.75

Know your out-of-pocket cost for care.

All Charges