Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DRESSING SURESITE 2-3/8x2-3/4

Facility

$1.56

Hospital Charge Code	270350205
Hospital Revenue Code	272
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.78
Rate for Payer: Aetna Commercial	$0.59
Rate for Payer: Aetna Medicare Advantage	$0.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.40
Rate for Payer: Cigna Commercial	$0.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.41
Rate for Payer: Oxford Commercial	$0.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.23
Rate for Payer: UnitedHealthcare Commercial	$0.31
Rate for Payer: UnitedHealthcare Community & State	$0.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.04

DRESSING TEGADERM FORM SQ 4X4

Facility

$114.75

Hospital Charge Code	270641597
Hospital Revenue Code	270
Min. Negotiated Rate	$17.21
Max. Negotiated Rate	$17.21
Rate for Payer: Qualcare PPO/HMO/WC	$17.21

DRESSING TEGADERM FORM SQ 4X4

Facility

$114.75

Hospital Charge Code	270641597
Hospital Revenue Code	270
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$57.38
Rate for Payer: Aetna Commercial	$43.60
Rate for Payer: Aetna Medicare Advantage	$34.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.26
Rate for Payer: Cigna Commercial	$57.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.84
Rate for Payer: Oxford Commercial	$22.95
Rate for Payer: Qualcare PPO/HMO/WC	$17.21
Rate for Payer: UnitedHealthcare Commercial	$22.95
Rate for Payer: UnitedHealthcare Community & State	$3.63
Rate for Payer: Wellpoint Medicaid Managed Care	$3.26

DRESSING TELFA 4 X 3 INCH

Facility

$21.36

Hospital Charge Code	270641461
Hospital Revenue Code	272
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.68
Rate for Payer: Aetna Commercial	$8.12
Rate for Payer: Aetna Medicare Advantage	$6.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.45
Rate for Payer: Cigna Commercial	$10.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.55
Rate for Payer: Oxford Commercial	$4.27
Rate for Payer: Qualcare PPO/HMO/WC	$3.20
Rate for Payer: UnitedHealthcare Commercial	$4.27
Rate for Payer: UnitedHealthcare Community & State	$0.67
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

DRESSING TELFA 4 X 3 INCH

Facility

$21.36

Hospital Charge Code	270641461
Hospital Revenue Code	272
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$3.20
Rate for Payer: Qualcare PPO/HMO/WC	$3.20

DRESSING TELFA ISLAND 4 X 5

Facility

$2.05

Hospital Charge Code	270625585
Hospital Revenue Code	272
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.02
Rate for Payer: Aetna Commercial	$0.78
Rate for Payer: Aetna Medicare Advantage	$0.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.52
Rate for Payer: Cigna Commercial	$1.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.53
Rate for Payer: Oxford Commercial	$0.41
Rate for Payer: Qualcare PPO/HMO/WC	$0.31
Rate for Payer: UnitedHealthcare Commercial	$0.41
Rate for Payer: UnitedHealthcare Community & State	$0.06
Rate for Payer: Wellpoint Medicaid Managed Care	$0.06

DRESSING TELFA ISLAND 4 X 5

Facility

$2.05

Hospital Charge Code	270625585
Hospital Revenue Code	272
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Qualcare PPO/HMO/WC	$0.31

DRESSING TUBIGRIP DZ E 151434

Facility

$145.55

Hospital Charge Code	270639043
Hospital Revenue Code	272
Min. Negotiated Rate	$4.13
Max. Negotiated Rate	$72.78
Rate for Payer: Aetna Commercial	$55.31
Rate for Payer: Aetna Medicare Advantage	$43.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.12
Rate for Payer: Cigna Commercial	$72.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.84
Rate for Payer: Oxford Commercial	$29.11
Rate for Payer: Qualcare PPO/HMO/WC	$21.83
Rate for Payer: UnitedHealthcare Commercial	$29.11
Rate for Payer: UnitedHealthcare Community & State	$4.60
Rate for Payer: Wellpoint Medicaid Managed Care	$4.13

DRESSING TUBIGRIP DZ E 151434

Facility

$145.55

Hospital Charge Code	270639043
Hospital Revenue Code	272
Min. Negotiated Rate	$21.83
Max. Negotiated Rate	$21.83
Rate for Payer: Qualcare PPO/HMO/WC	$21.83

DRESSING TUBIGRIP SZ D 151437

Facility

$138.40

Hospital Charge Code	270639042
Hospital Revenue Code	272
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$69.20
Rate for Payer: Aetna Commercial	$52.59
Rate for Payer: Aetna Medicare Advantage	$41.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.29
Rate for Payer: Cigna Commercial	$69.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.98
Rate for Payer: Oxford Commercial	$27.68
Rate for Payer: Qualcare PPO/HMO/WC	$20.76
Rate for Payer: UnitedHealthcare Commercial	$27.68
Rate for Payer: UnitedHealthcare Community & State	$4.37
Rate for Payer: Wellpoint Medicaid Managed Care	$3.93

DRESSING TUBIGRIP SZ D 151437

Facility

$138.40

Hospital Charge Code	270639042
Hospital Revenue Code	272
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$20.76
Rate for Payer: Qualcare PPO/HMO/WC	$20.76

DRESSING TUBIGRIP SZ F 151438

Facility

$170.40

Hospital Charge Code	270639044
Hospital Revenue Code	272
Min. Negotiated Rate	$4.84
Max. Negotiated Rate	$85.20
Rate for Payer: Aetna Commercial	$64.75
Rate for Payer: Aetna Medicare Advantage	$51.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.45
Rate for Payer: Cigna Commercial	$85.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.30
Rate for Payer: Oxford Commercial	$34.08
Rate for Payer: Qualcare PPO/HMO/WC	$25.56
Rate for Payer: UnitedHealthcare Commercial	$34.08
Rate for Payer: UnitedHealthcare Community & State	$5.38
Rate for Payer: Wellpoint Medicaid Managed Care	$4.84

DRESSING TUBIGRIP SZ F 151438

Facility

$170.40

Hospital Charge Code	270639044
Hospital Revenue Code	272
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$25.56
Rate for Payer: Qualcare PPO/HMO/WC	$25.56

DRESSING TUBIGRIP SZ G 151439

Facility

$196.95

Hospital Charge Code	270639045
Hospital Revenue Code	272
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$98.47
Rate for Payer: Aetna Commercial	$74.84
Rate for Payer: Aetna Medicare Advantage	$59.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$50.22
Rate for Payer: Cigna Commercial	$98.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$51.21
Rate for Payer: Oxford Commercial	$39.39
Rate for Payer: Qualcare PPO/HMO/WC	$29.54
Rate for Payer: UnitedHealthcare Commercial	$39.39
Rate for Payer: UnitedHealthcare Community & State	$6.22
Rate for Payer: Wellpoint Medicaid Managed Care	$5.59

DRESSING TUBIGRIP SZ G 151439

Facility

$196.95

Hospital Charge Code	270639045
Hospital Revenue Code	272
Min. Negotiated Rate	$29.54
Max. Negotiated Rate	$29.54
Rate for Payer: Qualcare PPO/HMO/WC	$29.54

DRESSING XERFORM 1X8 OVRP

Facility

$2.32

Hospital Charge Code	270649934
Hospital Revenue Code	270
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Qualcare PPO/HMO/WC	$0.35

DRESSING XERFORM 1X8 OVRP

Facility

$2.32

Hospital Charge Code	270649934
Hospital Revenue Code	270
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.16
Rate for Payer: Aetna Commercial	$0.88
Rate for Payer: Aetna Medicare Advantage	$0.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.59
Rate for Payer: Cigna Commercial	$1.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.60
Rate for Payer: Oxford Commercial	$0.46
Rate for Payer: Qualcare PPO/HMO/WC	$0.35
Rate for Payer: UnitedHealthcare Commercial	$0.46
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.07

DRIAN DUET EXTERNAL

Facility

$2,092.50

Service Code	HCPCS C1729
Hospital Charge Code	270697602
Hospital Revenue Code	278
Min. Negotiated Rate	$313.88
Max. Negotiated Rate	$506.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$418.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.38
Rate for Payer: Qualcare PPO/HMO/WC	$313.88

DRIAN DUET EXTERNAL

Facility

$2,092.50

Service Code	HCPCS C1729
Hospital Charge Code	270697602
Hospital Revenue Code	278
Min. Negotiated Rate	$59.43
Max. Negotiated Rate	$1,046.25
Rate for Payer: Aetna Commercial	$795.15
Rate for Payer: Aetna Medicare Advantage	$627.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$533.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$533.59
Rate for Payer: Cigna Commercial	$1,046.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.38
Rate for Payer: Qualcare PPO/HMO/WC	$313.88
Rate for Payer: UnitedHealthcare Community & State	$66.12
Rate for Payer: Wellpoint Medicaid Managed Care	$59.43

DRIL BIT1.8m W/DEP MARK310.509

Facility

$650.00

Hospital Charge Code	270637244
Hospital Revenue Code	272
Min. Negotiated Rate	$18.46
Max. Negotiated Rate	$325.00
Rate for Payer: Aetna Commercial	$247.00
Rate for Payer: Aetna Medicare Advantage	$195.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$165.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$165.75
Rate for Payer: Cigna Commercial	$325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.00
Rate for Payer: Oxford Commercial	$130.00
Rate for Payer: Qualcare PPO/HMO/WC	$97.50
Rate for Payer: UnitedHealthcare Commercial	$130.00
Rate for Payer: UnitedHealthcare Community & State	$20.54
Rate for Payer: Wellpoint Medicaid Managed Care	$18.46

DRIL BIT1.8m W/DEP MARK310.509

Facility

$650.00

Hospital Charge Code	270637244
Hospital Revenue Code	272
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$97.50
Rate for Payer: Qualcare PPO/HMO/WC	$97.50

DRIL BIT 2.4MM DIA 65MML

Facility

$2,625.00

Hospital Charge Code	270693359
Hospital Revenue Code	272
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$997.50
Rate for Payer: Aetna Medicare Advantage	$787.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$669.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$669.38
Rate for Payer: Cigna Commercial	$1,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$682.50
Rate for Payer: Oxford Commercial	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$393.75
Rate for Payer: UnitedHealthcare Commercial	$525.00
Rate for Payer: UnitedHealthcare Community & State	$82.95
Rate for Payer: Wellpoint Medicaid Managed Care	$74.55

DRIL BIT 2.4MM DIA 65MML

Facility

$2,625.00

Hospital Charge Code	270693359
Hospital Revenue Code	272
Min. Negotiated Rate	$393.75
Max. Negotiated Rate	$393.75
Rate for Payer: Qualcare PPO/HMO/WC	$393.75

DRILL 02.3x14MM PCC-1

Facility

$820.00

Hospital Charge Code	270684228
Hospital Revenue Code	272
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$311.60
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.20
Rate for Payer: Oxford Commercial	$164.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Commercial	$164.00
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$23.29

DRILL 02.3x14MM PCC-1

Facility

$820.00

Hospital Charge Code	270684228
Hospital Revenue Code	272
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

Know your out-of-pocket cost for care.

All Charges