Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TI ROD 70MM PREBENT LORDOTI

Facility

$4,580.00

Hospital Charge Code	270660949
Hospital Revenue Code	278
Min. Negotiated Rate	$687.00
Max. Negotiated Rate	$1,108.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$916.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,108.36
Rate for Payer: Qualcare PPO/HMO/WC	$687.00

TIS MATRX 9.6x19.3CM THIN

Facility

$27,445.00

Service Code	HCPCS Q4116
Hospital Charge Code	270675064
Hospital Revenue Code	278
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,489.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

TIS MATRX 9.6x19.3CM THIN

Facility

$27,445.00

Service Code	HCPCS Q4116
Hospital Charge Code	270675064
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$6,641.69
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	$5,489.00
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	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75
Rate for Payer: UnitedHealthcare Community & State	$867.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$779.44

TIS MATRX 9.6x19.3CM TH/SQCMJW

Facility

$139.69

Hospital Charge Code	270675064W
Hospital Revenue Code	636
Min. Negotiated Rate	$20.95
Max. Negotiated Rate	$33.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95

TIS MATRX 9.6x19.3CM TH/SQCMJW

Facility

$139.69

Hospital Charge Code	270675064W
Hospital Revenue Code	636
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$69.84
Rate for Payer: Aetna Commercial	$53.08
Rate for Payer: Aetna Medicare Advantage	$41.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$35.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$35.62
Rate for Payer: Cigna Commercial	$69.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$33.80
Rate for Payer: Qualcare PPO/HMO/WC	$20.95
Rate for Payer: UnitedHealthcare Community & State	$4.41
Rate for Payer: Wellpoint Medicaid Managed Care	$3.97

TI SPRL BLD 65MM F/T FEM NAILS

Facility

$2,563.85

Service Code	HCPCS C1713
Hospital Charge Code	270687937
Hospital Revenue Code	278
Min. Negotiated Rate	$384.58
Max. Negotiated Rate	$620.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$512.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.45
Rate for Payer: Qualcare PPO/HMO/WC	$384.58

TI SPRL BLD 65MM F/T FEM NAILS

Facility

$2,563.85

Service Code	HCPCS C1713
Hospital Charge Code	270687937
Hospital Revenue Code	278
Min. Negotiated Rate	$72.81
Max. Negotiated Rate	$1,281.92
Rate for Payer: Aetna Commercial	$974.26
Rate for Payer: Aetna Medicare Advantage	$769.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$653.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$653.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$512.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$653.78
Rate for Payer: Cigna Commercial	$1,281.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$620.45
Rate for Payer: Qualcare PPO/HMO/WC	$384.58
Rate for Payer: UnitedHealthcare Community & State	$81.02
Rate for Payer: Wellpoint Medicaid Managed Care	$72.81

TISS CULT/NON-NEOPLASTIC LYMPH

Facility

$820.00

Service Code	HCPCS 88230
Hospital Charge Code	38477207
Hospital Revenue Code	311
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$422.57
Rate for Payer: Aetna Commercial	$316.85
Rate for Payer: Aetna Medicare Advantage	$377.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$422.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$422.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$116.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$422.57
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: Cigna Medicare Advantage	$116.49
Rate for Payer: Clover Medicare Advantage	$110.67
Rate for Payer: EmblemHealth Commercial	$349.47
Rate for Payer: Humana Medicare Advantage	$119.98
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$116.49
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$213.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$93.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$116.49
Rate for Payer: Wellcare Medicare Advantage	$116.49
Rate for Payer: Wellpoint Medicaid Managed Care	$23.29

TISS CULT/NON-NEOPLASTIC LYMPH

Facility

$820.00

Service Code	HCPCS 88230
Hospital Charge Code	38477207
Hospital Revenue Code	311
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$123.00
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

TISSEAL FIBRIN SEALANT

Facility

$1,031.95

Hospital Charge Code	270660608
Hospital Revenue Code	272
Min. Negotiated Rate	$154.79
Max. Negotiated Rate	$154.79
Rate for Payer: Qualcare PPO/HMO/WC	$154.79

TISSEAL FIBRIN SEALANT

Facility

$1,031.95

Hospital Charge Code	270660608
Hospital Revenue Code	272
Min. Negotiated Rate	$29.31
Max. Negotiated Rate	$515.98
Rate for Payer: Aetna Commercial	$392.14
Rate for Payer: Aetna Medicare Advantage	$309.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.15
Rate for Payer: Cigna Commercial	$515.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.31
Rate for Payer: Oxford Commercial	$206.39
Rate for Payer: Qualcare PPO/HMO/WC	$154.79
Rate for Payer: UnitedHealthcare Commercial	$206.39
Rate for Payer: UnitedHealthcare Community & State	$32.61
Rate for Payer: Wellpoint Medicaid Managed Care	$29.31

TISSEEL 10ML FROZEN RTU

Facility

$957.85

Service Code	HCPCS C9250
Hospital Charge Code	270662412
Hospital Revenue Code	636
Min. Negotiated Rate	$27.20
Max. Negotiated Rate	$521.27
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.27
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.80
Rate for Payer: Qualcare PPO/HMO/WC	$143.68
Rate for Payer: UnitedHealthcare Community & State	$30.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$27.20

TISSEEL 10ML FROZEN RTU

Facility

$2,350.65

Service Code	HCPCS C9250
Hospital Charge Code	270662413
Hospital Revenue Code	636
Min. Negotiated Rate	$352.60
Max. Negotiated Rate	$568.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.86
Rate for Payer: Qualcare PPO/HMO/WC	$352.60

TISSEEL 10ML FROZEN RTU

Facility

$2,350.65

Service Code	HCPCS C9250
Hospital Charge Code	270662413
Hospital Revenue Code	636
Min. Negotiated Rate	$66.76
Max. Negotiated Rate	$568.86
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.27
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$568.86
Rate for Payer: Qualcare PPO/HMO/WC	$352.60
Rate for Payer: UnitedHealthcare Community & State	$74.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$66.76

TISSEEL 10ML FROZEN RTU

Facility

$957.85

Service Code	HCPCS C9250
Hospital Charge Code	270662412
Hospital Revenue Code	636
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$231.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.80
Rate for Payer: Qualcare PPO/HMO/WC	$143.68

TISSEEL 2ML FROZEN RTU

Facility

$571.45

Service Code	HCPCS C9250
Hospital Charge Code	270662411
Hospital Revenue Code	636
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$521.27
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.27
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.29
Rate for Payer: Qualcare PPO/HMO/WC	$85.72
Rate for Payer: UnitedHealthcare Community & State	$18.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$16.23

TISSEEL 2ML FROZEN RTU

Facility

$571.45

Service Code	HCPCS C9250
Hospital Charge Code	270662411
Hospital Revenue Code	636
Min. Negotiated Rate	$85.72
Max. Negotiated Rate	$138.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$138.29
Rate for Payer: Qualcare PPO/HMO/WC	$85.72

TISSEEL 4ML FROZEN PRIMA

Facility

$986.60

Service Code	HCPCS C9250
Hospital Charge Code	270687687
Hospital Revenue Code	636
Min. Negotiated Rate	$28.02
Max. Negotiated Rate	$521.27
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.27
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.76
Rate for Payer: Qualcare PPO/HMO/WC	$147.99
Rate for Payer: UnitedHealthcare Community & State	$31.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$28.02

TISSEEL 4ML FROZEN PRIMA

Facility

$986.60

Service Code	HCPCS C9250
Hospital Charge Code	270687687
Hospital Revenue Code	636
Min. Negotiated Rate	$147.99
Max. Negotiated Rate	$238.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$238.76
Rate for Payer: Qualcare PPO/HMO/WC	$147.99

TISSEEL FIBRIN SEALANT

Facility

$600.95

Service Code	HCPCS C9250
Hospital Charge Code	270653751
Hospital Revenue Code	636
Min. Negotiated Rate	$90.14
Max. Negotiated Rate	$145.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.43
Rate for Payer: Qualcare PPO/HMO/WC	$90.14

TISSEEL FIBRIN SEALANT

Facility

$600.95

Service Code	HCPCS C9250
Hospital Charge Code	270653751
Hospital Revenue Code	636
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$521.27
Rate for Payer: Aetna Commercial	$390.86
Rate for Payer: Aetna Medicare Advantage	$465.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.27
Rate for Payer: Cigna Medicare Advantage	$143.70
Rate for Payer: Clover Medicare Advantage	$136.51
Rate for Payer: EmblemHealth Commercial	$431.10
Rate for Payer: Humana Medicare Advantage	$148.01
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.43
Rate for Payer: Qualcare PPO/HMO/WC	$90.14
Rate for Payer: UnitedHealthcare Community & State	$18.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.70
Rate for Payer: Wellcare Medicare Advantage	$143.70
Rate for Payer: Wellpoint Medicaid Managed Care	$17.07

TISSEEL KIT 4ML

Facility

$516.64

Service Code	NDC 338840204
Hospital Charge Code	606361017
Hospital Revenue Code	250
Min. Negotiated Rate	$14.67
Max. Negotiated Rate	$258.32
Rate for Payer: Aetna Commercial	$196.32
Rate for Payer: Aetna Medicare Advantage	$154.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.74
Rate for Payer: Cigna Commercial	$258.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$134.33
Rate for Payer: Oxford Commercial	$103.33
Rate for Payer: Qualcare PPO/HMO/WC	$77.50
Rate for Payer: UnitedHealthcare Commercial	$103.33
Rate for Payer: UnitedHealthcare Community & State	$16.33
Rate for Payer: Wellpoint Medicaid Managed Care	$14.67

TISSEEL KIT 4ML

Facility

$516.64

Service Code	NDC 338840204
Hospital Charge Code	606361017
Hospital Revenue Code	250
Min. Negotiated Rate	$77.50
Max. Negotiated Rate	$77.50
Rate for Payer: Qualcare PPO/HMO/WC	$77.50

TISSEEL VHSD FROZEN PRIMA 2ML

Facility

$606.25

Hospital Charge Code	270687686
Hospital Revenue Code	272
Min. Negotiated Rate	$17.22
Max. Negotiated Rate	$303.12
Rate for Payer: Aetna Commercial	$230.38
Rate for Payer: Aetna Medicare Advantage	$181.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$154.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$154.59
Rate for Payer: Cigna Commercial	$303.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.62
Rate for Payer: Oxford Commercial	$121.25
Rate for Payer: Qualcare PPO/HMO/WC	$90.94
Rate for Payer: UnitedHealthcare Commercial	$121.25
Rate for Payer: UnitedHealthcare Community & State	$19.16
Rate for Payer: Wellpoint Medicaid Managed Care	$17.22

TISSEEL VHSD FROZEN PRIMA 2ML

Facility

$606.25

Hospital Charge Code	270687686
Hospital Revenue Code	272
Min. Negotiated Rate	$90.94
Max. Negotiated Rate	$90.94
Rate for Payer: Qualcare PPO/HMO/WC	$90.94

Know your out-of-pocket cost for care.

All Charges