Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TISSEEL VHSD FROZEN PRIMA 8ML

Facility

$2,421.17

Service Code	HCPCS A4649
Hospital Charge Code	270687688
Hospital Revenue Code	272
Min. Negotiated Rate	$68.76
Max. Negotiated Rate	$1,210.59
Rate for Payer: Aetna Commercial	$920.04
Rate for Payer: Aetna Medicare Advantage	$726.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$617.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$617.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$617.40
Rate for Payer: Cigna Commercial	$1,210.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$629.50
Rate for Payer: Oxford Commercial	$484.23
Rate for Payer: Qualcare PPO/HMO/WC	$363.18
Rate for Payer: UnitedHealthcare Commercial	$484.23
Rate for Payer: UnitedHealthcare Community & State	$76.51
Rate for Payer: Wellpoint Medicaid Managed Care	$68.76

TISSEEL VHSD FROZEN PRIMA 8ML

Facility

$2,421.17

Service Code	HCPCS A4649
Hospital Charge Code	270687688
Hospital Revenue Code	272
Min. Negotiated Rate	$363.18
Max. Negotiated Rate	$363.18
Rate for Payer: Qualcare PPO/HMO/WC	$363.18

TISS MATRX FIRM 20x25CM

Facility

$83,055.00

Hospital Charge Code	270661025
Hospital Revenue Code	636
Min. Negotiated Rate	$2,358.76
Max. Negotiated Rate	$41,527.50
Rate for Payer: Aetna Commercial	$31,560.90
Rate for Payer: Aetna Medicare Advantage	$24,916.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21,179.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21,179.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21,179.03
Rate for Payer: Cigna Commercial	$41,527.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,099.31
Rate for Payer: Qualcare PPO/HMO/WC	$12,458.25
Rate for Payer: UnitedHealthcare Community & State	$2,624.54
Rate for Payer: Wellpoint Medicaid Managed Care	$2,358.76

TISS MATRX FIRM 20x25CM

Facility

$83,055.00

Hospital Charge Code	270661025
Hospital Revenue Code	636
Min. Negotiated Rate	$12,458.25
Max. Negotiated Rate	$20,099.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,099.31
Rate for Payer: Qualcare PPO/HMO/WC	$12,458.25

TISS MATRX FIRM 20x25CM/SQCMJW

Facility

$166.11

Hospital Charge Code	270661025W
Hospital Revenue Code	636
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$40.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.92

TISS MATRX FIRM 20x25CM/SQCMJW

Facility

$166.11

Hospital Charge Code	270661025W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$83.06
Rate for Payer: Aetna Commercial	$63.12
Rate for Payer: Aetna Medicare Advantage	$49.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.36
Rate for Payer: Cigna Commercial	$83.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.92
Rate for Payer: UnitedHealthcare Community & State	$5.25
Rate for Payer: Wellpoint Medicaid Managed Care	$4.72

TISS THROMBOPLASTIN INH T

Facility

$51.80

Service Code	HCPCS 85705
Hospital Charge Code	39900185
Hospital Revenue Code	305
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$26.19
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.93
Rate for Payer: Cigna Commercial	$25.90
Rate for Payer: Cigna Medicare Advantage	$9.63
Rate for Payer: Clover Medicare Advantage	$9.15
Rate for Payer: EmblemHealth Commercial	$28.89
Rate for Payer: Humana Medicare Advantage	$9.92
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$9.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.47
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$7.77
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$7.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.63
Rate for Payer: Wellcare Medicare Advantage	$9.63
Rate for Payer: Wellpoint Medicaid Managed Care	$1.47

TISS THROMBOPLASTIN INH T

Facility

$51.80

Service Code	HCPCS 85705
Hospital Charge Code	39900185
Hospital Revenue Code	305
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$7.77
Rate for Payer: Qualcare PPO/HMO/WC	$7.77

TISS TRANSGLUTAMINASE IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39990009EX
Hospital Revenue Code	301
Min. Negotiated Rate	$9.22
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TISS TRANSGLUTAMINASE IGG

Facility

$390.00

Service Code	HCPCS 83516
Hospital Charge Code	39990009EX
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISS TRANSGLUTAMINASE IGG I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009A
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.67
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

TISS TRANSGLUTAMINASE IGG I

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

TISS TRANSGLUTAMINASE IGG II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009B
Hospital Revenue Code	301
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$28.75
Rate for Payer: Aetna Medicare Advantage	$22.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.29
Rate for Payer: Cigna Commercial	$37.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.67
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$11.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$2.39
Rate for Payer: Wellpoint Medicaid Managed Care	$2.15

TISS TRANSGLUTAMINASE IGG II

Facility

$75.65

Service Code	HCPCS 8351691
Hospital Charge Code	39990009B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.35
Max. Negotiated Rate	$11.35
Rate for Payer: Qualcare PPO/HMO/WC	$11.35

TISS TRNSGLTMNASE EA IG CLASS

Facility

$115.30

Service Code	HCPCS 86364
Hospital Charge Code	401186364B
Hospital Revenue Code	302
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$31.36
Rate for Payer: Aetna Medicare Advantage	$37.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$57.65
Rate for Payer: Cigna Medicare Advantage	$11.53
Rate for Payer: Clover Medicare Advantage	$10.95
Rate for Payer: EmblemHealth Commercial	$34.59
Rate for Payer: Humana Medicare Advantage	$11.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$17.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.53
Rate for Payer: Wellcare Medicare Advantage	$11.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.27

TISS TRNSGLTMNASE EA IG CLASS

Facility

$115.30

Service Code	HCPCS 86364
Hospital Charge Code	401186364B
Hospital Revenue Code	302
Min. Negotiated Rate	$17.30
Max. Negotiated Rate	$17.30
Rate for Payer: Qualcare PPO/HMO/WC	$17.30

TISSUE AUGMENT 3 CC

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270678103
Hospital Revenue Code	278
Min. Negotiated Rate	$2,621.25
Max. Negotiated Rate	$4,228.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25

TISSUE AUGMENT 3 CC

Facility

$17,475.00

Service Code	HCPCS C1713
Hospital Charge Code	270678103
Hospital Revenue Code	278
Min. Negotiated Rate	$496.29
Max. Negotiated Rate	$8,737.50
Rate for Payer: Aetna Commercial	$6,640.50
Rate for Payer: Aetna Medicare Advantage	$5,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,456.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,456.12
Rate for Payer: Cigna Commercial	$8,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,228.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,621.25
Rate for Payer: UnitedHealthcare Community & State	$552.21
Rate for Payer: Wellpoint Medicaid Managed Care	$496.29

TISSUE BIOFIX FLOW PLACENT 1CC

Facility

$10,875.00

Service Code	HCPCS Q4114
Hospital Charge Code	270681641
Hospital Revenue Code	636
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$2,631.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

TISSUE BIOFIX FLOW PLACENT 1CC

Facility

$10,875.00

Service Code	HCPCS Q4114
Hospital Charge Code	270681641
Hospital Revenue Code	636
Min. Negotiated Rate	$308.85
Max. Negotiated Rate	$5,437.50
Rate for Payer: Aetna Commercial	$4,132.50
Rate for Payer: Aetna Medicare Advantage	$3,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,773.12
Rate for Payer: Cigna Commercial	$5,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25
Rate for Payer: UnitedHealthcare Community & State	$343.65
Rate for Payer: Wellpoint Medicaid Managed Care	$308.85

TISSUE CLARIX COR 1K 1.5x1.5cm

Facility

$5,975.00

Service Code	HCPCS Q4100
Hospital Charge Code	270679120
Hospital Revenue Code	636
Min. Negotiated Rate	$169.69
Max. Negotiated Rate	$2,987.50
Rate for Payer: Aetna Commercial	$2,270.50
Rate for Payer: Aetna Medicare Advantage	$1,792.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,523.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,523.62
Rate for Payer: Cigna Commercial	$2,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25
Rate for Payer: UnitedHealthcare Community & State	$188.81
Rate for Payer: Wellpoint Medicaid Managed Care	$169.69

TISSUE CLARIX COR 1K 1.5x1.5cm

Facility

$5,975.00

Service Code	HCPCS Q4100
Hospital Charge Code	270679120
Hospital Revenue Code	636
Min. Negotiated Rate	$896.25
Max. Negotiated Rate	$1,445.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,445.95
Rate for Payer: Qualcare PPO/HMO/WC	$896.25

TISSUE CULT, ADDL STUDY

Facility

$156.00

Service Code	HCPCS 87253
Hospital Charge Code	38475118
Hospital Revenue Code	309
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$54.94
Rate for Payer: Aetna Medicare Advantage	$65.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$73.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$73.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$20.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$73.28
Rate for Payer: Cigna Commercial	$78.00
Rate for Payer: Cigna Medicare Advantage	$20.20
Rate for Payer: Clover Medicare Advantage	$19.19
Rate for Payer: EmblemHealth Commercial	$60.60
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$20.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$40.56
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$23.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.20
Rate for Payer: Wellcare Medicare Advantage	$20.20
Rate for Payer: Wellpoint Medicaid Managed Care	$4.43

TISSUE CULT, ADDL STUDY

Facility

$156.00

Service Code	HCPCS 87253
Hospital Charge Code	38475118
Hospital Revenue Code	309
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$23.40
Rate for Payer: Qualcare PPO/HMO/WC	$23.40

TISSUE CULT,NEOPLASTIC;BONE,BL

Facility

$889.00

Service Code	HCPCS 88237
Hospital Charge Code	38474056
Hospital Revenue Code	311
Min. Negotiated Rate	$133.35
Max. Negotiated Rate	$133.35
Rate for Payer: Qualcare PPO/HMO/WC	$133.35

Know your out-of-pocket cost for care.

All Charges