Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TISSUE CULT,NEOPLASTIC;BONE,BL

Facility

$889.00

Service Code	HCPCS 88237
Hospital Charge Code	38474056
Hospital Revenue Code	311
Min. Negotiated Rate	$25.25
Max. Negotiated Rate	$521.45
Rate for Payer: Aetna Commercial	$391.00
Rate for Payer: Aetna Medicare Advantage	$465.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$521.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$521.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$521.45
Rate for Payer: Cigna Commercial	$444.50
Rate for Payer: Cigna Medicare Advantage	$143.75
Rate for Payer: Clover Medicare Advantage	$136.56
Rate for Payer: EmblemHealth Commercial	$431.25
Rate for Payer: Humana Medicare Advantage	$148.06
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$143.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$231.14
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$133.35
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$115.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$143.75
Rate for Payer: Wellcare Medicare Advantage	$143.75
Rate for Payer: Wellpoint Medicaid Managed Care	$25.25

TISSUE CULT NEOPLASTIC SOLID

Facility

$1,038.00

Service Code	HCPCS 88239
Hospital Charge Code	38477212
Hospital Revenue Code	311
Min. Negotiated Rate	$29.48
Max. Negotiated Rate	$535.13
Rate for Payer: Aetna Commercial	$401.25
Rate for Payer: Aetna Medicare Advantage	$477.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$535.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$535.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$147.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$535.13
Rate for Payer: Cigna Commercial	$519.00
Rate for Payer: Cigna Medicare Advantage	$147.52
Rate for Payer: Clover Medicare Advantage	$140.14
Rate for Payer: EmblemHealth Commercial	$442.56
Rate for Payer: Humana Medicare Advantage	$151.95
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$147.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.88
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$155.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$118.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.52
Rate for Payer: Wellcare Medicare Advantage	$147.52
Rate for Payer: Wellpoint Medicaid Managed Care	$29.48

TISSUE CULT NEOPLASTIC SOLID

Facility

$1,038.00

Service Code	HCPCS 88239
Hospital Charge Code	38477212
Hospital Revenue Code	311
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$155.70
Rate for Payer: Qualcare PPO/HMO/WC	$155.70

TISSUE CULT NON-NEOPLASTIC AMN

Facility

$1,036.00

Service Code	HCPCS 88235
Hospital Charge Code	38477211
Hospital Revenue Code	311
Min. Negotiated Rate	$155.40
Max. Negotiated Rate	$155.40
Rate for Payer: Qualcare PPO/HMO/WC	$155.40

TISSUE CULT NON-NEOPLASTIC AMN

Facility

$1,036.00

Service Code	HCPCS 88235
Hospital Charge Code	38477211
Hospital Revenue Code	311
Min. Negotiated Rate	$29.42
Max. Negotiated Rate	$545.21
Rate for Payer: Aetna Commercial	$408.82
Rate for Payer: Aetna Medicare Advantage	$486.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$545.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$545.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$150.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$545.21
Rate for Payer: Cigna Commercial	$518.00
Rate for Payer: Cigna Medicare Advantage	$150.30
Rate for Payer: Clover Medicare Advantage	$142.78
Rate for Payer: EmblemHealth Commercial	$450.90
Rate for Payer: Humana Medicare Advantage	$154.81
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$150.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$269.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$155.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$120.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$150.30
Rate for Payer: Wellcare Medicare Advantage	$150.30
Rate for Payer: Wellpoint Medicaid Managed Care	$29.42

TISSUE EXAMNTN BY KOH SLIDE

Facility

$30.00

Service Code	HCPCS 87220
Hospital Charge Code	38477027
Hospital Revenue Code	309
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$11.61
Rate for Payer: Aetna Medicare Advantage	$13.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.49
Rate for Payer: Cigna Commercial	$15.00
Rate for Payer: Cigna Medicare Advantage	$4.27
Rate for Payer: Clover Medicare Advantage	$4.06
Rate for Payer: EmblemHealth Commercial	$12.81
Rate for Payer: Humana Medicare Advantage	$4.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.80
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$4.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.27
Rate for Payer: Wellcare Medicare Advantage	$4.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.85

TISSUE EXAMNTN BY KOH SLIDE

Facility

$30.00

Service Code	HCPCS 87220
Hospital Charge Code	38477027
Hospital Revenue Code	309
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Qualcare PPO/HMO/WC	$4.50

TISSUE EXPAND ALLOX2 360-430CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270695704
Hospital Revenue Code	278
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$4,500.00
Rate for Payer: Aetna Commercial	$3,420.00
Rate for Payer: Aetna Medicare Advantage	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,295.00
Rate for Payer: Cigna Commercial	$4,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00
Rate for Payer: UnitedHealthcare Community & State	$284.40
Rate for Payer: Wellpoint Medicaid Managed Care	$255.60

TISSUE EXPAND ALLOX2 360-430CC

Facility

$9,000.00

Service Code	HCPCS C1789
Hospital Charge Code	270695704
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

TISSUE EXPANDER 400CC

Facility

$5,650.00

Hospital Charge Code	270663196
Hospital Revenue Code	278
Min. Negotiated Rate	$160.46
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$178.54
Rate for Payer: Wellpoint Medicaid Managed Care	$160.46

TISSUE EXPANDER 400CC

Facility

$5,650.00

Hospital Charge Code	270663196
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

TISSUE EXPANDER 500CC

Facility

$5,650.00

Hospital Charge Code	270663197
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

TISSUE EXPANDER 500CC

Facility

$5,650.00

Hospital Charge Code	270663197
Hospital Revenue Code	278
Min. Negotiated Rate	$160.46
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$178.54
Rate for Payer: Wellpoint Medicaid Managed Care	$160.46

TISSUE EXPANDER 650cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270674353
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

TISSUE EXPANDER 650cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270674353
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

TISSUE EXPANDER - BREAST

Facility

$2,262.00

Hospital Charge Code	270335672
Hospital Revenue Code	278
Min. Negotiated Rate	$339.30
Max. Negotiated Rate	$547.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$452.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$547.40
Rate for Payer: Qualcare PPO/HMO/WC	$339.30

TISSUE EXPANDER - BREAST

Facility

$2,262.00

Hospital Charge Code	270335672
Hospital Revenue Code	278
Min. Negotiated Rate	$64.24
Max. Negotiated Rate	$1,131.00
Rate for Payer: Aetna Commercial	$859.56
Rate for Payer: Aetna Medicare Advantage	$678.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$576.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$576.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$452.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$576.81
Rate for Payer: Cigna Commercial	$1,131.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$547.40
Rate for Payer: Qualcare PPO/HMO/WC	$339.30
Rate for Payer: UnitedHealthcare Community & State	$71.48
Rate for Payer: Wellpoint Medicaid Managed Care	$64.24

TISSUE EXPANDER - FINGER

Facility

$1,600.00

Hospital Charge Code	270335671
Hospital Revenue Code	278
Min. Negotiated Rate	$45.44
Max. Negotiated Rate	$800.00
Rate for Payer: Aetna Commercial	$608.00
Rate for Payer: Aetna Medicare Advantage	$480.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$408.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$408.00
Rate for Payer: Cigna Commercial	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00
Rate for Payer: UnitedHealthcare Community & State	$50.56
Rate for Payer: Wellpoint Medicaid Managed Care	$45.44

TISSUE EXPANDER - FINGER

Facility

$1,600.00

Hospital Charge Code	270335671
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$387.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$387.20
Rate for Payer: Qualcare PPO/HMO/WC	$240.00

TISSUE EXPANDER HI PRO 475CC

Facility

$10,625.00

Hospital Charge Code	270675145
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER HI PRO 475CC

Facility

$10,625.00

Hospital Charge Code	270675145
Hospital Revenue Code	278
Min. Negotiated Rate	$301.75
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$335.75
Rate for Payer: Wellpoint Medicaid Managed Care	$301.75

TISSUE EXPANDER HI PRO 500CC

Facility

$10,625.00

Hospital Charge Code	270675146
Hospital Revenue Code	278
Min. Negotiated Rate	$301.75
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$335.75
Rate for Payer: Wellpoint Medicaid Managed Care	$301.75

TISSUE EXPANDER HI PRO 500CC

Facility

$10,625.00

Hospital Charge Code	270675146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

TISSUE EXPANDER HI PRO 600CC

Facility

$10,625.00

Hospital Charge Code	270675147
Hospital Revenue Code	278
Min. Negotiated Rate	$301.75
Max. Negotiated Rate	$5,312.50
Rate for Payer: Aetna Commercial	$4,037.50
Rate for Payer: Aetna Medicare Advantage	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,709.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,709.38
Rate for Payer: Cigna Commercial	$5,312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75
Rate for Payer: UnitedHealthcare Community & State	$335.75
Rate for Payer: Wellpoint Medicaid Managed Care	$301.75

TISSUE EXPANDER HI PRO 600CC

Facility

$10,625.00

Hospital Charge Code	270675147
Hospital Revenue Code	278
Min. Negotiated Rate	$1,593.75
Max. Negotiated Rate	$2,571.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,571.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,593.75

Know your out-of-pocket cost for care.

All Charges