Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TISSUE EXPANDER HI PRO 750CC

Facility

$10,625.00

Service Code	HCPCS C1789
Hospital Charge Code	270675148
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 750CC

Facility

$10,625.00

Service Code	HCPCS C1789
Hospital Charge Code	270675148
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 Matrix 600cc

Facility

$7,975.00

Hospital Charge Code	270663628
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

Tissue Expander Matrix 600cc

Facility

$7,975.00

Hospital Charge Code	270663628
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

TISSUE EXPANDERS 800cc W/TABS

Facility

$6,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270673926
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 EXPANDERS 800cc W/TABS

Facility

$6,750.00

Service Code	HCPCS C1789
Hospital Charge Code	270673926
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 EXPANDERS 900cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270673927
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 EXPANDERS 900cc W/TABS

Facility

$6,750.00

Hospital Charge Code	270673927
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 EXTRACTOR BRUSH BENT

Facility

$1,250.00

Hospital Charge Code	270674906
Hospital Revenue Code	272
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$325.00
Rate for Payer: Oxford Commercial	$250.00
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Commercial	$250.00
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

TISSUE EXTRACTOR BRUSH BENT

Facility

$1,250.00

Hospital Charge Code	270674906
Hospital Revenue Code	272
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$187.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

TISSUE FEM CNDYLLE HEMI LF LAT

Facility

$59,265.00

Hospital Charge Code	270684017
Hospital Revenue Code	278
Min. Negotiated Rate	$8,889.75
Max. Negotiated Rate	$14,342.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75

TISSUE FEM CNDYLLE HEMI LF LAT

Facility

$59,265.00

Hospital Charge Code	270684017
Hospital Revenue Code	278
Min. Negotiated Rate	$1,683.13
Max. Negotiated Rate	$29,632.50
Rate for Payer: Aetna Commercial	$22,520.70
Rate for Payer: Aetna Medicare Advantage	$17,779.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,112.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,853.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,112.58
Rate for Payer: Cigna Commercial	$29,632.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,342.13
Rate for Payer: Qualcare PPO/HMO/WC	$8,889.75
Rate for Payer: UnitedHealthcare Community & State	$1,872.77
Rate for Payer: Wellpoint Medicaid Managed Care	$1,683.13

TISSUE GRAFTS OTHER

Facility

$26,848.40

Service Code	HCPCS 15769
Hospital Charge Code	1600000620
Hospital Revenue Code	360
Min. Negotiated Rate	$762.49
Max. Negotiated Rate	$15,271.92
Rate for Payer: Aetna Commercial	$11,451.31
Rate for Payer: Aetna Medicare Advantage	$13,640.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,271.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4,210.04
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	$15,271.92
Rate for Payer: Cigna Commercial	$8,439.01
Rate for Payer: Cigna Medicare Advantage	$4,210.04
Rate for Payer: Clover Medicare Advantage	$3,999.54
Rate for Payer: EmblemHealth Commercial	$12,630.12
Rate for Payer: Humana Medicare Advantage	$4,336.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4,210.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,980.58
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$848.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,210.04
Rate for Payer: Wellcare Medicare Advantage	$4,210.04
Rate for Payer: Wellpoint Medicaid Managed Care	$762.49

TISSUE GRAFTS OTHER

Facility

$26,848.40

Service Code	HCPCS 15769
Hospital Charge Code	1600000620
Hospital Revenue Code	360
Min. Negotiated Rate	$4,027.26
Max. Negotiated Rate	$4,027.26
Rate for Payer: Qualcare PPO/HMO/WC	$4,027.26

TISSUE HUMAN DBM PLUS 10CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270663413
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

TISSUE HUMAN DBM PLUS 10CC

Facility

$9,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270663413
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$296.25
Rate for Payer: Wellpoint Medicaid Managed Care	$266.25

TISSUE HUMAN DBM PLUS 5CC

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270663414
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

TISSUE HUMAN DBM PLUS 5CC

Facility

$5,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270663414
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

TISSUE MATRIX 1x2CM THICK

Facility

$1,015.00

Hospital Charge Code	270675237
Hospital Revenue Code	636
Min. Negotiated Rate	$152.25
Max. Negotiated Rate	$245.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.63
Rate for Payer: Qualcare PPO/HMO/WC	$152.25

TISSUE MATRIX 1x2CM THICK

Facility

$1,015.00

Hospital Charge Code	270675237
Hospital Revenue Code	636
Min. Negotiated Rate	$28.83
Max. Negotiated Rate	$507.50
Rate for Payer: Aetna Commercial	$385.70
Rate for Payer: Aetna Medicare Advantage	$304.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$258.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$258.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$258.82
Rate for Payer: Cigna Commercial	$507.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.63
Rate for Payer: Qualcare PPO/HMO/WC	$152.25
Rate for Payer: UnitedHealthcare Community & State	$32.07
Rate for Payer: Wellpoint Medicaid Managed Care	$28.83

TISSUE MATRIX 5 X 7

Facility

$7,500.00

Hospital Charge Code	270666123
Hospital Revenue Code	636
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

TISSUE MATRIX 5 X 7

Facility

$7,500.00

Hospital Charge Code	270666123
Hospital Revenue Code	636
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

TISSUE MATRIX 6x12CM

Facility

$13,535.00

Service Code	HCPCS Q4116
Hospital Charge Code	270685337
Hospital Revenue Code	278
Min. Negotiated Rate	$2,030.25
Max. Negotiated Rate	$3,275.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,707.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,275.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,030.25

TISSUE MATRIX 6x12CM

Facility

$13,535.00

Service Code	HCPCS Q4116
Hospital Charge Code	270685337
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,275.47
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	$2,707.00
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	$3,275.47
Rate for Payer: Qualcare PPO/HMO/WC	$2,030.25
Rate for Payer: UnitedHealthcare Community & State	$427.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$384.39

TISSUE MATRIX LIQUID LARGE

Facility

$27,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270674908
Hospital Revenue Code	278
Min. Negotiated Rate	$772.48
Max. Negotiated Rate	$13,600.00
Rate for Payer: Aetna Commercial	$10,336.00
Rate for Payer: Aetna Medicare Advantage	$8,160.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,936.00
Rate for Payer: Cigna Commercial	$13,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,582.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,080.00
Rate for Payer: UnitedHealthcare Community & State	$859.52
Rate for Payer: Wellpoint Medicaid Managed Care	$772.48

Know your out-of-pocket cost for care.

All Charges