Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TISSUE MATRIX LIQUID LARGE

Facility

$27,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270674908
Hospital Revenue Code	278
Min. Negotiated Rate	$4,080.00
Max. Negotiated Rate	$6,582.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,582.40
Rate for Payer: Qualcare PPO/HMO/WC	$4,080.00

TISSUEMEND 6CMX 10 CM

Facility

$15,784.25

Service Code	HCPCS Q4100
Hospital Charge Code	270686061
Hospital Revenue Code	636
Min. Negotiated Rate	$2,367.64
Max. Negotiated Rate	$3,819.79
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,819.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,367.64

TISSUEMEND 6CMX 10 CM

Facility

$15,784.25

Service Code	HCPCS Q4100
Hospital Charge Code	270686061
Hospital Revenue Code	636
Min. Negotiated Rate	$448.27
Max. Negotiated Rate	$7,892.12
Rate for Payer: Aetna Commercial	$5,998.02
Rate for Payer: Aetna Medicare Advantage	$4,735.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,024.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,024.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,024.98
Rate for Payer: Cigna Commercial	$7,892.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,819.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,367.64
Rate for Payer: UnitedHealthcare Community & State	$498.78
Rate for Payer: Wellpoint Medicaid Managed Care	$448.27

TISSUE MEND PATCH

Facility

$3,373.00

Hospital Charge Code	270335733
Hospital Revenue Code	278
Min. Negotiated Rate	$505.95
Max. Negotiated Rate	$816.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$674.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.27
Rate for Payer: Qualcare PPO/HMO/WC	$505.95

TISSUE MEND PATCH

Facility

$3,373.00

Hospital Charge Code	270335733
Hospital Revenue Code	278
Min. Negotiated Rate	$95.79
Max. Negotiated Rate	$1,686.50
Rate for Payer: Aetna Commercial	$1,281.74
Rate for Payer: Aetna Medicare Advantage	$1,011.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$674.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.12
Rate for Payer: Cigna Commercial	$1,686.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$816.27
Rate for Payer: Qualcare PPO/HMO/WC	$505.95
Rate for Payer: UnitedHealthcare Community & State	$106.59
Rate for Payer: Wellpoint Medicaid Managed Care	$95.79

TISSUE PKP FULL THICKNESS

Facility

$17,250.00

Hospital Charge Code	270688742
Hospital Revenue Code	278
Min. Negotiated Rate	$489.90
Max. Negotiated Rate	$8,625.00
Rate for Payer: Aetna Commercial	$6,555.00
Rate for Payer: Aetna Medicare Advantage	$5,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,398.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,398.75
Rate for Payer: Cigna Commercial	$8,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50
Rate for Payer: UnitedHealthcare Community & State	$545.10
Rate for Payer: Wellpoint Medicaid Managed Care	$489.90

TISSUE PKP FULL THICKNESS

Facility

$17,250.00

Hospital Charge Code	270688742
Hospital Revenue Code	278
Min. Negotiated Rate	$2,587.50
Max. Negotiated Rate	$4,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,174.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,587.50

TISSUE REMOVAL KIT

Facility

$4,225.00

Hospital Charge Code	270662181
Hospital Revenue Code	272
Min. Negotiated Rate	$119.99
Max. Negotiated Rate	$2,112.50
Rate for Payer: Aetna Commercial	$1,605.50
Rate for Payer: Aetna Medicare Advantage	$1,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.38
Rate for Payer: Cigna Commercial	$2,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,098.50
Rate for Payer: Oxford Commercial	$845.00
Rate for Payer: Qualcare PPO/HMO/WC	$633.75
Rate for Payer: UnitedHealthcare Commercial	$845.00
Rate for Payer: UnitedHealthcare Community & State	$133.51
Rate for Payer: Wellpoint Medicaid Managed Care	$119.99

TISSUE REMOVAL KIT

Facility

$4,225.00

Hospital Charge Code	270662181
Hospital Revenue Code	272
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$633.75
Rate for Payer: Qualcare PPO/HMO/WC	$633.75

TISSUE REMOVAL KIT TX2

Facility

$4,225.00

Hospital Charge Code	270677971
Hospital Revenue Code	272
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$633.75
Rate for Payer: Qualcare PPO/HMO/WC	$633.75

TISSUE REMOVAL KIT TX2

Facility

$4,225.00

Hospital Charge Code	270677971
Hospital Revenue Code	272
Min. Negotiated Rate	$119.99
Max. Negotiated Rate	$2,112.50
Rate for Payer: Aetna Commercial	$1,605.50
Rate for Payer: Aetna Medicare Advantage	$1,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.38
Rate for Payer: Cigna Commercial	$2,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,098.50
Rate for Payer: Oxford Commercial	$845.00
Rate for Payer: Qualcare PPO/HMO/WC	$633.75
Rate for Payer: UnitedHealthcare Commercial	$845.00
Rate for Payer: UnitedHealthcare Community & State	$133.51
Rate for Payer: Wellpoint Medicaid Managed Care	$119.99

TISSUE REMOVAL SYSTEM

Facility

$3,490.00

Hospital Charge Code	270339541
Hospital Revenue Code	272
Min. Negotiated Rate	$523.50
Max. Negotiated Rate	$523.50
Rate for Payer: Qualcare PPO/HMO/WC	$523.50

TISSUE REMOVAL SYSTEM

Facility

$3,490.00

Hospital Charge Code	270339541
Hospital Revenue Code	272
Min. Negotiated Rate	$99.12
Max. Negotiated Rate	$1,745.00
Rate for Payer: Aetna Commercial	$1,326.20
Rate for Payer: Aetna Medicare Advantage	$1,047.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$889.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$889.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$889.95
Rate for Payer: Cigna Commercial	$1,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.40
Rate for Payer: Oxford Commercial	$698.00
Rate for Payer: Qualcare PPO/HMO/WC	$523.50
Rate for Payer: UnitedHealthcare Commercial	$698.00
Rate for Payer: UnitedHealthcare Community & State	$110.28
Rate for Payer: Wellpoint Medicaid Managed Care	$99.12

TISSUE SPLITTER BLADE SPIN

Facility

$5,231.25

Service Code	HCPCS A4649
Hospital Charge Code	270697433
Hospital Revenue Code	272
Min. Negotiated Rate	$784.69
Max. Negotiated Rate	$784.69
Rate for Payer: Qualcare PPO/HMO/WC	$784.69

TISSUE SPLITTER BLADE SPIN

Facility

$5,231.25

Service Code	HCPCS A4649
Hospital Charge Code	270697433
Hospital Revenue Code	272
Min. Negotiated Rate	$148.57
Max. Negotiated Rate	$2,615.62
Rate for Payer: Aetna Commercial	$1,987.88
Rate for Payer: Aetna Medicare Advantage	$1,569.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,333.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,333.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,333.97
Rate for Payer: Cigna Commercial	$2,615.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,360.12
Rate for Payer: Oxford Commercial	$1,046.25
Rate for Payer: Qualcare PPO/HMO/WC	$784.69
Rate for Payer: UnitedHealthcare Commercial	$1,046.25
Rate for Payer: UnitedHealthcare Community & State	$165.31
Rate for Payer: Wellpoint Medicaid Managed Care	$148.57

TISSUE TRANSGLUTAM(IGG,A) I

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISSUE TRANSGLUTAM(IGG,A) I

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071A
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TISSUE TRANSGLUTAM(IGG,A) II

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071B
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

TISSUE TRANSGLUTAM(IGG,A) II

Facility

$390.00

Service Code	HCPCS 8351691
Hospital Charge Code	39990071B
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
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	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

TISSUE TRANSGLUTAMINASE, IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476796
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTAMINASE, IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38476796
Hospital Revenue Code	301
Min. Negotiated Rate	$2.47
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	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$43.50
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	$22.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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	$2.47

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479420
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479418
Hospital Revenue Code	301
Min. Negotiated Rate	$2.47
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	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$43.50
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	$22.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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	$2.47

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479420
Hospital Revenue Code	301
Min. Negotiated Rate	$2.47
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	$14.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.83
Rate for Payer: Cigna Commercial	$43.50
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	$22.62
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.05
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	$2.47

TISSUE TRANSGLUTAMINASE,IGA

Facility

$87.00

Service Code	HCPCS 83516
Hospital Charge Code	38479418
Hospital Revenue Code	301
Min. Negotiated Rate	$13.05
Max. Negotiated Rate	$13.05
Rate for Payer: Qualcare PPO/HMO/WC	$13.05

Know your out-of-pocket cost for care.

All Charges