Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BREASTIMPSIENTRASMTHRNDMOD+415

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699947
Hospital Revenue Code	278
Min. Negotiated Rate	$109.62
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$121.98
Rate for Payer: Wellpoint Medicaid Managed Care	$109.62

BREASTIMPSIENTRASMTHRNDMOD+435

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699948
Hospital Revenue Code	278
Min. Negotiated Rate	$579.00
Max. Negotiated Rate	$934.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00

BREASTIMPSIENTRASMTHRNDMOD+435

Facility

$3,860.00

Service Code	HCPCS L8600
Hospital Charge Code	270699948
Hospital Revenue Code	278
Min. Negotiated Rate	$109.62
Max. Negotiated Rate	$1,930.00
Rate for Payer: Aetna Commercial	$1,466.80
Rate for Payer: Aetna Medicare Advantage	$1,158.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$984.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$772.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$984.30
Rate for Payer: Cigna Commercial	$1,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$934.12
Rate for Payer: Qualcare PPO/HMO/WC	$579.00
Rate for Payer: UnitedHealthcare Community & State	$121.98
Rate for Payer: Wellpoint Medicaid Managed Care	$109.62

BREAST LOCALIZATION MR GUIDE

Facility

$5,102.50

Service Code	HCPCS 19287
Hospital Charge Code	2409035
Hospital Revenue Code	361
Min. Negotiated Rate	$144.91
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.65
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.38
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$161.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$144.91

BREAST LOCALIZATION MR GUIDE

Facility

$5,102.50

Service Code	HCPCS 19287
Hospital Charge Code	2409035
Hospital Revenue Code	361
Min. Negotiated Rate	$765.38
Max. Negotiated Rate	$765.38
Rate for Payer: Qualcare PPO/HMO/WC	$765.38

BREAST LOCALIZATION US GUIDE

Facility

$2,748.55

Service Code	HCPCS 19285
Hospital Charge Code	2309085
Hospital Revenue Code	361
Min. Negotiated Rate	$78.06
Max. Negotiated Rate	$3,629.00
Rate for Payer: Aetna Commercial	$2,288.28
Rate for Payer: Aetna Medicare Advantage	$2,725.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,051.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$841.28
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	$3,051.74
Rate for Payer: Cigna Commercial	$1,686.34
Rate for Payer: Cigna Medicare Advantage	$841.28
Rate for Payer: Clover Medicare Advantage	$799.22
Rate for Payer: EmblemHealth Commercial	$2,523.84
Rate for Payer: Humana Medicare Advantage	$866.52
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$841.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$714.62
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$412.28
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$86.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$841.28
Rate for Payer: Wellcare Medicare Advantage	$841.28
Rate for Payer: Wellpoint Medicaid Managed Care	$78.06

BREAST LOCALIZATION US GUIDE

Facility

$2,748.55

Service Code	HCPCS 19285
Hospital Charge Code	2309085
Hospital Revenue Code	361
Min. Negotiated Rate	$412.28
Max. Negotiated Rate	$412.28
Rate for Payer: Qualcare PPO/HMO/WC	$412.28

BREAST LOCAL MR GUIDE EA ADD L

Facility

$983.40

Service Code	HCPCS 19288
Hospital Charge Code	2409040
Hospital Revenue Code	361
Min. Negotiated Rate	$147.51
Max. Negotiated Rate	$147.51
Rate for Payer: Qualcare PPO/HMO/WC	$147.51

BREAST LOCAL MR GUIDE EA ADD L

Facility

$983.40

Service Code	HCPCS 19288
Hospital Charge Code	2409040
Hospital Revenue Code	361
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$373.69
Rate for Payer: Aetna Medicare Advantage	$295.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$250.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$250.77
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	$250.77
Rate for Payer: Cigna Commercial	$491.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$255.68
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$147.51
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$31.08
Rate for Payer: Wellpoint Medicaid Managed Care	$27.93

BREAST LOCALUS GUIDE EA ADD LE

Facility

$2,321.15

Service Code	HCPCS 19286
Hospital Charge Code	2309090
Hospital Revenue Code	361
Min. Negotiated Rate	$65.92
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$882.04
Rate for Payer: Aetna Medicare Advantage	$696.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.89
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	$591.89
Rate for Payer: Cigna Commercial	$1,160.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.50
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$348.17
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$73.35
Rate for Payer: Wellpoint Medicaid Managed Care	$65.92

BREAST LOCALUS GUIDE EA ADD LE

Facility

$2,321.15

Service Code	HCPCS 19286
Hospital Charge Code	2309090
Hospital Revenue Code	361
Min. Negotiated Rate	$348.17
Max. Negotiated Rate	$348.17
Rate for Payer: Qualcare PPO/HMO/WC	$348.17

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$26,882.63

Service Code	APR-DRG 3632
Min. Negotiated Rate	$26,355.52
Max. Negotiated Rate	$26,882.63
Rate for Payer: UnitedHealthcare Community & State	$26,355.52
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$26,882.63
Rate for Payer: Wellpoint Medicaid Managed Care	$26,355.52

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$33,333.02

Service Code	APR-DRG 3633
Min. Negotiated Rate	$32,679.43
Max. Negotiated Rate	$33,333.02
Rate for Payer: UnitedHealthcare Community & State	$32,679.43
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$33,333.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32,679.43

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$14,111.22

Service Code	APR-DRG 3631
Min. Negotiated Rate	$13,834.53
Max. Negotiated Rate	$14,111.22
Rate for Payer: UnitedHealthcare Community & State	$13,834.53
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$14,111.22
Rate for Payer: Wellpoint Medicaid Managed Care	$13,834.53

BREAST PROCEDURES EXCEPT MASTECTOMY

Facility

$48,848.62

Service Code	APR-DRG 3634
Min. Negotiated Rate	$47,890.80
Max. Negotiated Rate	$48,848.62
Rate for Payer: UnitedHealthcare Community & State	$47,890.80
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$48,848.62
Rate for Payer: Wellpoint Medicaid Managed Care	$47,890.80

BREAST PUMP AMEDA SGL HYGIE

Facility

$96.39

Hospital Charge Code	270657026
Hospital Revenue Code	270
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$14.46
Rate for Payer: Qualcare PPO/HMO/WC	$14.46

BREAST PUMP AMEDA SGL HYGIE

Facility

$96.39

Hospital Charge Code	270657026
Hospital Revenue Code	270
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$48.20
Rate for Payer: Aetna Commercial	$36.63
Rate for Payer: Aetna Medicare Advantage	$28.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$24.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$24.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$24.58
Rate for Payer: Cigna Commercial	$48.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$25.06
Rate for Payer: Oxford Commercial	$19.28
Rate for Payer: Qualcare PPO/HMO/WC	$14.46
Rate for Payer: UnitedHealthcare Commercial	$19.28
Rate for Payer: UnitedHealthcare Community & State	$3.05
Rate for Payer: Wellpoint Medicaid Managed Care	$2.74

BREAST RECONSTR W FF

Facility

$31,390.90

Service Code	HCPCS 19364
Hospital Charge Code	16000537
Hospital Revenue Code	360
Min. Negotiated Rate	$891.50
Max. Negotiated Rate	$15,695.45
Rate for Payer: Aetna Commercial	$11,928.54
Rate for Payer: Aetna Medicare Advantage	$9,417.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,004.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,004.68
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	$8,004.68
Rate for Payer: Cigna Commercial	$15,695.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,161.63
Rate for Payer: Oxford Commercial	$11,677.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,708.64
Rate for Payer: UnitedHealthcare Commercial	$12,906.00
Rate for Payer: UnitedHealthcare Community & State	$991.95
Rate for Payer: Wellpoint Medicaid Managed Care	$891.50

BREAST RECONSTR W FF

Facility

$31,390.90

Service Code	HCPCS 19364
Hospital Charge Code	16000537
Hospital Revenue Code	360
Min. Negotiated Rate	$4,708.64
Max. Negotiated Rate	$4,708.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,708.64

BREAST RECONSTR W/ LAT FLAP

Facility

$21,668.55

Service Code	HCPCS 19361
Hospital Charge Code	1600000458
Hospital Revenue Code	360
Min. Negotiated Rate	$3,250.28
Max. Negotiated Rate	$3,250.28
Rate for Payer: Qualcare PPO/HMO/WC	$3,250.28

BREAST RECONSTR W/ LAT FLAP

Facility

$21,668.55

Service Code	HCPCS 19361
Hospital Charge Code	1600000458
Hospital Revenue Code	360
Min. Negotiated Rate	$615.39
Max. Negotiated Rate	$10,834.27
Rate for Payer: Aetna Commercial	$8,234.05
Rate for Payer: Aetna Medicare Advantage	$6,500.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,525.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,525.48
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	$5,525.48
Rate for Payer: Cigna Commercial	$10,834.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,633.82
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,250.28
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$684.73
Rate for Payer: Wellpoint Medicaid Managed Care	$615.39

BREAST RECONST W TISS EXP

Facility

$57,566.30

Service Code	HCPCS 19357
Hospital Charge Code	16000467
Hospital Revenue Code	360
Min. Negotiated Rate	$1,634.88
Max. Negotiated Rate	$59,389.94
Rate for Payer: Aetna Commercial	$44,532.22
Rate for Payer: Aetna Medicare Advantage	$53,045.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$59,389.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$59,389.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$16,372.14
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	$59,389.94
Rate for Payer: Cigna Commercial	$32,817.88
Rate for Payer: Cigna Medicare Advantage	$16,372.14
Rate for Payer: Clover Medicare Advantage	$15,553.53
Rate for Payer: EmblemHealth Commercial	$49,116.42
Rate for Payer: Humana Medicare Advantage	$16,863.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$16,372.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,967.24
Rate for Payer: Oxford Commercial	$13,407.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94
Rate for Payer: UnitedHealthcare Commercial	$14,869.00
Rate for Payer: UnitedHealthcare Community & State	$1,819.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$16,372.14
Rate for Payer: Wellcare Medicare Advantage	$16,372.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1,634.88

BREAST RECONST W TISS EXP

Facility

$57,566.30

Service Code	HCPCS 19357
Hospital Charge Code	16000467
Hospital Revenue Code	360
Min. Negotiated Rate	$8,634.94
Max. Negotiated Rate	$8,634.94
Rate for Payer: Qualcare PPO/HMO/WC	$8,634.94

BREAST SIZER 450CC

Facility

$1,500.00

Hospital Charge Code	270672833
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 450CC

Facility

$1,500.00

Hospital Charge Code	270672833
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

Know your out-of-pocket cost for care.

All Charges