Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGFT MAGNUS VIABLE CELL 2CC

Facility

$9,475.00

Service Code	HCPCS C1763
Hospital Charge Code	270692963
Hospital Revenue Code	278
Min. Negotiated Rate	$269.09
Max. Negotiated Rate	$4,737.50
Rate for Payer: Aetna Commercial	$3,600.50
Rate for Payer: Aetna Medicare Advantage	$2,842.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,416.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,416.12
Rate for Payer: Cigna Commercial	$4,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25
Rate for Payer: UnitedHealthcare Community & State	$299.41
Rate for Payer: Wellpoint Medicaid Managed Care	$269.09

ALLOGFT MAGNUS VIABLE CELL 2CC

Facility

$9,475.00

Service Code	HCPCS C1763
Hospital Charge Code	270692963
Hospital Revenue Code	278
Min. Negotiated Rate	$1,421.25
Max. Negotiated Rate	$2,292.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,895.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,292.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,421.25

ALLOGRAFT 10CC OF BONUS TRIAD

Facility

$29,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270691847
Hospital Revenue Code	278
Min. Negotiated Rate	$4,410.00
Max. Negotiated Rate	$7,114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,880.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,114.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,410.00

ALLOGRAFT 10CC OF BONUS TRIAD

Facility

$29,400.00

Service Code	HCPCS C1713
Hospital Charge Code	270691847
Hospital Revenue Code	278
Min. Negotiated Rate	$834.96
Max. Negotiated Rate	$14,700.00
Rate for Payer: Aetna Commercial	$11,172.00
Rate for Payer: Aetna Medicare Advantage	$8,820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,497.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,880.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,497.00
Rate for Payer: Cigna Commercial	$14,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,114.80
Rate for Payer: Qualcare PPO/HMO/WC	$4,410.00
Rate for Payer: UnitedHealthcare Community & State	$929.04
Rate for Payer: Wellpoint Medicaid Managed Care	$834.96

ALLOGRAFT ACUPAC ADVANCE 10CC

Facility

$37,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696335
Hospital Revenue Code	278
Min. Negotiated Rate	$1,072.10
Max. Negotiated Rate	$18,875.00
Rate for Payer: Aetna Commercial	$14,345.00
Rate for Payer: Aetna Medicare Advantage	$11,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,626.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,626.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,626.25
Rate for Payer: Cigna Commercial	$18,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,135.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,662.50
Rate for Payer: UnitedHealthcare Community & State	$1,192.90
Rate for Payer: Wellpoint Medicaid Managed Care	$1,072.10

ALLOGRAFT ACUPAC ADVANCE 10CC

Facility

$37,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270696335
Hospital Revenue Code	278
Min. Negotiated Rate	$5,662.50
Max. Negotiated Rate	$9,135.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,135.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,662.50

ALLOGRAFT AMINO EXCEL 4x8CM

Facility

$4,462.50

Service Code	HCPCS Q4137
Hospital Charge Code	270677589
Hospital Revenue Code	278
Min. Negotiated Rate	$669.38
Max. Negotiated Rate	$1,079.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,079.92
Rate for Payer: Qualcare PPO/HMO/WC	$669.38

ALLOGRAFT AMINO EXCEL 4x8CM

Facility

$4,462.50

Service Code	HCPCS Q4137
Hospital Charge Code	270677589
Hospital Revenue Code	278
Min. Negotiated Rate	$126.73
Max. Negotiated Rate	$1,079.92
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	$892.50
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	$1,079.92
Rate for Payer: Qualcare PPO/HMO/WC	$669.38
Rate for Payer: UnitedHealthcare Community & State	$141.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$126.73

ALLOGRAFT AMNIO MEMBRANE 2.0ML

Facility

$16,950.00

Service Code	HCPCS C1762
Hospital Charge Code	270662657
Hospital Revenue Code	278
Min. Negotiated Rate	$481.38
Max. Negotiated Rate	$8,475.00
Rate for Payer: Aetna Commercial	$6,441.00
Rate for Payer: Aetna Medicare Advantage	$5,085.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,322.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,322.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,322.25
Rate for Payer: Cigna Commercial	$8,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,101.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,542.50
Rate for Payer: UnitedHealthcare Community & State	$535.62
Rate for Payer: Wellpoint Medicaid Managed Care	$481.38

ALLOGRAFT AMNIO MEMBRANE 2.0ML

Facility

$16,950.00

Service Code	HCPCS C1762
Hospital Charge Code	270662657
Hospital Revenue Code	278
Min. Negotiated Rate	$2,542.50
Max. Negotiated Rate	$4,101.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,101.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,542.50

ALLOGRAFT AMNIOTC MEMBRANE 2x3

Facility

$5,883.75

Hospital Charge Code	270658378
Hospital Revenue Code	278
Min. Negotiated Rate	$167.10
Max. Negotiated Rate	$2,941.88
Rate for Payer: Aetna Commercial	$2,235.82
Rate for Payer: Aetna Medicare Advantage	$1,765.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,500.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,500.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,500.36
Rate for Payer: Cigna Commercial	$2,941.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,423.87
Rate for Payer: Qualcare PPO/HMO/WC	$882.56
Rate for Payer: UnitedHealthcare Community & State	$185.93
Rate for Payer: Wellpoint Medicaid Managed Care	$167.10

ALLOGRAFT AMNIOTC MEMBRANE 2x3

Facility

$5,883.75

Hospital Charge Code	270658378
Hospital Revenue Code	278
Min. Negotiated Rate	$882.56
Max. Negotiated Rate	$1,423.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,176.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,423.87
Rate for Payer: Qualcare PPO/HMO/WC	$882.56

ALLOGRAFT AMNIOTC MEMBRANE 3x3

Facility

$7,998.75

Service Code	HCPCS C1762
Hospital Charge Code	270658381
Hospital Revenue Code	278
Min. Negotiated Rate	$227.16
Max. Negotiated Rate	$3,999.38
Rate for Payer: Aetna Commercial	$3,039.53
Rate for Payer: Aetna Medicare Advantage	$2,399.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,039.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,039.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,599.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,039.68
Rate for Payer: Cigna Commercial	$3,999.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,935.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,199.81
Rate for Payer: UnitedHealthcare Community & State	$252.76
Rate for Payer: Wellpoint Medicaid Managed Care	$227.16

ALLOGRAFT AMNIOTC MEMBRANE 3x3

Facility

$7,998.75

Service Code	HCPCS C1762
Hospital Charge Code	270658381
Hospital Revenue Code	278
Min. Negotiated Rate	$1,199.81
Max. Negotiated Rate	$1,935.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,599.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,935.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,199.81

ALLOGRAFT AMNIOTC MEMBRANE 4x4

Facility

$12,440.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633
Hospital Revenue Code	636
Min. Negotiated Rate	$1,866.00
Max. Negotiated Rate	$3,010.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,010.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.00

ALLOGRAFT AMNIOTC MEMBRANE 4x4

Facility

$12,440.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633
Hospital Revenue Code	636
Min. Negotiated Rate	$353.30
Max. Negotiated Rate	$6,220.00
Rate for Payer: Aetna Commercial	$4,727.20
Rate for Payer: Aetna Medicare Advantage	$3,732.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,172.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,172.20
Rate for Payer: Cigna Commercial	$6,220.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,010.48
Rate for Payer: Qualcare PPO/HMO/WC	$1,866.00
Rate for Payer: UnitedHealthcare Community & State	$393.10
Rate for Payer: Wellpoint Medicaid Managed Care	$353.30

ALLOGRAFT AMNIOTC MEMBRANE 4X6

Facility

$17,690.00

Service Code	HCPCS C1762
Hospital Charge Code	270658382
Hospital Revenue Code	278
Min. Negotiated Rate	$502.40
Max. Negotiated Rate	$8,845.00
Rate for Payer: Aetna Commercial	$6,722.20
Rate for Payer: Aetna Medicare Advantage	$5,307.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,510.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,510.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,538.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,510.95
Rate for Payer: Cigna Commercial	$8,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,280.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,653.50
Rate for Payer: UnitedHealthcare Community & State	$559.00
Rate for Payer: Wellpoint Medicaid Managed Care	$502.40

ALLOGRAFT AMNIOTC MEMBRANE 4X6

Facility

$17,690.00

Service Code	HCPCS C1762
Hospital Charge Code	270658382
Hospital Revenue Code	278
Min. Negotiated Rate	$2,653.50
Max. Negotiated Rate	$4,280.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,538.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,280.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,653.50

ALLOGRAFT AMNIOTIC 100MG

Facility

$7,975.00

Service Code	HCPCS C1762
Hospital Charge Code	270664471
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

ALLOGRAFT AMNIOTIC 100MG

Facility

$7,975.00

Service Code	HCPCS C1762
Hospital Charge Code	270664471
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

ALLOGRAFT AMNIOTIC MEMBRANE

Facility

$7,975.00

Hospital Charge Code	270666218
Hospital Revenue Code	810
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) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,073.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

ALLOGRAFT AMNIOTIC MEMBRANE

Facility

$7,975.00

Hospital Charge Code	270666218
Hospital Revenue Code	810
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

ALLOGRAFT AMNIOTIC MEMBRANE 4X

Facility

$17,500.00

Hospital Charge Code	270663734
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

ALLOGRAFT AMNIOTIC MEMBRANE 4X

Facility

$17,500.00

Hospital Charge Code	270663734
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

ALLOGRAFT AMNIOTIC MEMBRANE4X4

Facility

$9,330.00

Service Code	HCPCS Q4100
Hospital Charge Code	270660633W
Hospital Revenue Code	636
Min. Negotiated Rate	$264.97
Max. Negotiated Rate	$4,665.00
Rate for Payer: Aetna Commercial	$3,545.40
Rate for Payer: Aetna Medicare Advantage	$2,799.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,379.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,379.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,379.15
Rate for Payer: Cigna Commercial	$4,665.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,257.86
Rate for Payer: Qualcare PPO/HMO/WC	$1,399.50
Rate for Payer: UnitedHealthcare Community & State	$294.83
Rate for Payer: Wellpoint Medicaid Managed Care	$264.97

Know your out-of-pocket cost for care.

All Charges