Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ALLOGRAFT VIADISC NP 100MG

Facility

$49,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270699928
Hospital Revenue Code	278
Min. Negotiated Rate	$7,496.25
Max. Negotiated Rate	$12,093.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,093.95
Rate for Payer: Qualcare PPO/HMO/WC	$7,496.25

ALLOGRAFT VIADISC NP 100MG

Facility

$49,975.00

Service Code	HCPCS C1889
Hospital Charge Code	270699928
Hospital Revenue Code	278
Min. Negotiated Rate	$1,419.29
Max. Negotiated Rate	$24,987.50
Rate for Payer: Aetna Commercial	$18,990.50
Rate for Payer: Aetna Medicare Advantage	$14,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12,743.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12,743.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12,743.62
Rate for Payer: Cigna Commercial	$24,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,093.95
Rate for Payer: Qualcare PPO/HMO/WC	$7,496.25
Rate for Payer: UnitedHealthcare Community & State	$1,579.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,419.29

ALLOGRAFT VIAFLOW MATRIX 1.0CC

Facility

$25,580.00

Service Code	HCPCS C1734
Hospital Charge Code	270700503
Hospital Revenue Code	278
Min. Negotiated Rate	$3,837.00
Max. Negotiated Rate	$6,190.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,190.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,837.00

ALLOGRAFT VIAFLOW MATRIX 1.0CC

Facility

$25,580.00

Service Code	HCPCS C1734
Hospital Charge Code	270700503
Hospital Revenue Code	278
Min. Negotiated Rate	$726.47
Max. Negotiated Rate	$12,790.00
Rate for Payer: Aetna Commercial	$9,720.40
Rate for Payer: Aetna Medicare Advantage	$7,674.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,522.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,522.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,522.90
Rate for Payer: Cigna Commercial	$12,790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,190.36
Rate for Payer: Qualcare PPO/HMO/WC	$3,837.00
Rate for Payer: UnitedHealthcare Community & State	$808.33
Rate for Payer: Wellpoint Medicaid Managed Care	$726.47

ALLOGRAFT VIAGENEX MAX 3X5CM

Facility

$8,500.00

Service Code	HCPCS Q4205
Hospital Charge Code	270699124
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,057.00
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	$1,700.00
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	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

ALLOGRAFT VIAGENEX MAX 3X5CM

Facility

$8,500.00

Service Code	HCPCS Q4205
Hospital Charge Code	270699124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

ALLOMATRIX 10CC

Facility

$5,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270677317
Hospital Revenue Code	278
Min. Negotiated Rate	$150.52
Max. Negotiated Rate	$2,650.00
Rate for Payer: Aetna Commercial	$2,014.00
Rate for Payer: Aetna Medicare Advantage	$1,590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,351.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,351.50
Rate for Payer: Cigna Commercial	$2,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: Qualcare PPO/HMO/WC	$795.00
Rate for Payer: UnitedHealthcare Community & State	$167.48
Rate for Payer: Wellpoint Medicaid Managed Care	$150.52

ALLOMATRIX 10CC

Facility

$5,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270677317
Hospital Revenue Code	278
Min. Negotiated Rate	$795.00
Max. Negotiated Rate	$1,282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,060.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,282.60
Rate for Payer: Qualcare PPO/HMO/WC	$795.00

ALLOMATRIX 20CC

Facility

$2,184.00

Hospital Charge Code	270335684
Hospital Revenue Code	278
Min. Negotiated Rate	$327.60
Max. Negotiated Rate	$528.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.53
Rate for Payer: Qualcare PPO/HMO/WC	$327.60

ALLOMATRIX 20CC

Facility

$2,184.00

Hospital Charge Code	270335684
Hospital Revenue Code	278
Min. Negotiated Rate	$62.03
Max. Negotiated Rate	$1,092.00
Rate for Payer: Aetna Commercial	$829.92
Rate for Payer: Aetna Medicare Advantage	$655.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.92
Rate for Payer: Cigna Commercial	$1,092.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.53
Rate for Payer: Qualcare PPO/HMO/WC	$327.60
Rate for Payer: UnitedHealthcare Community & State	$69.01
Rate for Payer: Wellpoint Medicaid Managed Care	$62.03

ALLOMATRIX 5CC PUTTY

Facility

$8,715.00

Service Code	HCPCS C9359
Hospital Charge Code	270665925
Hospital Revenue Code	278
Min. Negotiated Rate	$247.51
Max. Negotiated Rate	$4,357.50
Rate for Payer: Aetna Commercial	$3,311.70
Rate for Payer: Aetna Medicare Advantage	$2,614.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,222.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,222.32
Rate for Payer: Cigna Commercial	$4,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25
Rate for Payer: UnitedHealthcare Community & State	$275.39
Rate for Payer: Wellpoint Medicaid Managed Care	$247.51

ALLOMATRIX 5CC PUTTY

Facility

$8,715.00

Service Code	HCPCS C9359
Hospital Charge Code	270665925
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.25
Max. Negotiated Rate	$2,109.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,743.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,109.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,307.25

ALLOPATCH HD THICK 4CMx8CM

Facility

$8,840.00

Service Code	HCPCS Q4128
Hospital Charge Code	270683019
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,139.28
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	$1,768.00
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	$2,139.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.00
Rate for Payer: UnitedHealthcare Community & State	$279.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$251.06

ALLOPATCH HD THICK 4CMx8CM

Facility

$8,840.00

Service Code	HCPCS Q4128
Hospital Charge Code	270683019
Hospital Revenue Code	278
Min. Negotiated Rate	$1,326.00
Max. Negotiated Rate	$2,139.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,768.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,139.28
Rate for Payer: Qualcare PPO/HMO/WC	$1,326.00

ALLOPURE 8MM EVANS

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270682192
Hospital Revenue Code	278
Min. Negotiated Rate	$1,311.75
Max. Negotiated Rate	$2,116.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75

ALLOPURE 8MM EVANS

Facility

$8,745.00

Service Code	HCPCS C1713
Hospital Charge Code	270682192
Hospital Revenue Code	278
Min. Negotiated Rate	$248.36
Max. Negotiated Rate	$4,372.50
Rate for Payer: Aetna Commercial	$3,323.10
Rate for Payer: Aetna Medicare Advantage	$2,623.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,229.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,749.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,229.97
Rate for Payer: Cigna Commercial	$4,372.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,116.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,311.75
Rate for Payer: UnitedHealthcare Community & State	$276.34
Rate for Payer: Wellpoint Medicaid Managed Care	$248.36

ALLOPURE COTTON ALLOGRAFT

Facility

$2,640.00

Hospital Charge Code	270339463
Hospital Revenue Code	278
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$638.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

ALLOPURE COTTON ALLOGRAFT

Facility

$2,640.00

Hospital Charge Code	270339463
Hospital Revenue Code	278
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Community & State	$83.42
Rate for Payer: Wellpoint Medicaid Managed Care	$74.98

ALLOPURE EVANS WEDGE-BONE

Facility

$2,950.00

Hospital Charge Code	270339462
Hospital Revenue Code	278
Min. Negotiated Rate	$83.78
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$93.22
Rate for Payer: Wellpoint Medicaid Managed Care	$83.78

ALLOPURE EVANS WEDGE-BONE

Facility

$2,950.00

Hospital Charge Code	270339462
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

ALLOPURINOL 100 MG TAB

Facility

$4.00

Service Code	NDC 51079020520
Hospital Charge Code	60628511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

ALLOPURINOL 100 MG TAB

Facility

$4.00

Service Code	NDC 51079020520
Hospital Charge Code	60628511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

ALLOPURINOL 300 MG TAB

Facility

$5.09

Service Code	NDC 51079020620
Hospital Charge Code	60628512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$1.93
Rate for Payer: Aetna Medicare Advantage	$1.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.30
Rate for Payer: Cigna Commercial	$2.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.32
Rate for Payer: Oxford Commercial	$1.02
Rate for Payer: Qualcare PPO/HMO/WC	$0.76
Rate for Payer: UnitedHealthcare Commercial	$1.02
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.14

ALLOPURINOL 300 MG TAB

Facility

$5.09

Service Code	NDC 51079020620
Hospital Charge Code	60628512
Hospital Revenue Code	250
Min. Negotiated Rate	$0.76
Max. Negotiated Rate	$0.76
Rate for Payer: Qualcare PPO/HMO/WC	$0.76

ALLOSYNC DBM CHIPS 5CC

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705656
Hospital Revenue Code	278
Min. Negotiated Rate	$517.50
Max. Negotiated Rate	$834.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50

Know your out-of-pocket cost for care.

All Charges