Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ALLOSYNC DBM CHIPS 5CC

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270705656
Hospital Revenue Code	278
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$1,725.00
Rate for Payer: Aetna Commercial	$1,311.00
Rate for Payer: Aetna Medicare Advantage	$1,035.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$879.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$879.75
Rate for Payer: Cigna Commercial	$1,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$834.90
Rate for Payer: Qualcare PPO/HMO/WC	$517.50
Rate for Payer: UnitedHealthcare Community & State	$109.02
Rate for Payer: Wellpoint Medicaid Managed Care	$97.98

ALLOSYNC DBM GEL 10 CC

Facility

$6,000.00

Service Code	HCPCS C9359
Hospital Charge Code	270683168
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

ALLOSYNC DBM GEL 10 CC

Facility

$6,000.00

Service Code	HCPCS C9359
Hospital Charge Code	270683168
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

AlloSync DBM Gel, 1cc

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270684930
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$242.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00

AlloSync DBM Gel, 1cc

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270684930
Hospital Revenue Code	278
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$500.00
Rate for Payer: Aetna Commercial	$380.00
Rate for Payer: Aetna Medicare Advantage	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$255.00
Rate for Payer: Cigna Commercial	$500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$242.00
Rate for Payer: Qualcare PPO/HMO/WC	$150.00
Rate for Payer: UnitedHealthcare Community & State	$31.60
Rate for Payer: Wellpoint Medicaid Managed Care	$28.40

ALLOSYNC DBM PUTTY 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690303
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

ALLOSYNC DBM PUTTY 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690303
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

ALLOSYNC PURE 5CC

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686677
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

ALLOSYNC PURE 5CC

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270686677
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

ALLOWRAP DRY

Facility

$14,975.00

Service Code	HCPCS C1765
Hospital Charge Code	270704775
Hospital Revenue Code	278
Min. Negotiated Rate	$425.29
Max. Negotiated Rate	$7,487.50
Rate for Payer: Aetna Commercial	$5,690.50
Rate for Payer: Aetna Medicare Advantage	$4,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,818.62
Rate for Payer: Cigna Commercial	$7,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25
Rate for Payer: UnitedHealthcare Community & State	$473.21
Rate for Payer: Wellpoint Medicaid Managed Care	$425.29

ALLOWRAP DRY

Facility

$14,975.00

Service Code	HCPCS C1765
Hospital Charge Code	270704775
Hospital Revenue Code	278
Min. Negotiated Rate	$2,246.25
Max. Negotiated Rate	$3,623.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25

ALLOWRAP DS 2X 4 CM

Facility

$14,975.00

Hospital Charge Code	270703293
Hospital Revenue Code	278
Min. Negotiated Rate	$2,246.25
Max. Negotiated Rate	$3,623.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25

ALLOWRAP DS 2X 4 CM

Facility

$14,975.00

Hospital Charge Code	270703293
Hospital Revenue Code	278
Min. Negotiated Rate	$425.29
Max. Negotiated Rate	$7,487.50
Rate for Payer: Aetna Commercial	$5,690.50
Rate for Payer: Aetna Medicare Advantage	$4,492.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,818.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,818.62
Rate for Payer: Cigna Commercial	$7,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,623.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,246.25
Rate for Payer: UnitedHealthcare Community & State	$473.21
Rate for Payer: Wellpoint Medicaid Managed Care	$425.29

ALLOWRAP DS WET 2x2CM

Facility

$5,600.00

Service Code	HCPCS Q4150
Hospital Charge Code	270674063
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,355.20
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	$1,120.00
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	$1,355.20
Rate for Payer: Qualcare PPO/HMO/WC	$840.00
Rate for Payer: UnitedHealthcare Community & State	$176.96
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$159.04

ALLOWRAP DS WET 2x2CM

Facility

$5,600.00

Service Code	HCPCS Q4150
Hospital Charge Code	270674063
Hospital Revenue Code	278
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,355.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,355.20
Rate for Payer: Qualcare PPO/HMO/WC	$840.00

ALLOWRAP DS WET 2x4CM

Facility

$10,640.00

Hospital Charge Code	270678259
Hospital Revenue Code	636
Min. Negotiated Rate	$302.18
Max. Negotiated Rate	$5,320.00
Rate for Payer: Aetna Commercial	$4,043.20
Rate for Payer: Aetna Medicare Advantage	$3,192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.20
Rate for Payer: Cigna Commercial	$5,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.00
Rate for Payer: UnitedHealthcare Community & State	$336.22
Rate for Payer: Wellpoint Medicaid Managed Care	$302.18

ALLOWRAP DS WET 2x4CM

Facility

$10,640.00

Hospital Charge Code	270678259
Hospital Revenue Code	636
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,574.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,596.00

ALLOWRAP DS WET 4x4CM

Facility

$7,700.00

Service Code	HCPCS Q4150
Hospital Charge Code	270681551
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,863.40
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	$1,540.00
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	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$243.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$218.68

ALLOWRAP DS WET 4x4CM

Facility

$7,700.00

Service Code	HCPCS Q4150
Hospital Charge Code	270681551
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

ALL POLY PAT VE 35MM DIA

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692144
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

ALL POLY PAT VE 35MM DIA

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270692144
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

ALL POLY PAY VE 35MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690442
Hospital Revenue Code	278
Min. Negotiated Rate	$145.69
Max. Negotiated Rate	$2,565.00
Rate for Payer: Aetna Commercial	$1,949.40
Rate for Payer: Aetna Medicare Advantage	$1,539.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,308.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,308.15
Rate for Payer: Cigna Commercial	$2,565.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50
Rate for Payer: UnitedHealthcare Community & State	$162.11
Rate for Payer: Wellpoint Medicaid Managed Care	$145.69

ALL POLY PAY VE 35MM DIA

Facility

$5,130.00

Service Code	HCPCS C1776
Hospital Charge Code	270690442
Hospital Revenue Code	278
Min. Negotiated Rate	$769.50
Max. Negotiated Rate	$1,241.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,026.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,241.46
Rate for Payer: Qualcare PPO/HMO/WC	$769.50

ALL SUTURE ANCHOR 1.4MM

Facility

$1,755.00

Hospital Charge Code	270673196
Hospital Revenue Code	272
Min. Negotiated Rate	$49.84
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$456.30
Rate for Payer: Oxford Commercial	$351.00
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Commercial	$351.00
Rate for Payer: UnitedHealthcare Community & State	$55.46
Rate for Payer: Wellpoint Medicaid Managed Care	$49.84

ALL SUTURE ANCHOR 1.4MM

Facility

$1,755.00

Hospital Charge Code	270673196
Hospital Revenue Code	272
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$263.25
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

Know your out-of-pocket cost for care.

All Charges