Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GMK STEM EXTEN 11mmx30mm

Facility

$2,750.00

Service Code	HCPCS C1776
Hospital Charge Code	270679835
Hospital Revenue Code	278
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$1,375.00
Rate for Payer: Aetna Commercial	$1,045.00
Rate for Payer: Aetna Medicare Advantage	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$701.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$701.25
Rate for Payer: Cigna Commercial	$1,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$665.50
Rate for Payer: Qualcare PPO/HMO/WC	$412.50
Rate for Payer: UnitedHealthcare Community & State	$86.90
Rate for Payer: Wellpoint Medicaid Managed Care	$78.10

GMK TIBIAL TRAY HINGE LEFT S2

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687684
Hospital Revenue Code	278
Min. Negotiated Rate	$691.40
Max. Negotiated Rate	$12,172.50
Rate for Payer: Aetna Commercial	$9,251.10
Rate for Payer: Aetna Medicare Advantage	$7,303.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,207.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,207.98
Rate for Payer: Cigna Commercial	$12,172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75
Rate for Payer: UnitedHealthcare Community & State	$769.30
Rate for Payer: Wellpoint Medicaid Managed Care	$691.40

GMK TIBIAL TRAY HINGE LEFT S2

Facility

$24,345.00

Service Code	HCPCS C1776
Hospital Charge Code	270687684
Hospital Revenue Code	278
Min. Negotiated Rate	$3,651.75
Max. Negotiated Rate	$5,891.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,869.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,891.49
Rate for Payer: Qualcare PPO/HMO/WC	$3,651.75

GNS II CMT TIB SIZE 3 RIGHT

Facility

$15,872.50

Service Code	HCPCS C1776
Hospital Charge Code	270686902
Hospital Revenue Code	278
Min. Negotiated Rate	$450.78
Max. Negotiated Rate	$7,936.25
Rate for Payer: Aetna Commercial	$6,031.55
Rate for Payer: Aetna Medicare Advantage	$4,761.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,047.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,047.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,174.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,047.49
Rate for Payer: Cigna Commercial	$7,936.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,841.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,380.88
Rate for Payer: UnitedHealthcare Community & State	$501.57
Rate for Payer: Wellpoint Medicaid Managed Care	$450.78

GNS II CMT TIB SIZE 3 RIGHT

Facility

$15,872.50

Service Code	HCPCS C1776
Hospital Charge Code	270686902
Hospital Revenue Code	278
Min. Negotiated Rate	$2,380.88
Max. Negotiated Rate	$3,841.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,174.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,841.14
Rate for Payer: Qualcare PPO/HMO/WC	$2,380.88

GNS II CON INS SZ 3-4 18MM

Facility

$20,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270686904
Hospital Revenue Code	278
Min. Negotiated Rate	$3,024.00
Max. Negotiated Rate	$4,878.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,032.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,878.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,024.00

GNS II CON INS SZ 3-4 18MM

Facility

$20,160.00

Service Code	HCPCS C1776
Hospital Charge Code	270686904
Hospital Revenue Code	278
Min. Negotiated Rate	$572.54
Max. Negotiated Rate	$10,080.00
Rate for Payer: Aetna Commercial	$7,660.80
Rate for Payer: Aetna Medicare Advantage	$6,048.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,140.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,032.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,140.80
Rate for Payer: Cigna Commercial	$10,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,878.72
Rate for Payer: Qualcare PPO/HMO/WC	$3,024.00
Rate for Payer: UnitedHealthcare Community & State	$637.06
Rate for Payer: Wellpoint Medicaid Managed Care	$572.54

GNS II RESURF PAT 32MM

Facility

$6,702.50

Service Code	HCPCS C1776
Hospital Charge Code	270686905
Hospital Revenue Code	278
Min. Negotiated Rate	$1,005.38
Max. Negotiated Rate	$1,622.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.38

GNS II RESURF PAT 32MM

Facility

$6,702.50

Service Code	HCPCS C1776
Hospital Charge Code	270686905
Hospital Revenue Code	278
Min. Negotiated Rate	$190.35
Max. Negotiated Rate	$3,351.25
Rate for Payer: Aetna Commercial	$2,546.95
Rate for Payer: Aetna Medicare Advantage	$2,010.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,709.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,709.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,709.14
Rate for Payer: Cigna Commercial	$3,351.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,622.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,005.38
Rate for Payer: UnitedHealthcare Community & State	$211.80
Rate for Payer: Wellpoint Medicaid Managed Care	$190.35

GOLD PROBE ARGON COAGULATOR

Facility

$443.00

Hospital Charge Code	270334803
Hospital Revenue Code	272
Min. Negotiated Rate	$12.58
Max. Negotiated Rate	$221.50
Rate for Payer: Aetna Commercial	$168.34
Rate for Payer: Aetna Medicare Advantage	$132.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$112.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$112.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$112.97
Rate for Payer: Cigna Commercial	$221.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.18
Rate for Payer: Oxford Commercial	$88.60
Rate for Payer: Qualcare PPO/HMO/WC	$66.45
Rate for Payer: UnitedHealthcare Commercial	$88.60
Rate for Payer: UnitedHealthcare Community & State	$14.00
Rate for Payer: Wellpoint Medicaid Managed Care	$12.58

GOLD PROBE ARGON COAGULATOR

Facility

$443.00

Hospital Charge Code	270334803
Hospital Revenue Code	272
Min. Negotiated Rate	$66.45
Max. Negotiated Rate	$66.45
Rate for Payer: Qualcare PPO/HMO/WC	$66.45

GONIO LENS

Facility

$300.00

Hospital Charge Code	270687726
Hospital Revenue Code	272
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$114.00
Rate for Payer: Aetna Medicare Advantage	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.50
Rate for Payer: Cigna Commercial	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.00
Rate for Payer: Oxford Commercial	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00
Rate for Payer: UnitedHealthcare Commercial	$60.00
Rate for Payer: UnitedHealthcare Community & State	$9.48
Rate for Payer: Wellpoint Medicaid Managed Care	$8.52

GONIO LENS

Facility

$300.00

Hospital Charge Code	270687726
Hospital Revenue Code	272
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$45.00
Rate for Payer: Qualcare PPO/HMO/WC	$45.00

GORE ACUSEAL VASCULAR GRAFT

Facility

$7,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679633
Hospital Revenue Code	278
Min. Negotiated Rate	$212.86
Max. Negotiated Rate	$3,747.50
Rate for Payer: Aetna Commercial	$2,848.10
Rate for Payer: Aetna Medicare Advantage	$2,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,911.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,911.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,911.22
Rate for Payer: Cigna Commercial	$3,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,813.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,124.25
Rate for Payer: UnitedHealthcare Community & State	$236.84
Rate for Payer: Wellpoint Medicaid Managed Care	$212.86

GORE ACUSEAL VASCULAR GRAFT

Facility

$7,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270679633
Hospital Revenue Code	278
Min. Negotiated Rate	$1,124.25
Max. Negotiated Rate	$1,813.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,813.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,124.25

GORETEX 80CM THINWALL W/20CM R

Facility

$6,666.00

Hospital Charge Code	270335072
Hospital Revenue Code	278
Min. Negotiated Rate	$189.31
Max. Negotiated Rate	$3,333.00
Rate for Payer: Aetna Commercial	$2,533.08
Rate for Payer: Aetna Medicare Advantage	$1,999.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,699.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,699.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,699.83
Rate for Payer: Cigna Commercial	$3,333.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,613.17
Rate for Payer: Qualcare PPO/HMO/WC	$999.90
Rate for Payer: UnitedHealthcare Community & State	$210.65
Rate for Payer: Wellpoint Medicaid Managed Care	$189.31

GORETEX 80CM THINWALL W/20CM R

Facility

$6,666.00

Hospital Charge Code	270335072
Hospital Revenue Code	278
Min. Negotiated Rate	$999.90
Max. Negotiated Rate	$1,613.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,333.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,613.17
Rate for Payer: Qualcare PPO/HMO/WC	$999.90

GORETEX DUALMESH BIO 75-96SQ C

Facility

$128.00

Hospital Charge Code	270335386
Hospital Revenue Code	278
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna Commercial	$48.64
Rate for Payer: Aetna Medicare Advantage	$38.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$32.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$32.64
Rate for Payer: Cigna Commercial	$64.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20
Rate for Payer: UnitedHealthcare Community & State	$4.04
Rate for Payer: Wellpoint Medicaid Managed Care	$3.64

GORETEX DUALMESH BIO 75-96SQ C

Facility

$128.00

Hospital Charge Code	270335386
Hospital Revenue Code	278
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$25.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.98
Rate for Payer: Qualcare PPO/HMO/WC	$19.20

GORETEX GRAFT W/20 CM + RINGS

Facility

$6,039.00

Hospital Charge Code	270335071
Hospital Revenue Code	278
Min. Negotiated Rate	$171.51
Max. Negotiated Rate	$3,019.50
Rate for Payer: Aetna Commercial	$2,294.82
Rate for Payer: Aetna Medicare Advantage	$1,811.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,539.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,539.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,207.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,539.94
Rate for Payer: Cigna Commercial	$3,019.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,461.44
Rate for Payer: Qualcare PPO/HMO/WC	$905.85
Rate for Payer: UnitedHealthcare Community & State	$190.83
Rate for Payer: Wellpoint Medicaid Managed Care	$171.51

GORETEX GRAFT W/20 CM + RINGS

Facility

$6,039.00

Hospital Charge Code	270335071
Hospital Revenue Code	278
Min. Negotiated Rate	$905.85
Max. Negotiated Rate	$1,461.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,207.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,461.44
Rate for Payer: Qualcare PPO/HMO/WC	$905.85

GORETEX TAPED GRAFT UP TO X70

Facility

$4,364.00

Hospital Charge Code	270335065
Hospital Revenue Code	278
Min. Negotiated Rate	$123.94
Max. Negotiated Rate	$2,182.00
Rate for Payer: Aetna Commercial	$1,658.32
Rate for Payer: Aetna Medicare Advantage	$1,309.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,112.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,112.82
Rate for Payer: Cigna Commercial	$2,182.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,056.09
Rate for Payer: Qualcare PPO/HMO/WC	$654.60
Rate for Payer: UnitedHealthcare Community & State	$137.90
Rate for Payer: Wellpoint Medicaid Managed Care	$123.94

GORETEX TAPED GRAFT UP TO X70

Facility

$4,364.00

Hospital Charge Code	270335065
Hospital Revenue Code	278
Min. Negotiated Rate	$654.60
Max. Negotiated Rate	$1,056.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,056.09
Rate for Payer: Qualcare PPO/HMO/WC	$654.60

GORETEX THIN WALLED STRAIGHT/T

Facility

$6,957.00

Hospital Charge Code	270335069
Hospital Revenue Code	278
Min. Negotiated Rate	$197.58
Max. Negotiated Rate	$3,478.50
Rate for Payer: Aetna Commercial	$2,643.66
Rate for Payer: Aetna Medicare Advantage	$2,087.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,774.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,774.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,391.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,774.04
Rate for Payer: Cigna Commercial	$3,478.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,683.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,043.55
Rate for Payer: UnitedHealthcare Community & State	$219.84
Rate for Payer: Wellpoint Medicaid Managed Care	$197.58

GORETEX THIN WALLED STRAIGHT/T

Facility

$6,957.00

Hospital Charge Code	270335069
Hospital Revenue Code	278
Min. Negotiated Rate	$1,043.55
Max. Negotiated Rate	$1,683.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,391.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,683.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,043.55

Know your out-of-pocket cost for care.

All Charges