Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ALDERM NON-MH 200 201010

Facility

$41.20

Service Code	HCPCS Q4116
Hospital Charge Code	270633030
Hospital Revenue Code	636
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$9.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.18

GRAFT ALDERM NON-MH 200 201010

Facility

$41.20

Service Code	HCPCS Q4116
Hospital Charge Code	270633030
Hospital Revenue Code	636
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$536.29
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	$156.71
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	$9.97
Rate for Payer: Qualcare PPO/HMO/WC	$6.18
Rate for Payer: UnitedHealthcare Community & State	$1.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1.17

GRAFT ALLOAID PIP SZ 2.5X16MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270698494
Hospital Revenue Code	278
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$1,905.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25

GRAFT ALLOAID PIP SZ 2.5X16MM

Facility

$7,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270698494
Hospital Revenue Code	278
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$3,937.50
Rate for Payer: Aetna Commercial	$2,992.50
Rate for Payer: Aetna Medicare Advantage	$2,362.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,008.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,008.12
Rate for Payer: Cigna Commercial	$3,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,905.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,181.25
Rate for Payer: UnitedHealthcare Community & State	$248.85
Rate for Payer: Wellpoint Medicaid Managed Care	$223.65

GRAFT ALLODERM 4X12CM

Facility

$1,859.00

Hospital Charge Code	270664937
Hospital Revenue Code	636
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$929.50
Rate for Payer: Aetna Commercial	$706.42
Rate for Payer: Aetna Medicare Advantage	$557.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$474.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$474.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$474.05
Rate for Payer: Cigna Commercial	$929.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.88
Rate for Payer: Qualcare PPO/HMO/WC	$278.85
Rate for Payer: UnitedHealthcare Community & State	$58.74
Rate for Payer: Wellpoint Medicaid Managed Care	$52.80

GRAFT ALLODERM 4X12CM

Facility

$1,859.00

Hospital Charge Code	270664937
Hospital Revenue Code	636
Min. Negotiated Rate	$278.85
Max. Negotiated Rate	$449.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$449.88
Rate for Payer: Qualcare PPO/HMO/WC	$278.85

GRAFT ALLODERM 4X12CM/SQCMJW

Facility

$38.73

Hospital Charge Code	270664937W
Hospital Revenue Code	636
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$19.36
Rate for Payer: Aetna Commercial	$14.72
Rate for Payer: Aetna Medicare Advantage	$11.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.88
Rate for Payer: Cigna Commercial	$19.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.81
Rate for Payer: UnitedHealthcare Community & State	$1.22
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

GRAFT ALLODERM 4X12CM/SQCMJW

Facility

$38.73

Hospital Charge Code	270664937W
Hospital Revenue Code	636
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$9.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.37
Rate for Payer: Qualcare PPO/HMO/WC	$5.81

GRAFT ALLODERM LG PERF THICK

Facility

$34,095.00

Hospital Charge Code	270677774
Hospital Revenue Code	636
Min. Negotiated Rate	$5,114.25
Max. Negotiated Rate	$8,250.99
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25

GRAFT ALLODERM LG PERF THICK

Facility

$34,095.00

Hospital Charge Code	270677774
Hospital Revenue Code	636
Min. Negotiated Rate	$968.30
Max. Negotiated Rate	$17,047.50
Rate for Payer: Aetna Commercial	$12,956.10
Rate for Payer: Aetna Medicare Advantage	$10,228.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,694.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,694.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,694.23
Rate for Payer: Cigna Commercial	$17,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,250.99
Rate for Payer: Qualcare PPO/HMO/WC	$5,114.25
Rate for Payer: UnitedHealthcare Community & State	$1,077.40
Rate for Payer: Wellpoint Medicaid Managed Care	$968.30

GRAFT ALLODERM MED PERF THICK

Facility

$27,445.00

Hospital Charge Code	270677773
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM MED PERF THICK

Facility

$27,445.00

Hospital Charge Code	270677773
Hospital Revenue Code	636
Min. Negotiated Rate	$779.44
Max. Negotiated Rate	$13,722.50
Rate for Payer: Aetna Commercial	$10,429.10
Rate for Payer: Aetna Medicare Advantage	$8,233.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,998.48
Rate for Payer: Cigna Commercial	$13,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75
Rate for Payer: UnitedHealthcare Community & State	$867.26
Rate for Payer: Wellpoint Medicaid Managed Care	$779.44

GRAFT ALLODERM MED PERF THIN

Facility

$27,445.00

Hospital Charge Code	270677772
Hospital Revenue Code	636
Min. Negotiated Rate	$4,116.75
Max. Negotiated Rate	$6,641.69
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75

GRAFT ALLODERM MED PERF THIN

Facility

$27,445.00

Hospital Charge Code	270677772
Hospital Revenue Code	636
Min. Negotiated Rate	$779.44
Max. Negotiated Rate	$13,722.50
Rate for Payer: Aetna Commercial	$10,429.10
Rate for Payer: Aetna Medicare Advantage	$8,233.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,998.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,998.48
Rate for Payer: Cigna Commercial	$13,722.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,641.69
Rate for Payer: Qualcare PPO/HMO/WC	$4,116.75
Rate for Payer: UnitedHealthcare Community & State	$867.26
Rate for Payer: Wellpoint Medicaid Managed Care	$779.44

GRAFT ALLODERM THIN 4x12CM

Facility

$9,170.00

Service Code	HCPCS Q4116
Hospital Charge Code	270677712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,375.50
Max. Negotiated Rate	$2,219.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,834.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50

GRAFT ALLODERM THIN 4x12CM

Facility

$9,170.00

Service Code	HCPCS Q4116
Hospital Charge Code	270677712
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,219.14
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	$1,834.00
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	$2,219.14
Rate for Payer: Qualcare PPO/HMO/WC	$1,375.50
Rate for Payer: UnitedHealthcare Community & State	$289.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$260.43

GRAFT ALLOSYNC DBM PUTTY 1CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690969
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

GRAFT ALLOSYNC DBM PUTTY 1CC

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690969
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

GRAFT ALLOSYNE 10 CC PURE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270688461
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

GRAFT ALLOSYNE 10 CC PURE

Facility

$8,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270688461
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
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	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
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: Wellpoint Medicaid Managed Care	$241.40

GRAFTALTAPOREBNMATRIX15.80ML

Facility

$17,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270692787
Hospital Revenue Code	278
Min. Negotiated Rate	$2,562.00
Max. Negotiated Rate	$4,133.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,416.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,133.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,562.00

GRAFTALTAPOREBNMATRIX15.80ML

Facility

$17,080.00

Service Code	HCPCS C1713
Hospital Charge Code	270692787
Hospital Revenue Code	278
Min. Negotiated Rate	$485.07
Max. Negotiated Rate	$8,540.00
Rate for Payer: Aetna Commercial	$6,490.40
Rate for Payer: Aetna Medicare Advantage	$5,124.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,355.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,355.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,416.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,355.40
Rate for Payer: Cigna Commercial	$8,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,133.36
Rate for Payer: Qualcare PPO/HMO/WC	$2,562.00
Rate for Payer: UnitedHealthcare Community & State	$539.73
Rate for Payer: Wellpoint Medicaid Managed Care	$485.07

GRAFT ALTAPORE BN MATRIX 2.6ML

Facility

$4,441.90

Service Code	HCPCS C1713
Hospital Charge Code	270698820
Hospital Revenue Code	278
Min. Negotiated Rate	$126.15
Max. Negotiated Rate	$2,220.95
Rate for Payer: Aetna Commercial	$1,687.92
Rate for Payer: Aetna Medicare Advantage	$1,332.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,132.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,132.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,132.68
Rate for Payer: Cigna Commercial	$2,220.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.94
Rate for Payer: Qualcare PPO/HMO/WC	$666.28
Rate for Payer: UnitedHealthcare Community & State	$140.36
Rate for Payer: Wellpoint Medicaid Managed Care	$126.15

GRAFT ALTAPORE BN MATRIX 2.6ML

Facility

$4,441.90

Service Code	HCPCS C1713
Hospital Charge Code	270698820
Hospital Revenue Code	278
Min. Negotiated Rate	$666.28
Max. Negotiated Rate	$1,074.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$888.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,074.94
Rate for Payer: Qualcare PPO/HMO/WC	$666.28

GRAFT ALTAPORE BN MATRIX 8ML

Facility

$9,179.90

Service Code	HCPCS C1713
Hospital Charge Code	270698821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,376.98
Max. Negotiated Rate	$2,221.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,221.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.98

Know your out-of-pocket cost for care.

All Charges