Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ALTAPORE BN MATRIX 8ML

Facility

$9,179.90

Service Code	HCPCS C1713
Hospital Charge Code	270698821
Hospital Revenue Code	278
Min. Negotiated Rate	$260.71
Max. Negotiated Rate	$4,589.95
Rate for Payer: Aetna Commercial	$3,488.36
Rate for Payer: Aetna Medicare Advantage	$2,753.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,340.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,340.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,835.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,340.87
Rate for Payer: Cigna Commercial	$4,589.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,221.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,376.98
Rate for Payer: UnitedHealthcare Community & State	$290.08
Rate for Payer: Wellpoint Medicaid Managed Care	$260.71

GRAFT ALTO ABD STENT 26 MM

Facility

$74,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270690553
Hospital Revenue Code	278
Min. Negotiated Rate	$11,137.50
Max. Negotiated Rate	$17,968.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,968.50
Rate for Payer: Qualcare PPO/HMO/WC	$11,137.50

GRAFT ALTO ABD STENT 26 MM

Facility

$74,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270690553
Hospital Revenue Code	278
Min. Negotiated Rate	$2,108.70
Max. Negotiated Rate	$37,125.00
Rate for Payer: Aetna Commercial	$28,215.00
Rate for Payer: Aetna Medicare Advantage	$22,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18,933.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18,933.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$14,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18,933.75
Rate for Payer: Cigna Commercial	$37,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,968.50
Rate for Payer: Qualcare PPO/HMO/WC	$11,137.50
Rate for Payer: UnitedHealthcare Community & State	$2,346.30
Rate for Payer: Wellpoint Medicaid Managed Care	$2,108.70

GRAFT AMBIO 52 X 3CM

Facility

$3,375.00

Service Code	HCPCS C1762
Hospital Charge Code	270653917
Hospital Revenue Code	810
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

GRAFT AMBIO 52 X 3CM

Facility

$3,375.00

Service Code	HCPCS C1762
Hospital Charge Code	270653917
Hospital Revenue Code	810
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.50
Rate for Payer: Oxford Commercial	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Commercial	$675.00
Rate for Payer: UnitedHealthcare Community & State	$106.65
Rate for Payer: Wellpoint Medicaid Managed Care	$95.85

GRAFT AMINO EXCEL 15 MM

Facility

$1,050.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684014
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
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	$210.00
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	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

GRAFT AMINO EXCEL 15 MM

Facility

$1,050.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684014
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

GRAFT AMINO MAX 4 X 8 CM

Facility

$15,705.00

Service Code	HCPCS Q4100
Hospital Charge Code	270686265
Hospital Revenue Code	636
Min. Negotiated Rate	$446.02
Max. Negotiated Rate	$7,852.50
Rate for Payer: Aetna Commercial	$5,967.90
Rate for Payer: Aetna Medicare Advantage	$4,711.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,004.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,004.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,004.78
Rate for Payer: Cigna Commercial	$7,852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,800.61
Rate for Payer: Qualcare PPO/HMO/WC	$2,355.75
Rate for Payer: UnitedHealthcare Community & State	$496.28
Rate for Payer: Wellpoint Medicaid Managed Care	$446.02

GRAFT AMINO MAX 4 X 8 CM

Facility

$15,705.00

Service Code	HCPCS Q4100
Hospital Charge Code	270686265
Hospital Revenue Code	636
Min. Negotiated Rate	$2,355.75
Max. Negotiated Rate	$3,800.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,800.61
Rate for Payer: Qualcare PPO/HMO/WC	$2,355.75

GRAFT AMNIO EXCEL 10CMX10CM

Facility

$18,480.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684035
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,472.16
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	$3,696.00
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	$4,472.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.00
Rate for Payer: UnitedHealthcare Community & State	$583.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$524.83

GRAFT AMNIO EXCEL 10CMX10CM

Facility

$18,480.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684035
Hospital Revenue Code	278
Min. Negotiated Rate	$2,772.00
Max. Negotiated Rate	$4,472.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,472.16
Rate for Payer: Qualcare PPO/HMO/WC	$2,772.00

GRAFT AMNIO EXCEL 1.5 CM X 1.5

Facility

$2,310.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684015
Hospital Revenue Code	278
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$559.02
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	$462.00
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	$559.02
Rate for Payer: Qualcare PPO/HMO/WC	$346.50
Rate for Payer: UnitedHealthcare Community & State	$73.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$65.60

GRAFT AMNIO EXCEL 1.5 CM X 1.5

Facility

$2,310.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684015
Hospital Revenue Code	278
Min. Negotiated Rate	$346.50
Max. Negotiated Rate	$559.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$559.02
Rate for Payer: Qualcare PPO/HMO/WC	$346.50

GRAFT AMNIOEXCEL 18 MM

Facility

$2,100.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684016
Hospital Revenue Code	278
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$508.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$420.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00

GRAFT AMNIOEXCEL 18 MM

Facility

$2,100.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684016
Hospital Revenue Code	278
Min. Negotiated Rate	$59.64
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	$420.00
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	$508.20
Rate for Payer: Qualcare PPO/HMO/WC	$315.00
Rate for Payer: UnitedHealthcare Community & State	$66.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$59.64

GRAFT AMNIO EXCEL 24 MM

Facility

$2,450.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684031
Hospital Revenue Code	278
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$592.90
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	$490.00
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	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50
Rate for Payer: UnitedHealthcare Community & State	$77.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$69.58

GRAFT AMNIO EXCEL 24 MM

Facility

$2,450.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684031
Hospital Revenue Code	278
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$592.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$592.90
Rate for Payer: Qualcare PPO/HMO/WC	$367.50

GRAFT AMNIO EXCEL 2CM X3 CM

Facility

$3,150.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684030
Hospital Revenue Code	278
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$762.30
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	$630.00
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	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50
Rate for Payer: UnitedHealthcare Community & State	$99.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$89.46

GRAFT AMNIO EXCEL 2CM X3 CM

Facility

$3,150.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684030
Hospital Revenue Code	278
Min. Negotiated Rate	$472.50
Max. Negotiated Rate	$762.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$630.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$762.30
Rate for Payer: Qualcare PPO/HMO/WC	$472.50

GRAFT AMNIO EXCEL 3.5 CM X 3.5

Facility

$3,412.50

Service Code	HCPCS Q4137
Hospital Charge Code	270684032
Hospital Revenue Code	278
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$825.83
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	$682.50
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	$825.83
Rate for Payer: Qualcare PPO/HMO/WC	$511.88
Rate for Payer: UnitedHealthcare Community & State	$107.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$96.92

GRAFT AMNIO EXCEL 3.5 CM X 3.5

Facility

$3,412.50

Service Code	HCPCS Q4137
Hospital Charge Code	270684032
Hospital Revenue Code	278
Min. Negotiated Rate	$511.88
Max. Negotiated Rate	$825.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$682.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$825.83
Rate for Payer: Qualcare PPO/HMO/WC	$511.88

GRAFT AMNIO EXCEL 4CMX 4 CM

Facility

$3,570.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684034
Hospital Revenue Code	278
Min. Negotiated Rate	$101.39
Max. Negotiated Rate	$863.94
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	$714.00
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	$863.94
Rate for Payer: Qualcare PPO/HMO/WC	$535.50
Rate for Payer: UnitedHealthcare Community & State	$112.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$101.39

GRAFT AMNIO EXCEL 4CMX 4 CM

Facility

$3,570.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684034
Hospital Revenue Code	278
Min. Negotiated Rate	$535.50
Max. Negotiated Rate	$863.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$714.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$863.94
Rate for Payer: Qualcare PPO/HMO/WC	$535.50

GRAFT AMNIO EXCEL 5CMX 5 CM

Facility

$4,025.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684033
Hospital Revenue Code	278
Min. Negotiated Rate	$114.31
Max. Negotiated Rate	$974.05
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	$805.00
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	$974.05
Rate for Payer: Qualcare PPO/HMO/WC	$603.75
Rate for Payer: UnitedHealthcare Community & State	$127.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$114.31

GRAFT AMNIO EXCEL 5CMX 5 CM

Facility

$4,025.00

Service Code	HCPCS Q4137
Hospital Charge Code	270684033
Hospital Revenue Code	278
Min. Negotiated Rate	$603.75
Max. Negotiated Rate	$974.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$805.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$974.05
Rate for Payer: Qualcare PPO/HMO/WC	$603.75

Know your out-of-pocket cost for care.

All Charges