Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT AMNIO EXCEL PER SQ CM

Facility

$278.57

Service Code	HCPCS Q4137
Hospital Charge Code	270684032W
Hospital Revenue Code	636
Min. Negotiated Rate	$7.91
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	$67.41
Rate for Payer: Qualcare PPO/HMO/WC	$41.79
Rate for Payer: UnitedHealthcare Community & State	$8.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$7.91

GRAFT AMNIO EXCEL PER SQ CM

Facility

$278.57

Service Code	HCPCS Q4137
Hospital Charge Code	270684032W
Hospital Revenue Code	636
Min. Negotiated Rate	$41.79
Max. Negotiated Rate	$67.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.41
Rate for Payer: Qualcare PPO/HMO/WC	$41.79

GRAFT AMNIO MATRIX .5 ML SSPNS

Facility

$3,570.00

Service Code	HCPCS Q4139
Hospital Charge Code	270684063
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 MATRIX .5 ML SSPNS

Facility

$3,570.00

Service Code	HCPCS Q4139
Hospital Charge Code	270684063
Hospital Revenue Code	278
Min. Negotiated Rate	$101.39
Max. Negotiated Rate	$1,785.00
Rate for Payer: Aetna Commercial	$1,356.60
Rate for Payer: Aetna Medicare Advantage	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$910.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$910.35
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	$910.35
Rate for Payer: Cigna Commercial	$1,785.00
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: Wellpoint Medicaid Managed Care	$101.39

GRAFT AMNION MATRIX 3CMX3CM

Facility

$12,250.00

Service Code	HCPCS Q4148
Hospital Charge Code	270687488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT AMNION MATRIX 3CMX3CM

Facility

$12,250.00

Service Code	HCPCS Q4148
Hospital Charge Code	270687488
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,964.50
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	$2,450.00
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	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Community & State	$387.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$347.90

GRAFT AMNIOTIC MEMBRANE 4X8CM

Facility

$15,690.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694408
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,796.98
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	$3,138.00
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	$3,796.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,353.50
Rate for Payer: UnitedHealthcare Community & State	$495.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$445.60

GRAFT AMNIOTIC MEMBRANE 4X8CM

Facility

$15,690.00

Service Code	HCPCS Q4205
Hospital Charge Code	270694408
Hospital Revenue Code	278
Min. Negotiated Rate	$2,353.50
Max. Negotiated Rate	$3,796.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,138.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,796.98
Rate for Payer: Qualcare PPO/HMO/WC	$2,353.50

GRAFT AMNITIC MEMBRANE 4X4CM

Facility

$8,225.00

Hospital Charge Code	270701104
Hospital Revenue Code	278
Min. Negotiated Rate	$233.59
Max. Negotiated Rate	$4,112.50
Rate for Payer: Aetna Commercial	$3,125.50
Rate for Payer: Aetna Medicare Advantage	$2,467.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,097.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,097.38
Rate for Payer: Cigna Commercial	$4,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.75
Rate for Payer: UnitedHealthcare Community & State	$259.91
Rate for Payer: Wellpoint Medicaid Managed Care	$233.59

GRAFT AMNITIC MEMBRANE 4X4CM

Facility

$8,225.00

Hospital Charge Code	270701104
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.75
Max. Negotiated Rate	$1,990.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,990.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,233.75

GRAFT ANTERIOR TIBIALIS SHORT

Facility

$9,725.00

Hospital Charge Code	270675480
Hospital Revenue Code	278
Min. Negotiated Rate	$1,458.75
Max. Negotiated Rate	$2,353.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,353.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,458.75

GRAFT ANTERIOR TIBIALIS SHORT

Facility

$9,725.00

Hospital Charge Code	270675480
Hospital Revenue Code	278
Min. Negotiated Rate	$276.19
Max. Negotiated Rate	$4,862.50
Rate for Payer: Aetna Commercial	$3,695.50
Rate for Payer: Aetna Medicare Advantage	$2,917.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,479.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,479.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,945.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,479.88
Rate for Payer: Cigna Commercial	$4,862.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,353.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,458.75
Rate for Payer: UnitedHealthcare Community & State	$307.31
Rate for Payer: Wellpoint Medicaid Managed Care	$276.19

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,534.50

Service Code	HCPCS C1762
Hospital Charge Code	270675692
Hospital Revenue Code	278
Min. Negotiated Rate	$299.18
Max. Negotiated Rate	$5,267.25
Rate for Payer: Aetna Commercial	$4,003.11
Rate for Payer: Aetna Medicare Advantage	$3,160.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,686.30
Rate for Payer: Cigna Commercial	$5,267.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,549.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,580.17
Rate for Payer: UnitedHealthcare Community & State	$332.89
Rate for Payer: Wellpoint Medicaid Managed Care	$299.18

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,534.50

Service Code	HCPCS C1762
Hospital Charge Code	270675692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,580.17
Max. Negotiated Rate	$2,549.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,549.35
Rate for Payer: Qualcare PPO/HMO/WC	$1,580.17

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,000.00

Hospital Charge Code	270666077
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT ANTERIOR TIBIALIS TENDON

Facility

$10,000.00

Hospital Charge Code	270666077
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

GRAFT AORTIC EXT 34x34x80

Facility

$26,495.00

Hospital Charge Code	270677193
Hospital Revenue Code	278
Min. Negotiated Rate	$752.46
Max. Negotiated Rate	$13,247.50
Rate for Payer: Aetna Commercial	$10,068.10
Rate for Payer: Aetna Medicare Advantage	$7,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,756.23
Rate for Payer: Cigna Commercial	$13,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25
Rate for Payer: UnitedHealthcare Community & State	$837.24
Rate for Payer: Wellpoint Medicaid Managed Care	$752.46

GRAFT AORTIC EXT 34x34x80

Facility

$26,495.00

Hospital Charge Code	270677193
Hospital Revenue Code	278
Min. Negotiated Rate	$3,974.25
Max. Negotiated Rate	$6,411.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25

GRAFT AORTIC EXTENSION CV100V

Facility

$24,775.00

Service Code	HCPCS C1768
Hospital Charge Code	270666862
Hospital Revenue Code	278
Min. Negotiated Rate	$3,716.25
Max. Negotiated Rate	$5,995.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,995.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,716.25

GRAFT AORTIC EXTENSION CV100V

Facility

$24,775.00

Service Code	HCPCS C1768
Hospital Charge Code	270666862
Hospital Revenue Code	278
Min. Negotiated Rate	$703.61
Max. Negotiated Rate	$12,387.50
Rate for Payer: Aetna Commercial	$9,414.50
Rate for Payer: Aetna Medicare Advantage	$7,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,317.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,317.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,317.62
Rate for Payer: Cigna Commercial	$12,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,995.55
Rate for Payer: Qualcare PPO/HMO/WC	$3,716.25
Rate for Payer: UnitedHealthcare Community & State	$782.89
Rate for Payer: Wellpoint Medicaid Managed Care	$703.61

GRAFT APX-FBR 10CC

Facility

$11,937.80

Service Code	HCPCS C9359
Hospital Charge Code	270692410
Hospital Revenue Code	278
Min. Negotiated Rate	$339.03
Max. Negotiated Rate	$5,968.90
Rate for Payer: Aetna Commercial	$4,536.36
Rate for Payer: Aetna Medicare Advantage	$3,581.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,044.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,044.14
Rate for Payer: Cigna Commercial	$5,968.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67
Rate for Payer: UnitedHealthcare Community & State	$377.23
Rate for Payer: Wellpoint Medicaid Managed Care	$339.03

GRAFT APX-FBR 10CC

Facility

$11,937.80

Service Code	HCPCS C9359
Hospital Charge Code	270692410
Hospital Revenue Code	278
Min. Negotiated Rate	$1,790.67
Max. Negotiated Rate	$2,888.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,387.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,888.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,790.67

GRAFT ARTEGRAFT 5 MM 34 CM

Facility

$7,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270690091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,064.25
Max. Negotiated Rate	$1,716.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25

GRAFT ARTEGRAFT 5 MM 34 CM

Facility

$7,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270690091
Hospital Revenue Code	278
Min. Negotiated Rate	$201.50
Max. Negotiated Rate	$3,547.50
Rate for Payer: Aetna Commercial	$2,696.10
Rate for Payer: Aetna Medicare Advantage	$2,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,809.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,809.22
Rate for Payer: Cigna Commercial	$3,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,716.99
Rate for Payer: Qualcare PPO/HMO/WC	$1,064.25
Rate for Payer: UnitedHealthcare Community & State	$224.20
Rate for Payer: Wellpoint Medicaid Managed Care	$201.50

GRAFT AVANCE NERVE 4-5x70MM

Facility

$24,125.00

Hospital Charge Code	270660289
Hospital Revenue Code	278
Min. Negotiated Rate	$3,618.75
Max. Negotiated Rate	$5,838.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,838.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,618.75

Know your out-of-pocket cost for care.

All Charges