Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT AVANCE NERVE 4-5x70MM

Facility

$24,125.00

Hospital Charge Code	270660289
Hospital Revenue Code	278
Min. Negotiated Rate	$685.15
Max. Negotiated Rate	$12,062.50
Rate for Payer: Aetna Commercial	$9,167.50
Rate for Payer: Aetna Medicare Advantage	$7,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,151.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,151.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,151.88
Rate for Payer: Cigna Commercial	$12,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,838.25
Rate for Payer: Qualcare PPO/HMO/WC	$3,618.75
Rate for Payer: UnitedHealthcare Community & State	$762.35
Rate for Payer: Wellpoint Medicaid Managed Care	$685.15

GRAFT AX BI FEM 8mm 90cm/40cm

Facility

$13,430.00

Service Code	HCPCS C1768
Hospital Charge Code	270664526
Hospital Revenue Code	278
Min. Negotiated Rate	$381.41
Max. Negotiated Rate	$6,715.00
Rate for Payer: Aetna Commercial	$5,103.40
Rate for Payer: Aetna Medicare Advantage	$4,029.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,424.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,424.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,686.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,424.65
Rate for Payer: Cigna Commercial	$6,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,250.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,014.50
Rate for Payer: UnitedHealthcare Community & State	$424.39
Rate for Payer: Wellpoint Medicaid Managed Care	$381.41

GRAFT AX BI FEM 8mm 90cm/40cm

Facility

$13,430.00

Service Code	HCPCS C1768
Hospital Charge Code	270664526
Hospital Revenue Code	278
Min. Negotiated Rate	$2,014.50
Max. Negotiated Rate	$3,250.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,686.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,250.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,014.50

GRAFT BG MAT S 300 2.5 CM

Facility

$6,140.00

Service Code	HCPCS Q4100
Hospital Charge Code	270700855
Hospital Revenue Code	278
Min. Negotiated Rate	$921.00
Max. Negotiated Rate	$1,485.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00

GRAFT BG MAT S 300 2.5 CM

Facility

$6,140.00

Service Code	HCPCS Q4100
Hospital Charge Code	270700855
Hospital Revenue Code	278
Min. Negotiated Rate	$174.38
Max. Negotiated Rate	$3,070.00
Rate for Payer: Aetna Commercial	$2,333.20
Rate for Payer: Aetna Medicare Advantage	$1,842.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,565.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,565.70
Rate for Payer: Cigna Commercial	$3,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,485.88
Rate for Payer: Qualcare PPO/HMO/WC	$921.00
Rate for Payer: UnitedHealthcare Community & State	$194.02
Rate for Payer: Wellpoint Medicaid Managed Care	$174.38

GRAFT BIFURC TH WALL 16/8 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270638412
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$1,104.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

GRAFT BIFURC TH WALL 16/8 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270638412
Hospital Revenue Code	278
Min. Negotiated Rate	$129.65
Max. Negotiated Rate	$2,282.50
Rate for Payer: Aetna Commercial	$1,734.70
Rate for Payer: Aetna Medicare Advantage	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.08
Rate for Payer: Cigna Commercial	$2,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75
Rate for Payer: UnitedHealthcare Community & State	$144.25
Rate for Payer: Wellpoint Medicaid Managed Care	$129.65

GRAFT BIFURC TH/WALL 18/9 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270637984
Hospital Revenue Code	278
Min. Negotiated Rate	$684.75
Max. Negotiated Rate	$1,104.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75

GRAFT BIFURC TH/WALL 18/9 40cm

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270637984
Hospital Revenue Code	278
Min. Negotiated Rate	$129.65
Max. Negotiated Rate	$2,282.50
Rate for Payer: Aetna Commercial	$1,734.70
Rate for Payer: Aetna Medicare Advantage	$1,369.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,164.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$913.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,164.08
Rate for Payer: Cigna Commercial	$2,282.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,104.73
Rate for Payer: Qualcare PPO/HMO/WC	$684.75
Rate for Payer: UnitedHealthcare Community & State	$144.25
Rate for Payer: Wellpoint Medicaid Managed Care	$129.65

GRAFT BIOBRACE 23MM

Facility

$19,250.00

Service Code	HCPCS C1781
Hospital Charge Code	270697767
Hospital Revenue Code	278
Min. Negotiated Rate	$546.70
Max. Negotiated Rate	$9,625.00
Rate for Payer: Aetna Commercial	$7,315.00
Rate for Payer: Aetna Medicare Advantage	$5,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,908.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,908.75
Rate for Payer: Cigna Commercial	$9,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50
Rate for Payer: UnitedHealthcare Community & State	$608.30
Rate for Payer: Wellpoint Medicaid Managed Care	$546.70

GRAFT BIOBRACE 23MM

Facility

$19,250.00

Service Code	HCPCS C1781
Hospital Charge Code	270697767
Hospital Revenue Code	278
Min. Negotiated Rate	$2,887.50
Max. Negotiated Rate	$4,658.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,658.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,887.50

GRAFT BIOBRACE 5X25MM

Facility

$12,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270699462
Hospital Revenue Code	278
Min. Negotiated Rate	$365.65
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$406.85
Rate for Payer: Wellpoint Medicaid Managed Care	$365.65

GRAFT BIOBRACE 5X25MM

Facility

$12,875.00

Service Code	HCPCS C1781
Hospital Charge Code	270699462
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

GRAFT BIOCORE MOLDABLE100X20MM

Facility

$23,079.00

Service Code	HCPCS C1713
Hospital Charge Code	270699954
Hospital Revenue Code	278
Min. Negotiated Rate	$3,461.85
Max. Negotiated Rate	$5,585.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,615.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,585.12
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.85

GRAFT BIOCORE MOLDABLE100X20MM

Facility

$23,079.00

Service Code	HCPCS C1713
Hospital Charge Code	270699954
Hospital Revenue Code	278
Min. Negotiated Rate	$655.44
Max. Negotiated Rate	$11,539.50
Rate for Payer: Aetna Commercial	$8,770.02
Rate for Payer: Aetna Medicare Advantage	$6,923.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,885.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,885.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,615.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,885.15
Rate for Payer: Cigna Commercial	$11,539.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,585.12
Rate for Payer: Qualcare PPO/HMO/WC	$3,461.85
Rate for Payer: UnitedHealthcare Community & State	$729.30
Rate for Payer: Wellpoint Medicaid Managed Care	$655.44

GRAFT BIO DBM PUTTY PLUS 5CC

Facility

$11,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270693378
Hospital Revenue Code	278
Min. Negotiated Rate	$316.23
Max. Negotiated Rate	$5,567.50
Rate for Payer: Aetna Commercial	$4,231.30
Rate for Payer: Aetna Medicare Advantage	$3,340.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,839.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,839.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,227.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,839.43
Rate for Payer: Cigna Commercial	$5,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,694.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,670.25
Rate for Payer: UnitedHealthcare Community & State	$351.87
Rate for Payer: Wellpoint Medicaid Managed Care	$316.23

GRAFT BIO DBM PUTTY PLUS 5CC

Facility

$11,135.00

Service Code	HCPCS C1713
Hospital Charge Code	270693378
Hospital Revenue Code	278
Min. Negotiated Rate	$1,670.25
Max. Negotiated Rate	$2,694.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,227.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,694.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,670.25

GRAFT BIOD RESTORE S

Facility

$1,705.00

Service Code	HCPCS C1763
Hospital Charge Code	270684070
Hospital Revenue Code	278
Min. Negotiated Rate	$48.42
Max. Negotiated Rate	$852.50
Rate for Payer: Aetna Commercial	$647.90
Rate for Payer: Aetna Medicare Advantage	$511.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$434.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$434.77
Rate for Payer: Cigna Commercial	$852.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: Qualcare PPO/HMO/WC	$255.75
Rate for Payer: UnitedHealthcare Community & State	$53.88
Rate for Payer: Wellpoint Medicaid Managed Care	$48.42

GRAFT BIOD RESTORE S

Facility

$1,705.00

Service Code	HCPCS C1763
Hospital Charge Code	270684070
Hospital Revenue Code	278
Min. Negotiated Rate	$255.75
Max. Negotiated Rate	$412.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$341.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.61
Rate for Payer: Qualcare PPO/HMO/WC	$255.75

GRAFT BONE AUGMENT REG 1.5CC

Facility

$12,350.00

Service Code	HCPCS C1734
Hospital Charge Code	270697750
Hospital Revenue Code	278
Min. Negotiated Rate	$350.74
Max. Negotiated Rate	$6,175.00
Rate for Payer: Aetna Commercial	$4,693.00
Rate for Payer: Aetna Medicare Advantage	$3,705.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,149.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,149.25
Rate for Payer: Cigna Commercial	$6,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,988.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,852.50
Rate for Payer: UnitedHealthcare Community & State	$390.26
Rate for Payer: Wellpoint Medicaid Managed Care	$350.74

GRAFT BONE AUGMENT REG 1.5CC

Facility

$12,350.00

Service Code	HCPCS C1734
Hospital Charge Code	270697750
Hospital Revenue Code	278
Min. Negotiated Rate	$1,852.50
Max. Negotiated Rate	$2,988.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,988.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,852.50

GRAFT BONE BIOCORE 50X20MM

Facility

$16,578.00

Service Code	HCPCS C1713
Hospital Charge Code	270698070
Hospital Revenue Code	278
Min. Negotiated Rate	$2,486.70
Max. Negotiated Rate	$4,011.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,315.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,011.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,486.70

GRAFT BONE BIOCORE 50X20MM

Facility

$16,578.00

Service Code	HCPCS C1713
Hospital Charge Code	270698070
Hospital Revenue Code	278
Min. Negotiated Rate	$470.82
Max. Negotiated Rate	$8,289.00
Rate for Payer: Aetna Commercial	$6,299.64
Rate for Payer: Aetna Medicare Advantage	$4,973.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,227.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,227.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,315.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,227.39
Rate for Payer: Cigna Commercial	$8,289.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,011.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,486.70
Rate for Payer: UnitedHealthcare Community & State	$523.86
Rate for Payer: Wellpoint Medicaid Managed Care	$470.82

GRAFT BONE GENEX 10CC

Facility

$13,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696121
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

GRAFT BONE GENEX 10CC

Facility

$13,975.00

Service Code	HCPCS C1713
Hospital Charge Code	270696121
Hospital Revenue Code	278
Min. Negotiated Rate	$396.89
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$5,310.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Community & State	$441.61
Rate for Payer: Wellpoint Medicaid Managed Care	$396.89

Know your out-of-pocket cost for care.

All Charges