Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT BONE MAGNETOS 10CC 1-2MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699275
Hospital Revenue Code	278
Min. Negotiated Rate	$2,437.50
Max. Negotiated Rate	$3,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50

GRAFT BONE MAGNETOS 10CC 1-2MM

Facility

$16,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270699275
Hospital Revenue Code	278
Min. Negotiated Rate	$461.50
Max. Negotiated Rate	$8,125.00
Rate for Payer: Aetna Commercial	$6,175.00
Rate for Payer: Aetna Medicare Advantage	$4,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,143.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,143.75
Rate for Payer: Cigna Commercial	$8,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,932.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,437.50
Rate for Payer: UnitedHealthcare Community & State	$513.50
Rate for Payer: Wellpoint Medicaid Managed Care	$461.50

GRAFT BONE MAGNETOS 5CC 1-2MM

Facility

$8,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699107
Hospital Revenue Code	278
Min. Negotiated Rate	$230.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$256.75
Rate for Payer: Wellpoint Medicaid Managed Care	$230.75

GRAFT BONE MAGNETOS 5CC 1-2MM

Facility

$8,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270699107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

GRAFT BONE PASTE FD 5cc DBX

Facility

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	270679739
Hospital Revenue Code	278
Min. Negotiated Rate	$107.25
Max. Negotiated Rate	$173.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.03
Rate for Payer: Qualcare PPO/HMO/WC	$107.25

GRAFT BONE PASTE FD 5cc DBX

Facility

$715.00

Service Code	HCPCS C1713
Hospital Charge Code	270679739
Hospital Revenue Code	278
Min. Negotiated Rate	$20.31
Max. Negotiated Rate	$357.50
Rate for Payer: Aetna Commercial	$271.70
Rate for Payer: Aetna Medicare Advantage	$214.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$182.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$182.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$182.32
Rate for Payer: Cigna Commercial	$357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.03
Rate for Payer: Qualcare PPO/HMO/WC	$107.25
Rate for Payer: UnitedHealthcare Community & State	$22.59
Rate for Payer: Wellpoint Medicaid Managed Care	$20.31

GRAFT BONE SPACER 16MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270691814
Hospital Revenue Code	278
Min. Negotiated Rate	$3,225.00
Max. Negotiated Rate	$5,203.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00

GRAFT BONE SPACER 16MM

Facility

$21,500.00

Service Code	HCPCS C1889
Hospital Charge Code	270691814
Hospital Revenue Code	278
Min. Negotiated Rate	$610.60
Max. Negotiated Rate	$10,750.00
Rate for Payer: Aetna Commercial	$8,170.00
Rate for Payer: Aetna Medicare Advantage	$6,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,482.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,482.50
Rate for Payer: Cigna Commercial	$10,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,203.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,225.00
Rate for Payer: UnitedHealthcare Community & State	$679.40
Rate for Payer: Wellpoint Medicaid Managed Care	$610.60

GRAFT BONE SUBS ALTAPORE 1.6ML

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270693009
Hospital Revenue Code	278
Min. Negotiated Rate	$345.00
Max. Negotiated Rate	$556.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00

GRAFT BONE SUBS ALTAPORE 1.6ML

Facility

$2,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270693009
Hospital Revenue Code	278
Min. Negotiated Rate	$65.32
Max. Negotiated Rate	$1,150.00
Rate for Payer: Aetna Commercial	$874.00
Rate for Payer: Aetna Medicare Advantage	$690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$586.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$586.50
Rate for Payer: Cigna Commercial	$1,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$556.60
Rate for Payer: Qualcare PPO/HMO/WC	$345.00
Rate for Payer: UnitedHealthcare Community & State	$72.68
Rate for Payer: Wellpoint Medicaid Managed Care	$65.32

GRAFT BONE SUBST GENEX 5CC

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696087
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

GRAFT BONE SUBST GENEX 5CC

Facility

$7,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270696087
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

GRAFT CARTIFORM 10MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270677098
Hospital Revenue Code	278
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$4,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00

GRAFT CARTIFORM 10MM

Facility

$17,500.00

Service Code	HCPCS C1713
Hospital Charge Code	270677098
Hospital Revenue Code	278
Min. Negotiated Rate	$497.00
Max. Negotiated Rate	$8,750.00
Rate for Payer: Aetna Commercial	$6,650.00
Rate for Payer: Aetna Medicare Advantage	$5,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,462.50
Rate for Payer: Cigna Commercial	$8,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,235.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,625.00
Rate for Payer: UnitedHealthcare Community & State	$553.00
Rate for Payer: Wellpoint Medicaid Managed Care	$497.00

GRAFT CONDUIT 3MMX3CM NERVE

Facility

$6,482.50

Service Code	HCPCS C1889
Hospital Charge Code	270684389
Hospital Revenue Code	278
Min. Negotiated Rate	$184.10
Max. Negotiated Rate	$3,241.25
Rate for Payer: Aetna Commercial	$2,463.35
Rate for Payer: Aetna Medicare Advantage	$1,944.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,653.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,653.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,653.04
Rate for Payer: Cigna Commercial	$3,241.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.77
Rate for Payer: Qualcare PPO/HMO/WC	$972.38
Rate for Payer: UnitedHealthcare Community & State	$204.85
Rate for Payer: Wellpoint Medicaid Managed Care	$184.10

GRAFT CONDUIT 3MMX3CM NERVE

Facility

$6,482.50

Service Code	HCPCS C1889
Hospital Charge Code	270684389
Hospital Revenue Code	278
Min. Negotiated Rate	$972.38
Max. Negotiated Rate	$1,568.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,296.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,568.77
Rate for Payer: Qualcare PPO/HMO/WC	$972.38

GRAFT CONDYL RT LATERAL

Facility

$56,000.00

Hospital Charge Code	270676320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,590.40
Max. Negotiated Rate	$28,000.00
Rate for Payer: Aetna Commercial	$21,280.00
Rate for Payer: Aetna Medicare Advantage	$16,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,280.00
Rate for Payer: Cigna Commercial	$28,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,400.00
Rate for Payer: UnitedHealthcare Community & State	$1,769.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1,590.40

GRAFT CONDYL RT LATERAL

Facility

$56,000.00

Hospital Charge Code	270676320
Hospital Revenue Code	278
Min. Negotiated Rate	$8,400.00
Max. Negotiated Rate	$13,552.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,552.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,400.00

GRAFT DBM PRIME HD 2.5ML LF

Facility

$1,290.00

Service Code	HCPCS C1762
Hospital Charge Code	270698873
Hospital Revenue Code	278
Min. Negotiated Rate	$193.50
Max. Negotiated Rate	$312.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$258.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.18
Rate for Payer: Qualcare PPO/HMO/WC	$193.50

GRAFT DBM PRIME HD 2.5ML LF

Facility

$1,290.00

Service Code	HCPCS C1762
Hospital Charge Code	270698873
Hospital Revenue Code	278
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$645.00
Rate for Payer: Aetna Commercial	$490.20
Rate for Payer: Aetna Medicare Advantage	$387.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$328.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$328.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$258.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$328.95
Rate for Payer: Cigna Commercial	$645.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$312.18
Rate for Payer: Qualcare PPO/HMO/WC	$193.50
Rate for Payer: UnitedHealthcare Community & State	$40.76
Rate for Payer: Wellpoint Medicaid Managed Care	$36.64

GRAFT DBM SPONGE SMALL

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690648
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 DBM SPONGE SMALL

Facility

$10,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270690648
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 DCELL DERMIS 40x70x1.5MM

Facility

$10,808.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659719
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,615.54
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	$2,161.60
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	$2,615.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,621.20
Rate for Payer: UnitedHealthcare Community & State	$341.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$306.95

GRAFT DCELL DERMIS 40x70x1.5MM

Facility

$10,808.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659719
Hospital Revenue Code	278
Min. Negotiated Rate	$1,621.20
Max. Negotiated Rate	$2,615.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,161.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,615.54
Rate for Payer: Qualcare PPO/HMO/WC	$1,621.20

GRAFT DECELL DERM 35x35x1.5MM

Facility

$9,092.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659716
Hospital Revenue Code	636
Min. Negotiated Rate	$1,363.80
Max. Negotiated Rate	$2,200.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,200.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,363.80

Know your out-of-pocket cost for care.

All Charges