Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT DECELL DERM 35x35x1.5MM

Facility

$9,092.00

Service Code	HCPCS Q4125
Hospital Charge Code	270659716
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,200.26
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	$2,200.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,363.80
Rate for Payer: UnitedHealthcare Community & State	$287.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$258.21

GRAFT DECELL DERM 50x90MM

Facility

$18,355.00

Hospital Charge Code	270677582
Hospital Revenue Code	278
Min. Negotiated Rate	$521.28
Max. Negotiated Rate	$9,177.50
Rate for Payer: Aetna Commercial	$6,974.90
Rate for Payer: Aetna Medicare Advantage	$5,506.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,680.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,680.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,671.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,680.52
Rate for Payer: Cigna Commercial	$9,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,441.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,753.25
Rate for Payer: UnitedHealthcare Community & State	$580.02
Rate for Payer: Wellpoint Medicaid Managed Care	$521.28

GRAFT DECELL DERM 50x90MM

Facility

$18,355.00

Hospital Charge Code	270677582
Hospital Revenue Code	278
Min. Negotiated Rate	$2,753.25
Max. Negotiated Rate	$4,441.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,671.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,441.91
Rate for Payer: Qualcare PPO/HMO/WC	$2,753.25

GRAFT DECELL DERMIS 35x35x2MM

Facility

$12,260.00

Hospital Charge Code	270657238
Hospital Revenue Code	278
Min. Negotiated Rate	$1,839.00
Max. Negotiated Rate	$2,966.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,452.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,966.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.00

GRAFT DECELL DERMIS 35x35x2MM

Facility

$12,260.00

Hospital Charge Code	270657238
Hospital Revenue Code	278
Min. Negotiated Rate	$348.18
Max. Negotiated Rate	$6,130.00
Rate for Payer: Aetna Commercial	$4,658.80
Rate for Payer: Aetna Medicare Advantage	$3,678.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,126.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,126.30
Rate for Payer: Cigna Commercial	$6,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,966.92
Rate for Payer: Qualcare PPO/HMO/WC	$1,839.00
Rate for Payer: UnitedHealthcare Community & State	$387.42
Rate for Payer: Wellpoint Medicaid Managed Care	$348.18

GRAFT DELIVERY KIT

Facility

$3,050.00

Hospital Charge Code	270650007
Hospital Revenue Code	272
Min. Negotiated Rate	$457.50
Max. Negotiated Rate	$457.50
Rate for Payer: Qualcare PPO/HMO/WC	$457.50

GRAFT DELIVERY KIT

Facility

$3,050.00

Hospital Charge Code	270650007
Hospital Revenue Code	272
Min. Negotiated Rate	$86.62
Max. Negotiated Rate	$1,525.00
Rate for Payer: Aetna Commercial	$1,159.00
Rate for Payer: Aetna Medicare Advantage	$915.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$777.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$777.75
Rate for Payer: Cigna Commercial	$1,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.00
Rate for Payer: Oxford Commercial	$610.00
Rate for Payer: Qualcare PPO/HMO/WC	$457.50
Rate for Payer: UnitedHealthcare Commercial	$610.00
Rate for Payer: UnitedHealthcare Community & State	$96.38
Rate for Payer: Wellpoint Medicaid Managed Care	$86.62

GRAFT DEVELL DERMIS 30X40X.5MM

Facility

$4,708.00

Service Code	HCPCS Q4125
Hospital Charge Code	270674076
Hospital Revenue Code	278
Min. Negotiated Rate	$706.20
Max. Negotiated Rate	$1,139.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$941.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,139.34
Rate for Payer: Qualcare PPO/HMO/WC	$706.20

GRAFT DEVELL DERMIS 30X40X.5MM

Facility

$4,708.00

Service Code	HCPCS Q4125
Hospital Charge Code	270674076
Hospital Revenue Code	278
Min. Negotiated Rate	$133.71
Max. Negotiated Rate	$1,139.34
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	$941.60
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	$1,139.34
Rate for Payer: Qualcare PPO/HMO/WC	$706.20
Rate for Payer: UnitedHealthcare Community & State	$148.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$133.71

GRAFT DURAGEN 3 X3

Facility

$4,081.45

Service Code	HCPCS C1889
Hospital Charge Code	270690203
Hospital Revenue Code	278
Min. Negotiated Rate	$115.91
Max. Negotiated Rate	$2,040.72
Rate for Payer: Aetna Commercial	$1,550.95
Rate for Payer: Aetna Medicare Advantage	$1,224.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,040.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,040.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,040.77
Rate for Payer: Cigna Commercial	$2,040.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.71
Rate for Payer: Qualcare PPO/HMO/WC	$612.22
Rate for Payer: UnitedHealthcare Community & State	$128.97
Rate for Payer: Wellpoint Medicaid Managed Care	$115.91

GRAFT DURAGEN 3 X3

Facility

$4,081.45

Service Code	HCPCS C1889
Hospital Charge Code	270690203
Hospital Revenue Code	278
Min. Negotiated Rate	$612.22
Max. Negotiated Rate	$987.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$816.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$987.71
Rate for Payer: Qualcare PPO/HMO/WC	$612.22

GRAFT DURAL IMPLANT 1X1 DURAFO

Facility

$968.00

Hospital Charge Code	270663921
Hospital Revenue Code	278
Min. Negotiated Rate	$27.49
Max. Negotiated Rate	$484.00
Rate for Payer: Aetna Commercial	$367.84
Rate for Payer: Aetna Medicare Advantage	$290.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$246.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$246.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$246.84
Rate for Payer: Cigna Commercial	$484.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.26
Rate for Payer: Qualcare PPO/HMO/WC	$145.20
Rate for Payer: UnitedHealthcare Community & State	$30.59
Rate for Payer: Wellpoint Medicaid Managed Care	$27.49

GRAFT DURAL IMPLANT 1X1 DURAFO

Facility

$968.00

Hospital Charge Code	270663921
Hospital Revenue Code	278
Min. Negotiated Rate	$145.20
Max. Negotiated Rate	$234.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.26
Rate for Payer: Qualcare PPO/HMO/WC	$145.20

GRAFT EPIFIX 2.0x3.0CM

Facility

$5,720.00

Service Code	HCPCS Q4186
Hospital Charge Code	270658379
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,384.24
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	$1,144.00
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	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00
Rate for Payer: UnitedHealthcare Community & State	$180.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$162.45

GRAFT EPIFIX 2.0x3.0CM

Facility

$5,720.00

Service Code	HCPCS Q4186
Hospital Charge Code	270658379
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,384.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,144.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,384.24
Rate for Payer: Qualcare PPO/HMO/WC	$858.00

GRAFT EPIFIX 2.0x3.0CM/SQCM JW

Facility

$1,104.17

Hospital Charge Code	270658379W
Hospital Revenue Code	636
Min. Negotiated Rate	$165.63
Max. Negotiated Rate	$267.21
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.21
Rate for Payer: Qualcare PPO/HMO/WC	$165.63

GRAFT EPIFIX 2.0x3.0CM/SQCM JW

Facility

$1,104.17

Hospital Charge Code	270658379W
Hospital Revenue Code	636
Min. Negotiated Rate	$31.36
Max. Negotiated Rate	$552.09
Rate for Payer: Aetna Commercial	$419.58
Rate for Payer: Aetna Medicare Advantage	$331.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$281.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$281.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$281.56
Rate for Payer: Cigna Commercial	$552.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$267.21
Rate for Payer: Qualcare PPO/HMO/WC	$165.63
Rate for Payer: UnitedHealthcare Community & State	$34.89
Rate for Payer: Wellpoint Medicaid Managed Care	$31.36

GRAFT EPIFIX 4.0x4.5CM

Facility

$6,970.00

Service Code	HCPCS Q4186
Hospital Charge Code	270680653
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,686.74
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	$1,394.00
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	$1,686.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,045.50
Rate for Payer: UnitedHealthcare Community & State	$220.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$197.95

GRAFT EPIFIX 4.0x4.5CM

Facility

$6,970.00

Service Code	HCPCS Q4186
Hospital Charge Code	270680653
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.50
Max. Negotiated Rate	$1,686.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,394.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,686.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,045.50

GRAFT EXCLUDER AAA ENDOPRO CL

Facility

$23,695.00

Hospital Charge Code	270683789
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$5,734.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25

GRAFT EXCLUDER AAA ENDOPRO CL

Facility

$23,695.00

Hospital Charge Code	270683789
Hospital Revenue Code	278
Min. Negotiated Rate	$672.94
Max. Negotiated Rate	$11,847.50
Rate for Payer: Aetna Commercial	$9,004.10
Rate for Payer: Aetna Medicare Advantage	$7,108.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,042.23
Rate for Payer: Cigna Commercial	$11,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25
Rate for Payer: UnitedHealthcare Community & State	$748.76
Rate for Payer: Wellpoint Medicaid Managed Care	$672.94

GRAFT EXCLUDER AAA ENDOPRO MB

Facility

$57,785.00

Hospital Charge Code	270683788
Hospital Revenue Code	278
Min. Negotiated Rate	$8,667.75
Max. Negotiated Rate	$13,983.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75

GRAFT EXCLUDER AAA ENDOPRO MB

Facility

$57,785.00

Hospital Charge Code	270683788
Hospital Revenue Code	278
Min. Negotiated Rate	$1,641.09
Max. Negotiated Rate	$28,892.50
Rate for Payer: Aetna Commercial	$21,958.30
Rate for Payer: Aetna Medicare Advantage	$17,335.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,735.17
Rate for Payer: Cigna Commercial	$28,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75
Rate for Payer: UnitedHealthcare Community & State	$1,826.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1,641.09

GRAFT EXTREMITY 4CC INJECTABLE

Facility

$10,350.00

Hospital Charge Code	270656821
Hospital Revenue Code	278
Min. Negotiated Rate	$293.94
Max. Negotiated Rate	$5,175.00
Rate for Payer: Aetna Commercial	$3,933.00
Rate for Payer: Aetna Medicare Advantage	$3,105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,639.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,070.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,639.25
Rate for Payer: Cigna Commercial	$5,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,504.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50
Rate for Payer: UnitedHealthcare Community & State	$327.06
Rate for Payer: Wellpoint Medicaid Managed Care	$293.94

GRAFT EXTREMITY 4CC INJECTABLE

Facility

$10,350.00

Hospital Charge Code	270656821
Hospital Revenue Code	278
Min. Negotiated Rate	$1,552.50
Max. Negotiated Rate	$2,504.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,504.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,552.50

Know your out-of-pocket cost for care.

All Charges