Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT GTX RG 6 70 R06070070L

Facility

$4,400.85

Service Code	HCPCS C1768
Hospital Charge Code	270601146
Hospital Revenue Code	278
Min. Negotiated Rate	$660.13
Max. Negotiated Rate	$1,065.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.01
Rate for Payer: Qualcare PPO/HMO/WC	$660.13

GRAFT GTX RG 6 70 R06070070L

Facility

$4,400.85

Service Code	HCPCS C1768
Hospital Charge Code	270601146
Hospital Revenue Code	278
Min. Negotiated Rate	$124.98
Max. Negotiated Rate	$2,200.43
Rate for Payer: Aetna Commercial	$1,672.32
Rate for Payer: Aetna Medicare Advantage	$1,320.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,122.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$880.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,122.22
Rate for Payer: Cigna Commercial	$2,200.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,065.01
Rate for Payer: Qualcare PPO/HMO/WC	$660.13
Rate for Payer: UnitedHealthcare Community & State	$139.07
Rate for Payer: Wellpoint Medicaid Managed Care	$124.98

GRAFT GTX TH WL 6 80 VT06080L

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270601130
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 GTX TH WL 6 80 VT06080L

Facility

$4,565.00

Service Code	HCPCS C1768
Hospital Charge Code	270601130
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

GRAFTGUN CARTRIDGE KIT

Facility

$6,875.00

Hospital Charge Code	270692127
Hospital Revenue Code	272
Min. Negotiated Rate	$195.25
Max. Negotiated Rate	$3,437.50
Rate for Payer: Aetna Commercial	$2,612.50
Rate for Payer: Aetna Medicare Advantage	$2,062.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,753.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,753.12
Rate for Payer: Cigna Commercial	$3,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,787.50
Rate for Payer: Oxford Commercial	$1,375.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25
Rate for Payer: UnitedHealthcare Commercial	$1,375.00
Rate for Payer: UnitedHealthcare Community & State	$217.25
Rate for Payer: Wellpoint Medicaid Managed Care	$195.25

GRAFTGUN CARTRIDGE KIT

Facility

$6,875.00

Hospital Charge Code	270692127
Hospital Revenue Code	272
Min. Negotiated Rate	$1,031.25
Max. Negotiated Rate	$1,031.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,031.25

GRAFTGUN UNIV GDS GRAFT DEL SY

Facility

$6,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270691275
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

GRAFTGUN UNIV GDS GRAFT DEL SY

Facility

$6,750.00

Service Code	HCPCS C1763
Hospital Charge Code	270691275
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

GRAFT HARVEST

Facility

$8,500.00

Hospital Charge Code	270667378
Hospital Revenue Code	272
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,210.00
Rate for Payer: Oxford Commercial	$1,700.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Commercial	$1,700.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

GRAFT HARVEST

Facility

$8,500.00

Hospital Charge Code	270667378
Hospital Revenue Code	272
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFT HEMAGARD 20mmx10mmX50cm

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679499
Hospital Revenue Code	278
Min. Negotiated Rate	$87.27
Max. Negotiated Rate	$1,536.45
Rate for Payer: Aetna Commercial	$1,167.70
Rate for Payer: Aetna Medicare Advantage	$921.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$783.59
Rate for Payer: Cigna Commercial	$1,536.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94
Rate for Payer: UnitedHealthcare Community & State	$97.10
Rate for Payer: Wellpoint Medicaid Managed Care	$87.27

GRAFT HEMAGARD 20mmx10mmX50cm

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679499
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$743.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMAGARD 6MMX 20CM

Facility

$1,672.70

Service Code	HCPCS L8670
Hospital Charge Code	270690318
Hospital Revenue Code	278
Min. Negotiated Rate	$250.91
Max. Negotiated Rate	$404.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.79
Rate for Payer: Qualcare PPO/HMO/WC	$250.91

GRAFT HEMAGARD 6MMX 20CM

Facility

$1,672.70

Service Code	HCPCS L8670
Hospital Charge Code	270690318
Hospital Revenue Code	278
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$836.35
Rate for Payer: Aetna Commercial	$635.63
Rate for Payer: Aetna Medicare Advantage	$501.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$426.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$426.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$334.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$426.54
Rate for Payer: Cigna Commercial	$836.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$404.79
Rate for Payer: Qualcare PPO/HMO/WC	$250.91
Rate for Payer: UnitedHealthcare Community & State	$52.86
Rate for Payer: Wellpoint Medicaid Managed Care	$47.50

GRAFT HEMASHEILD 14mmX7mmX40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270679500
Hospital Revenue Code	278
Min. Negotiated Rate	$93.09
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$1,245.55
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66
Rate for Payer: UnitedHealthcare Community & State	$103.58
Rate for Payer: Wellpoint Medicaid Managed Care	$93.09

GRAFT HEMASHEILD 14mmX7mmX40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270679500
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHIELD 16x8mm 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270617414
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASHIELD 16x8mm 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270617414
Hospital Revenue Code	278
Min. Negotiated Rate	$93.09
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$1,245.55
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66
Rate for Payer: UnitedHealthcare Community & State	$103.58
Rate for Payer: Wellpoint Medicaid Managed Care	$93.09

GRAFT HEMASHIELD 20mmX10mmX50c

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679501
Hospital Revenue Code	278
Min. Negotiated Rate	$460.94
Max. Negotiated Rate	$743.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94

GRAFT HEMASHIELD 20mmX10mmX50c

Facility

$3,072.90

Service Code	HCPCS C1768
Hospital Charge Code	270679501
Hospital Revenue Code	278
Min. Negotiated Rate	$87.27
Max. Negotiated Rate	$1,536.45
Rate for Payer: Aetna Commercial	$1,167.70
Rate for Payer: Aetna Medicare Advantage	$921.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$783.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$614.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$783.59
Rate for Payer: Cigna Commercial	$1,536.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$743.64
Rate for Payer: Qualcare PPO/HMO/WC	$460.94
Rate for Payer: UnitedHealthcare Community & State	$97.10
Rate for Payer: Wellpoint Medicaid Managed Care	$87.27

GRAFT HEMASHIELD 24x12mm 40cm

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270657648
Hospital Revenue Code	278
Min. Negotiated Rate	$609.34
Max. Negotiated Rate	$983.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: Qualcare PPO/HMO/WC	$609.34

GRAFT HEMASHIELD 24x12mm 40cm

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270657648
Hospital Revenue Code	278
Min. Negotiated Rate	$115.37
Max. Negotiated Rate	$2,031.12
Rate for Payer: Aetna Commercial	$1,543.65
Rate for Payer: Aetna Medicare Advantage	$1,218.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.87
Rate for Payer: Cigna Commercial	$2,031.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: Qualcare PPO/HMO/WC	$609.34
Rate for Payer: UnitedHealthcare Community & State	$128.37
Rate for Payer: Wellpoint Medicaid Managed Care	$115.37

GRAFT HEMASHIELD 8 X 15

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686403
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD 8 X 15

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686403
Hospital Revenue Code	278
Min. Negotiated Rate	$83.78
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$93.22
Rate for Payer: Wellpoint Medicaid Managed Care	$83.78

GRAFT HEMASHIELD 8 X 30

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686402
Hospital Revenue Code	278
Min. Negotiated Rate	$83.78
Max. Negotiated Rate	$1,475.00
Rate for Payer: Aetna Commercial	$1,121.00
Rate for Payer: Aetna Medicare Advantage	$885.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$752.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$752.25
Rate for Payer: Cigna Commercial	$1,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50
Rate for Payer: UnitedHealthcare Community & State	$93.22
Rate for Payer: Wellpoint Medicaid Managed Care	$83.78

Know your out-of-pocket cost for care.

All Charges