Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT ILIAC LIMB 14x14x160MM

Facility

$24,995.00

Hospital Charge Code	270678253
Hospital Revenue Code	278
Min. Negotiated Rate	$709.86
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$789.84
Rate for Payer: Wellpoint Medicaid Managed Care	$709.86

GRAFT ILIAC LIMB 14x14x160MM

Facility

$24,995.00

Hospital Charge Code	270678253
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

GRAFT ILIAC LIMB 14x14x80

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270677224
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

GRAFT ILIAC LIMB 14x14x80

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270677224
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

GRAFT ILIAC LIMB 14x16x120

Facility

$30,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677355
Hospital Revenue Code	278
Min. Negotiated Rate	$859.10
Max. Negotiated Rate	$15,125.00
Rate for Payer: Aetna Commercial	$11,495.00
Rate for Payer: Aetna Medicare Advantage	$9,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,713.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,713.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,713.75
Rate for Payer: Cigna Commercial	$15,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,320.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,537.50
Rate for Payer: UnitedHealthcare Community & State	$955.90
Rate for Payer: Wellpoint Medicaid Managed Care	$859.10

GRAFT ILIAC LIMB 14x16x120

Facility

$30,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270677355
Hospital Revenue Code	278
Min. Negotiated Rate	$4,537.50
Max. Negotiated Rate	$7,320.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,320.50
Rate for Payer: Qualcare PPO/HMO/WC	$4,537.50

GRAFT ILIAC LIMB 14x16x160MM

Facility

$24,995.00

Hospital Charge Code	270678254
Hospital Revenue Code	278
Min. Negotiated Rate	$709.86
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$789.84
Rate for Payer: Wellpoint Medicaid Managed Care	$709.86

GRAFT ILIAC LIMB 14x16x160MM

Facility

$24,995.00

Hospital Charge Code	270678254
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

GRAFT ILIAC LIMB 14X18X140mm

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270686649O
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

GRAFT ILIAC LIMB 14X18X140mm

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270686649O
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

GRAFT ILIAC LIMB 14X18X140mm

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270646689
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

GRAFT ILIAC LIMB 14X18X140mm

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270646689
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

GRAFT ILIAC LIMB 14X18X140mm

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270686649
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

GRAFT ILIAC LIMB 14X18X140mm

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270686649
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

GRAFT ILIAC LIMB 22X160MM

Facility

$27,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270687404
Hospital Revenue Code	278
Min. Negotiated Rate	$780.86
Max. Negotiated Rate	$13,747.50
Rate for Payer: Aetna Commercial	$10,448.10
Rate for Payer: Aetna Medicare Advantage	$8,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,011.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,011.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,011.23
Rate for Payer: Cigna Commercial	$13,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,653.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,124.25
Rate for Payer: UnitedHealthcare Community & State	$868.84
Rate for Payer: Wellpoint Medicaid Managed Care	$780.86

GRAFT ILIAC LIMB 22X160MM

Facility

$27,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270687404
Hospital Revenue Code	278
Min. Negotiated Rate	$4,124.25
Max. Negotiated Rate	$6,653.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,653.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,124.25

GRAFT JACKET 4 X 8 MM

Facility

$12,795.00

Hospital Charge Code	270689582
Hospital Revenue Code	272
Min. Negotiated Rate	$363.38
Max. Negotiated Rate	$6,397.50
Rate for Payer: Aetna Commercial	$4,862.10
Rate for Payer: Aetna Medicare Advantage	$3,838.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,262.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,262.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,262.72
Rate for Payer: Cigna Commercial	$6,397.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,326.70
Rate for Payer: Oxford Commercial	$2,559.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,919.25
Rate for Payer: UnitedHealthcare Commercial	$2,559.00
Rate for Payer: UnitedHealthcare Community & State	$404.32
Rate for Payer: Wellpoint Medicaid Managed Care	$363.38

GRAFT JACKET 4 X 8 MM

Facility

$12,795.00

Hospital Charge Code	270689582
Hospital Revenue Code	272
Min. Negotiated Rate	$1,919.25
Max. Negotiated Rate	$1,919.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,919.25

GRAFTJACKET EXPRESS 2CC

Facility

$11,000.00

Service Code	HCPCS Q4113
Hospital Charge Code	270659717
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$2,662.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00

GRAFTJACKET EXPRESS 2CC

Facility

$11,000.00

Service Code	HCPCS Q4113
Hospital Charge Code	270659717
Hospital Revenue Code	278
Min. Negotiated Rate	$312.40
Max. Negotiated Rate	$5,500.00
Rate for Payer: Aetna Commercial	$4,180.00
Rate for Payer: Aetna Medicare Advantage	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,805.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,805.00
Rate for Payer: Cigna Commercial	$5,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,662.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,650.00
Rate for Payer: UnitedHealthcare Community & State	$347.60
Rate for Payer: Wellpoint Medicaid Managed Care	$312.40

GRAFTJACKET EXPRESS 2CC/1CCJW

Facility

$5,500.00

Hospital Charge Code	270659717W
Hospital Revenue Code	636
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GRAFTJACKET EXPRESS 2CC/1CCJW

Facility

$5,500.00

Hospital Charge Code	270659717W
Hospital Revenue Code	636
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

GRAFT JACKET NOW STANDARD 4X4C

Facility

$11,535.00

Service Code	HCPCS Q4107
Hospital Charge Code	270687972
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,791.47
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	$2,307.00
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	$2,791.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,730.25
Rate for Payer: UnitedHealthcare Community & State	$364.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$327.59

GRAFT JACKET NOW STANDARD 4X4C

Facility

$11,535.00

Service Code	HCPCS Q4107
Hospital Charge Code	270687972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,730.25
Max. Negotiated Rate	$2,791.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,307.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,791.47
Rate for Payer: Qualcare PPO/HMO/WC	$1,730.25

GRAFTJACKET TISSUE 4 X 7

Facility

$10,710.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652320
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,591.82
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	$2,142.00
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	$2,591.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,606.50
Rate for Payer: UnitedHealthcare Community & State	$338.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$304.16

Know your out-of-pocket cost for care.

All Charges