Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFTJACKET TISSUE 4 X 7

Facility

$10,710.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,606.50
Max. Negotiated Rate	$2,591.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,591.82
Rate for Payer: Qualcare PPO/HMO/WC	$1,606.50

GRAFTJACKET TISSUE 5 X 5

Facility

$9,765.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652321
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,363.13
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	$1,953.00
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	$2,363.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,464.75
Rate for Payer: UnitedHealthcare Community & State	$308.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$277.33

GRAFTJACKET TISSUE 5 X 5

Facility

$9,765.00

Service Code	HCPCS Q4107
Hospital Charge Code	270652321
Hospital Revenue Code	278
Min. Negotiated Rate	$1,464.75
Max. Negotiated Rate	$2,363.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,953.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,363.13
Rate for Payer: Qualcare PPO/HMO/WC	$1,464.75

GRAFT LENEVA 1.5CC

Facility

$5,937.50

Service Code	HCPCS J3590
Hospital Charge Code	270701098
Hospital Revenue Code	278
Min. Negotiated Rate	$168.62
Max. Negotiated Rate	$2,968.75
Rate for Payer: Aetna Commercial	$2,256.25
Rate for Payer: Aetna Medicare Advantage	$1,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,514.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,514.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,514.06
Rate for Payer: Cigna Commercial	$2,968.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,436.88
Rate for Payer: Qualcare PPO/HMO/WC	$890.62
Rate for Payer: UnitedHealthcare Community & State	$187.62
Rate for Payer: Wellpoint Medicaid Managed Care	$168.62

GRAFT LENEVA 1.5CC

Facility

$5,937.50

Service Code	HCPCS J3590
Hospital Charge Code	270701098
Hospital Revenue Code	278
Min. Negotiated Rate	$890.62
Max. Negotiated Rate	$1,436.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,436.88
Rate for Payer: Qualcare PPO/HMO/WC	$890.62

GRAFT LENEVA ADIPOSE MATRIX3CC

Facility

$11,850.00

Service Code	HCPCS J3590
Hospital Charge Code	270697048
Hospital Revenue Code	636
Min. Negotiated Rate	$336.54
Max. Negotiated Rate	$5,925.00
Rate for Payer: Aetna Commercial	$4,503.00
Rate for Payer: Aetna Medicare Advantage	$3,555.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,021.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,021.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,021.75
Rate for Payer: Cigna Commercial	$5,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,867.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,777.50
Rate for Payer: UnitedHealthcare Community & State	$374.46
Rate for Payer: Wellpoint Medicaid Managed Care	$336.54

GRAFT LENEVA ADIPOSE MATRIX3CC

Facility

$11,850.00

Service Code	HCPCS J3590
Hospital Charge Code	270697048
Hospital Revenue Code	636
Min. Negotiated Rate	$1,777.50
Max. Negotiated Rate	$2,867.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,867.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,777.50

GRAFT LIM AFXZ 16X16X55 CM

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684062
Hospital Revenue Code	278
Min. Negotiated Rate	$2,467.50
Max. Negotiated Rate	$3,980.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50

GRAFT LIM AFXZ 16X16X55 CM

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684062
Hospital Revenue Code	278
Min. Negotiated Rate	$467.18
Max. Negotiated Rate	$8,225.00
Rate for Payer: Aetna Commercial	$6,251.00
Rate for Payer: Aetna Medicare Advantage	$4,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,194.75
Rate for Payer: Cigna Commercial	$8,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50
Rate for Payer: UnitedHealthcare Community & State	$519.82
Rate for Payer: Wellpoint Medicaid Managed Care	$467.18

GRAFT LIM AFXZ 16X 16 X 88

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684071
Hospital Revenue Code	278
Min. Negotiated Rate	$2,467.50
Max. Negotiated Rate	$3,980.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50

GRAFT LIM AFXZ 16X 16 X 88

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270684071
Hospital Revenue Code	278
Min. Negotiated Rate	$467.18
Max. Negotiated Rate	$8,225.00
Rate for Payer: Aetna Commercial	$6,251.00
Rate for Payer: Aetna Medicare Advantage	$4,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,194.75
Rate for Payer: Cigna Commercial	$8,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50
Rate for Payer: UnitedHealthcare Community & State	$519.82
Rate for Payer: Wellpoint Medicaid Managed Care	$467.18

GRAFT LIMB EXTN 20mmx13x88mm

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270680044
Hospital Revenue Code	278
Min. Negotiated Rate	$2,467.50
Max. Negotiated Rate	$3,980.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50

GRAFT LIMB EXTN 20mmx13x88mm

Facility

$16,450.00

Service Code	HCPCS C1768
Hospital Charge Code	270680044
Hospital Revenue Code	278
Min. Negotiated Rate	$467.18
Max. Negotiated Rate	$8,225.00
Rate for Payer: Aetna Commercial	$6,251.00
Rate for Payer: Aetna Medicare Advantage	$4,935.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,194.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,194.75
Rate for Payer: Cigna Commercial	$8,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,980.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,467.50
Rate for Payer: UnitedHealthcare Community & State	$519.82
Rate for Payer: Wellpoint Medicaid Managed Care	$467.18

GRAFTLINK PREP ATTACH

Facility

$2,615.00

Hospital Charge Code	270676220
Hospital Revenue Code	272
Min. Negotiated Rate	$392.25
Max. Negotiated Rate	$392.25
Rate for Payer: Qualcare PPO/HMO/WC	$392.25

GRAFTLINK PREP ATTACH

Facility

$2,615.00

Hospital Charge Code	270676220
Hospital Revenue Code	272
Min. Negotiated Rate	$74.27
Max. Negotiated Rate	$1,307.50
Rate for Payer: Aetna Commercial	$993.70
Rate for Payer: Aetna Medicare Advantage	$784.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.83
Rate for Payer: Cigna Commercial	$1,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$679.90
Rate for Payer: Oxford Commercial	$523.00
Rate for Payer: Qualcare PPO/HMO/WC	$392.25
Rate for Payer: UnitedHealthcare Commercial	$523.00
Rate for Payer: UnitedHealthcare Community & State	$82.63
Rate for Payer: Wellpoint Medicaid Managed Care	$74.27

GRAFTLINK PREP ATT W/TENSIONER

Facility

$4,590.00

Hospital Charge Code	270676221
Hospital Revenue Code	272
Min. Negotiated Rate	$688.50
Max. Negotiated Rate	$688.50
Rate for Payer: Qualcare PPO/HMO/WC	$688.50

GRAFTLINK PREP ATT W/TENSIONER

Facility

$4,590.00

Hospital Charge Code	270676221
Hospital Revenue Code	272
Min. Negotiated Rate	$130.36
Max. Negotiated Rate	$2,295.00
Rate for Payer: Aetna Commercial	$1,744.20
Rate for Payer: Aetna Medicare Advantage	$1,377.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,170.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,170.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,170.45
Rate for Payer: Cigna Commercial	$2,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,193.40
Rate for Payer: Oxford Commercial	$918.00
Rate for Payer: Qualcare PPO/HMO/WC	$688.50
Rate for Payer: UnitedHealthcare Commercial	$918.00
Rate for Payer: UnitedHealthcare Community & State	$145.04
Rate for Payer: Wellpoint Medicaid Managed Care	$130.36

GRAFTLINK XL

Facility

$12,500.00

Hospital Charge Code	270677863
Hospital Revenue Code	278
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Community & State	$395.00
Rate for Payer: Wellpoint Medicaid Managed Care	$355.00

GRAFTLINK XL

Facility

$12,500.00

Hospital Charge Code	270677863
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,025.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

GRAFT MAG EX GRAFT DELIVERY SY

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704715
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

GRAFT MAG EX GRAFT DELIVERY SY

Facility

$25,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270704715
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

GRAFT MAIN BODY 20MM

Facility

$56,395.00

Hospital Charge Code	270683414
Hospital Revenue Code	278
Min. Negotiated Rate	$8,459.25
Max. Negotiated Rate	$13,647.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,647.59
Rate for Payer: Qualcare PPO/HMO/WC	$8,459.25

GRAFT MAIN BODY 20MM

Facility

$56,395.00

Hospital Charge Code	270683414
Hospital Revenue Code	278
Min. Negotiated Rate	$1,601.62
Max. Negotiated Rate	$28,197.50
Rate for Payer: Aetna Commercial	$21,430.10
Rate for Payer: Aetna Medicare Advantage	$16,918.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,380.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,380.73
Rate for Payer: Cigna Commercial	$28,197.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,647.59
Rate for Payer: Qualcare PPO/HMO/WC	$8,459.25
Rate for Payer: UnitedHealthcare Community & State	$1,782.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,601.62

GRAFT MAIN BODY 25x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270678152
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT MAIN BODY 25x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270678152
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

Know your out-of-pocket cost for care.

All Charges