Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT MAIN BODY 28x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270677223
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 28x100

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270677223
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

GRAFT MAIN BODY 28x80

Facility

$65,795.00

Hospital Charge Code	270677194
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 28x80

Facility

$65,795.00

Hospital Charge Code	270677194
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

GRAFT MAIN BODY 29MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270677356
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 29MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270677356
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 AFX2 16 X 40CM

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061
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 AFX2 16 X 40CM

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061
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

GRAFT MANIPULATION EXP BRAID

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	270662947
Hospital Revenue Code	278
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

GRAFT MANIPULATION EXP BRAID

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	270662947
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GRAFT MANPULATION EXPRESS BRAI

Facility

$450.00

Hospital Charge Code	270668499
Hospital Revenue Code	278
Min. Negotiated Rate	$67.50
Max. Negotiated Rate	$108.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50

GRAFT MANPULATION EXPRESS BRAI

Facility

$450.00

Hospital Charge Code	270668499
Hospital Revenue Code	278
Min. Negotiated Rate	$12.78
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$171.00
Rate for Payer: Aetna Medicare Advantage	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.75
Rate for Payer: Cigna Commercial	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.90
Rate for Payer: Qualcare PPO/HMO/WC	$67.50
Rate for Payer: UnitedHealthcare Community & State	$14.22
Rate for Payer: Wellpoint Medicaid Managed Care	$12.78

GRAFT MATRIX 8.0X3.0 cm

Facility

$15,475.00

Service Code	HCPCS Q4148
Hospital Charge Code	270680389
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,744.95
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	$3,095.00
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	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25
Rate for Payer: UnitedHealthcare Community & State	$489.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$439.49

GRAFT MATRIX 8.0X3.0 cm

Facility

$15,475.00

Service Code	HCPCS Q4148
Hospital Charge Code	270680389
Hospital Revenue Code	278
Min. Negotiated Rate	$2,321.25
Max. Negotiated Rate	$3,744.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,744.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,321.25

GRAFT MATRIX OSTEO 10CC

Facility

$25,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270698432
Hospital Revenue Code	278
Min. Negotiated Rate	$3,869.25
Max. Negotiated Rate	$6,242.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,242.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,869.25

GRAFT MATRIX OSTEO 10CC

Facility

$25,795.00

Service Code	HCPCS C1713
Hospital Charge Code	270698432
Hospital Revenue Code	278
Min. Negotiated Rate	$732.58
Max. Negotiated Rate	$12,897.50
Rate for Payer: Aetna Commercial	$9,802.10
Rate for Payer: Aetna Medicare Advantage	$7,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,577.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,577.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,577.73
Rate for Payer: Cigna Commercial	$12,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,242.39
Rate for Payer: Qualcare PPO/HMO/WC	$3,869.25
Rate for Payer: UnitedHealthcare Community & State	$815.12
Rate for Payer: Wellpoint Medicaid Managed Care	$732.58

GRAFT MATRIX REINFORCE 4X7 CM

Facility

$10,140.00

Service Code	HCPCS C1763
Hospital Charge Code	270684064
Hospital Revenue Code	278
Min. Negotiated Rate	$287.98
Max. Negotiated Rate	$5,070.00
Rate for Payer: Aetna Commercial	$3,853.20
Rate for Payer: Aetna Medicare Advantage	$3,042.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,585.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,585.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,028.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,585.70
Rate for Payer: Cigna Commercial	$5,070.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,453.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.00
Rate for Payer: UnitedHealthcare Community & State	$320.42
Rate for Payer: Wellpoint Medicaid Managed Care	$287.98

GRAFT MATRIX REINFORCE 4X7 CM

Facility

$10,140.00

Service Code	HCPCS C1763
Hospital Charge Code	270684064
Hospital Revenue Code	278
Min. Negotiated Rate	$1,521.00
Max. Negotiated Rate	$2,453.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,028.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,453.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,521.00

GRAFT MATRIX REINFORCE 5X10CM

Facility

$11,427.50

Service Code	HCPCS C1763
Hospital Charge Code	270684065
Hospital Revenue Code	278
Min. Negotiated Rate	$324.54
Max. Negotiated Rate	$5,713.75
Rate for Payer: Aetna Commercial	$4,342.45
Rate for Payer: Aetna Medicare Advantage	$3,428.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,914.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,914.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,914.01
Rate for Payer: Cigna Commercial	$5,713.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.12
Rate for Payer: UnitedHealthcare Community & State	$361.11
Rate for Payer: Wellpoint Medicaid Managed Care	$324.54

GRAFT MATRIX REINFORCE 5X10CM

Facility

$11,427.50

Service Code	HCPCS C1763
Hospital Charge Code	270684065
Hospital Revenue Code	278
Min. Negotiated Rate	$1,714.12
Max. Negotiated Rate	$2,765.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,285.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,765.45
Rate for Payer: Qualcare PPO/HMO/WC	$1,714.12

GRAFT MATRIX WND 6X3CM

Facility

$9,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270673866
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,413.95
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	$1,995.00
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	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

GRAFT MATRIX WND 6X3CM

Facility

$9,975.00

Service Code	HCPCS Q4148
Hospital Charge Code	270673866
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

GRAFT MATRIX WND 6X3CM/SQCM JW

Facility

$887.19

Hospital Charge Code	270673866W
Hospital Revenue Code	636
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$443.60
Rate for Payer: Aetna Commercial	$337.13
Rate for Payer: Aetna Medicare Advantage	$266.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$226.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$226.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$226.23
Rate for Payer: Cigna Commercial	$443.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.70
Rate for Payer: Qualcare PPO/HMO/WC	$133.08
Rate for Payer: UnitedHealthcare Community & State	$28.04
Rate for Payer: Wellpoint Medicaid Managed Care	$25.20

GRAFT MATRIX WND 6X3CM/SQCM JW

Facility

$887.19

Hospital Charge Code	270673866W
Hospital Revenue Code	636
Min. Negotiated Rate	$133.08
Max. Negotiated Rate	$214.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$214.70
Rate for Payer: Qualcare PPO/HMO/WC	$133.08

GRAFT MEMBRANE 2 x 3 MM

Facility

$2,800.00

Service Code	HCPCS Q4248
Hospital Charge Code	270696212
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$677.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$677.60
Rate for Payer: Qualcare PPO/HMO/WC	$420.00

Know your out-of-pocket cost for care.

All Charges