Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT NEURAWRAP 10MMX4CM NERVE

Facility

$6,542.50

Service Code	HCPCS C9353
Hospital Charge Code	270684067
Hospital Revenue Code	278
Min. Negotiated Rate	$981.38
Max. Negotiated Rate	$1,583.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.29
Rate for Payer: Qualcare PPO/HMO/WC	$981.38

GRAFT NEURAWRAP 10MMX4CM NERVE

Facility

$6,542.50

Service Code	HCPCS C9353
Hospital Charge Code	270684067
Hospital Revenue Code	278
Min. Negotiated Rate	$185.81
Max. Negotiated Rate	$3,271.25
Rate for Payer: Aetna Commercial	$2,486.15
Rate for Payer: Aetna Medicare Advantage	$1,962.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,668.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,668.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,308.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,668.34
Rate for Payer: Cigna Commercial	$3,271.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,583.29
Rate for Payer: Qualcare PPO/HMO/WC	$981.38
Rate for Payer: UnitedHealthcare Community & State	$206.74
Rate for Payer: Wellpoint Medicaid Managed Care	$185.81

GRAFT NEUROWRAP 3MM X 20CM

Facility

$4,777.50

Service Code	HCPCS C9361
Hospital Charge Code	270688282
Hospital Revenue Code	278
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,815.45
Rate for Payer: Aetna Medicare Advantage	$1,433.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,218.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,218.26
Rate for Payer: Cigna Commercial	$2,388.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62
Rate for Payer: UnitedHealthcare Community & State	$150.97
Rate for Payer: Wellpoint Medicaid Managed Care	$135.68

GRAFT NEUROWRAP 3MM X 20CM

Facility

$4,777.50

Service Code	HCPCS C9361
Hospital Charge Code	270688282
Hospital Revenue Code	278
Min. Negotiated Rate	$716.62
Max. Negotiated Rate	$1,156.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,156.15
Rate for Payer: Qualcare PPO/HMO/WC	$716.62

GRAFT NEVOS SPONGE 50X20X5MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692930
Hospital Revenue Code	278
Min. Negotiated Rate	$390.50
Max. Negotiated Rate	$6,875.00
Rate for Payer: Aetna Commercial	$5,225.00
Rate for Payer: Aetna Medicare Advantage	$4,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,506.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,506.25
Rate for Payer: Cigna Commercial	$6,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50
Rate for Payer: UnitedHealthcare Community & State	$434.50
Rate for Payer: Wellpoint Medicaid Managed Care	$390.50

GRAFT NEVOS SPONGE 50X20X5MM

Facility

$13,750.00

Service Code	HCPCS C1713
Hospital Charge Code	270692930
Hospital Revenue Code	278
Min. Negotiated Rate	$2,062.50
Max. Negotiated Rate	$3,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,327.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,062.50

GRAFT NU SHIELD 6 SQ CM

Facility

$3,975.00

Service Code	HCPCS Q4160
Hospital Charge Code	270686858
Hospital Revenue Code	278
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$961.95
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	$795.00
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	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25
Rate for Payer: UnitedHealthcare Community & State	$125.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$112.89

GRAFT NU SHIELD 6 SQ CM

Facility

$3,975.00

Service Code	HCPCS Q4160
Hospital Charge Code	270686858
Hospital Revenue Code	278
Min. Negotiated Rate	$596.25
Max. Negotiated Rate	$961.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$961.95
Rate for Payer: Qualcare PPO/HMO/WC	$596.25

GRAFT OMNIGRAFT 2.5CM X 2.5 CM

Facility

$2,975.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684011
Hospital Revenue Code	278
Min. Negotiated Rate	$84.49
Max. Negotiated Rate	$719.95
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	$595.00
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	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Community & State	$94.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$84.49

GRAFT OMNIGRAFT 2.5CM X 2.5 CM

Facility

$2,975.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684011
Hospital Revenue Code	278
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$719.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$719.95
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012W
Hospital Revenue Code	636
Min. Negotiated Rate	$124.25
Max. Negotiated Rate	$1,058.75
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	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$138.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$124.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012W
Hospital Revenue Code	636
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

GRAFT OMNIGRAFT 4CM X 4 CM

Facility

$4,375.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684012
Hospital Revenue Code	278
Min. Negotiated Rate	$124.25
Max. Negotiated Rate	$1,058.75
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	$875.00
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	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$138.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$124.25

GRAFT OMNIGRAFT 7 CM X 7 CM

Facility

$8,750.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684013
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

GRAFT OMNIGRAFT 7 CM X 7 CM

Facility

$8,750.00

Service Code	HCPCS Q4105
Hospital Charge Code	270684013
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,117.50
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	$1,750.00
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	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$276.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$248.50

GRAFTON 1CC GEL

Facility

$1,145.00

Hospital Charge Code	270665043
Hospital Revenue Code	270
Min. Negotiated Rate	$32.52
Max. Negotiated Rate	$572.50
Rate for Payer: Aetna Commercial	$435.10
Rate for Payer: Aetna Medicare Advantage	$343.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$291.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$291.98
Rate for Payer: Cigna Commercial	$572.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$297.70
Rate for Payer: Oxford Commercial	$229.00
Rate for Payer: Qualcare PPO/HMO/WC	$171.75
Rate for Payer: UnitedHealthcare Commercial	$229.00
Rate for Payer: UnitedHealthcare Community & State	$36.18
Rate for Payer: Wellpoint Medicaid Managed Care	$32.52

GRAFTON 1CC GEL

Facility

$1,145.00

Hospital Charge Code	270665043
Hospital Revenue Code	270
Min. Negotiated Rate	$171.75
Max. Negotiated Rate	$171.75
Rate for Payer: Qualcare PPO/HMO/WC	$171.75

GRAFTON GEL 2.5CC

Facility

$1,333.00

Hospital Charge Code	270335432
Hospital Revenue Code	278
Min. Negotiated Rate	$37.86
Max. Negotiated Rate	$666.50
Rate for Payer: Aetna Commercial	$506.54
Rate for Payer: Aetna Medicare Advantage	$399.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$339.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$339.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$266.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$339.92
Rate for Payer: Cigna Commercial	$666.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.59
Rate for Payer: Qualcare PPO/HMO/WC	$199.95
Rate for Payer: UnitedHealthcare Community & State	$42.12
Rate for Payer: Wellpoint Medicaid Managed Care	$37.86

GRAFTON GEL 2.5CC

Facility

$1,333.00

Hospital Charge Code	270335432
Hospital Revenue Code	278
Min. Negotiated Rate	$199.95
Max. Negotiated Rate	$322.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$266.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$322.59
Rate for Payer: Qualcare PPO/HMO/WC	$199.95

GRAFTON GEL DIVERTED FILL TUBE

Facility

$405.00

Hospital Charge Code	270335296
Hospital Revenue Code	272
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$153.90
Rate for Payer: Aetna Medicare Advantage	$121.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.28
Rate for Payer: Cigna Commercial	$202.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.30
Rate for Payer: Oxford Commercial	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.75
Rate for Payer: UnitedHealthcare Commercial	$81.00
Rate for Payer: UnitedHealthcare Community & State	$12.80
Rate for Payer: Wellpoint Medicaid Managed Care	$11.50

GRAFTON GEL DIVERTED FILL TUBE

Facility

$405.00

Hospital Charge Code	270335296
Hospital Revenue Code	272
Min. Negotiated Rate	$60.75
Max. Negotiated Rate	$60.75
Rate for Payer: Qualcare PPO/HMO/WC	$60.75

GRAFTON GEL MUSCULOSKELET 1CC

Facility

$378.00

Hospital Charge Code	270335506
Hospital Revenue Code	278
Min. Negotiated Rate	$10.74
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$143.64
Rate for Payer: Aetna Medicare Advantage	$113.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$96.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$96.39
Rate for Payer: Cigna Commercial	$189.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: Qualcare PPO/HMO/WC	$56.70
Rate for Payer: UnitedHealthcare Community & State	$11.94
Rate for Payer: Wellpoint Medicaid Managed Care	$10.74

GRAFTON GEL MUSCULOSKELET 1CC

Facility

$378.00

Hospital Charge Code	270335506
Hospital Revenue Code	278
Min. Negotiated Rate	$56.70
Max. Negotiated Rate	$91.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.48
Rate for Payer: Qualcare PPO/HMO/WC	$56.70

GRAFTON GEL STRAIGHT FILL TUBE

Facility

$301.00

Hospital Charge Code	270335297
Hospital Revenue Code	272
Min. Negotiated Rate	$45.15
Max. Negotiated Rate	$45.15
Rate for Payer: Qualcare PPO/HMO/WC	$45.15

Know your out-of-pocket cost for care.

All Charges