Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFTON GEL STRAIGHT FILL TUBE

Facility

$301.00

Hospital Charge Code	270335297
Hospital Revenue Code	272
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$150.50
Rate for Payer: Aetna Commercial	$114.38
Rate for Payer: Aetna Medicare Advantage	$90.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$76.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$76.75
Rate for Payer: Cigna Commercial	$150.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.26
Rate for Payer: Oxford Commercial	$60.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.15
Rate for Payer: UnitedHealthcare Commercial	$60.20
Rate for Payer: UnitedHealthcare Community & State	$9.51
Rate for Payer: Wellpoint Medicaid Managed Care	$8.55

GRAFTON PLUS PASTE

Facility

$2,293.00

Hospital Charge Code	270335650
Hospital Revenue Code	278
Min. Negotiated Rate	$343.95
Max. Negotiated Rate	$554.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$458.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$554.91
Rate for Payer: Qualcare PPO/HMO/WC	$343.95

GRAFTON PLUS PASTE

Facility

$2,293.00

Hospital Charge Code	270335650
Hospital Revenue Code	278
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$1,146.50
Rate for Payer: Aetna Commercial	$871.34
Rate for Payer: Aetna Medicare Advantage	$687.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$584.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$584.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$584.72
Rate for Payer: Cigna Commercial	$1,146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$554.91
Rate for Payer: Qualcare PPO/HMO/WC	$343.95
Rate for Payer: UnitedHealthcare Community & State	$72.46
Rate for Payer: Wellpoint Medicaid Managed Care	$65.12

GRAFTON PLUS PASTE 10CC

Facility

$2,293.00

Hospital Charge Code	270335651
Hospital Revenue Code	278
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$1,146.50
Rate for Payer: Aetna Commercial	$871.34
Rate for Payer: Aetna Medicare Advantage	$687.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$584.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$584.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$584.72
Rate for Payer: Cigna Commercial	$1,146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$554.91
Rate for Payer: Qualcare PPO/HMO/WC	$343.95
Rate for Payer: UnitedHealthcare Community & State	$72.46
Rate for Payer: Wellpoint Medicaid Managed Care	$65.12

GRAFTON PLUS PASTE 10CC

Facility

$2,293.00

Hospital Charge Code	270335651
Hospital Revenue Code	278
Min. Negotiated Rate	$343.95
Max. Negotiated Rate	$554.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$458.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$554.91
Rate for Payer: Qualcare PPO/HMO/WC	$343.95

GRAFTON PLUS PASTE 5CC

Facility

$1,485.00

Hospital Charge Code	270335652
Hospital Revenue Code	278
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$742.50
Rate for Payer: Aetna Commercial	$564.30
Rate for Payer: Aetna Medicare Advantage	$445.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$378.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$378.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$378.68
Rate for Payer: Cigna Commercial	$742.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.37
Rate for Payer: Qualcare PPO/HMO/WC	$222.75
Rate for Payer: UnitedHealthcare Community & State	$46.93
Rate for Payer: Wellpoint Medicaid Managed Care	$42.17

GRAFTON PLUS PASTE 5CC

Facility

$1,485.00

Hospital Charge Code	270335652
Hospital Revenue Code	278
Min. Negotiated Rate	$222.75
Max. Negotiated Rate	$359.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$297.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$359.37
Rate for Payer: Qualcare PPO/HMO/WC	$222.75

GRAFTON PUTTY 10CC

Facility

$2,293.00

Hospital Charge Code	270335558
Hospital Revenue Code	278
Min. Negotiated Rate	$343.95
Max. Negotiated Rate	$554.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$458.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$554.91
Rate for Payer: Qualcare PPO/HMO/WC	$343.95

GRAFTON PUTTY 10CC

Facility

$2,293.00

Hospital Charge Code	270335558
Hospital Revenue Code	278
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$1,146.50
Rate for Payer: Aetna Commercial	$871.34
Rate for Payer: Aetna Medicare Advantage	$687.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$584.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$584.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$458.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$584.72
Rate for Payer: Cigna Commercial	$1,146.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$554.91
Rate for Payer: Qualcare PPO/HMO/WC	$343.95
Rate for Payer: UnitedHealthcare Community & State	$72.46
Rate for Payer: Wellpoint Medicaid Managed Care	$65.12

GRAFT OSTEO-LINK DBM 10CC

Facility

$10,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270698876
Hospital Revenue Code	278
Min. Negotiated Rate	$1,579.50
Max. Negotiated Rate	$2,548.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50

GRAFT OSTEO-LINK DBM 10CC

Facility

$10,530.00

Service Code	HCPCS C1713
Hospital Charge Code	270698876
Hospital Revenue Code	278
Min. Negotiated Rate	$299.05
Max. Negotiated Rate	$5,265.00
Rate for Payer: Aetna Commercial	$4,001.40
Rate for Payer: Aetna Medicare Advantage	$3,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,685.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,106.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,685.15
Rate for Payer: Cigna Commercial	$5,265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,548.26
Rate for Payer: Qualcare PPO/HMO/WC	$1,579.50
Rate for Payer: UnitedHealthcare Community & State	$332.75
Rate for Payer: Wellpoint Medicaid Managed Care	$299.05

GRAFT OSTEO-LINK DBM 2.5CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270698826
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

GRAFT OSTEO-LINK DBM 2.5CC

Facility

$4,125.00

Service Code	HCPCS C1713
Hospital Charge Code	270698826
Hospital Revenue Code	278
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$130.35
Rate for Payer: Wellpoint Medicaid Managed Care	$117.15

GRAFT OVATION ILIAC EXT 16x45

Facility

$22,495.00

Hospital Charge Code	270678256
Hospital Revenue Code	278
Min. Negotiated Rate	$3,374.25
Max. Negotiated Rate	$5,443.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25

GRAFT OVATION ILIAC EXT 16x45

Facility

$22,495.00

Hospital Charge Code	270678256
Hospital Revenue Code	278
Min. Negotiated Rate	$638.86
Max. Negotiated Rate	$11,247.50
Rate for Payer: Aetna Commercial	$8,548.10
Rate for Payer: Aetna Medicare Advantage	$6,748.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,736.23
Rate for Payer: Cigna Commercial	$11,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25
Rate for Payer: UnitedHealthcare Community & State	$710.84
Rate for Payer: Wellpoint Medicaid Managed Care	$638.86

GRAFT OVATION ILIAC EXTENSION

Facility

$22,495.00

Hospital Charge Code	270677831
Hospital Revenue Code	278
Min. Negotiated Rate	$3,374.25
Max. Negotiated Rate	$5,443.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25

GRAFT OVATION ILIAC EXTENSION

Facility

$22,495.00

Hospital Charge Code	270677831
Hospital Revenue Code	278
Min. Negotiated Rate	$638.86
Max. Negotiated Rate	$11,247.50
Rate for Payer: Aetna Commercial	$8,548.10
Rate for Payer: Aetna Medicare Advantage	$6,748.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,736.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,736.23
Rate for Payer: Cigna Commercial	$11,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,443.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,374.25
Rate for Payer: UnitedHealthcare Community & State	$710.84
Rate for Payer: Wellpoint Medicaid Managed Care	$638.86

GRAFT OVATION ILIAC LIMB

Facility

$18,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270676754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

GRAFT OVATION ILIAC LIMB

Facility

$18,750.00

Service Code	HCPCS C1768
Hospital Charge Code	270676754
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$592.50
Rate for Payer: Wellpoint Medicaid Managed Care	$532.50

GRAFT OVATION IX 12 X 160 MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270686737
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 OVATION IX 12 X 160 MM

Facility

$56,395.00

Service Code	HCPCS C1768
Hospital Charge Code	270686737
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 OVATION IX ILIAC 12X

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270686738
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 OVATION IX ILIAC 12X

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270686738
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 PASTE BONE 1 CC

Facility

$1,185.00

Service Code	HCPCS C1713
Hospital Charge Code	270656923
Hospital Revenue Code	278
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$592.50
Rate for Payer: Aetna Commercial	$450.30
Rate for Payer: Aetna Medicare Advantage	$355.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$302.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$302.18
Rate for Payer: Cigna Commercial	$592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75
Rate for Payer: UnitedHealthcare Community & State	$37.45
Rate for Payer: Wellpoint Medicaid Managed Care	$33.65

GRAFT PASTE BONE 1 CC

Facility

$1,185.00

Service Code	HCPCS C1713
Hospital Charge Code	270656923
Hospital Revenue Code	278
Min. Negotiated Rate	$177.75
Max. Negotiated Rate	$286.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$237.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$286.77
Rate for Payer: Qualcare PPO/HMO/WC	$177.75

Know your out-of-pocket cost for care.

All Charges