Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT PRIMATRIX 6X6CM

Facility

$7,695.00

Service Code	HCPCS Q4110
Hospital Charge Code	270675446
Hospital Revenue Code	278
Min. Negotiated Rate	$1,154.25
Max. Negotiated Rate	$1,862.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,539.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,862.19
Rate for Payer: Qualcare PPO/HMO/WC	$1,154.25

GRAFT PRIMATRIX 8x12CM

Facility

$17,200.00

Service Code	HCPCS Q4110
Hospital Charge Code	270677842
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,162.40
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	$3,440.00
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	$4,162.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00
Rate for Payer: UnitedHealthcare Community & State	$543.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$488.48

GRAFT PRIMATRIX 8x12CM

Facility

$17,200.00

Service Code	HCPCS Q4110
Hospital Charge Code	270677842
Hospital Revenue Code	278
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$4,162.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,162.40
Rate for Payer: Qualcare PPO/HMO/WC	$2,580.00

GRAFT PRIMATRIX AG 10X25CM

Facility

$32,071.00

Service Code	HCPCS Q4110
Hospital Charge Code	270692965
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$7,761.18
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	$6,414.20
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	$7,761.18
Rate for Payer: Qualcare PPO/HMO/WC	$4,810.65
Rate for Payer: UnitedHealthcare Community & State	$1,013.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$910.82

GRAFT PRIMATRIX AG 10X25CM

Facility

$32,071.00

Service Code	HCPCS Q4110
Hospital Charge Code	270692965
Hospital Revenue Code	278
Min. Negotiated Rate	$4,810.65
Max. Negotiated Rate	$7,761.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,414.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,761.18
Rate for Payer: Qualcare PPO/HMO/WC	$4,810.65

GRAFT PRIMATRIX AG 4X4CM

Facility

$3,865.00

Service Code	HCPCS Q4110
Hospital Charge Code	270678340
Hospital Revenue Code	278
Min. Negotiated Rate	$579.75
Max. Negotiated Rate	$935.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$773.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.33
Rate for Payer: Qualcare PPO/HMO/WC	$579.75

GRAFT PRIMATRIX AG 4X4CM

Facility

$3,865.00

Service Code	HCPCS Q4110
Hospital Charge Code	270678340
Hospital Revenue Code	278
Min. Negotiated Rate	$109.77
Max. Negotiated Rate	$935.33
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	$773.00
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	$935.33
Rate for Payer: Qualcare PPO/HMO/WC	$579.75
Rate for Payer: UnitedHealthcare Community & State	$122.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$109.77

GRAFT PRIMATRIX AG 4X4CM

Facility

$3,865.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673840
Hospital Revenue Code	278
Min. Negotiated Rate	$579.75
Max. Negotiated Rate	$935.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$773.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$935.33
Rate for Payer: Qualcare PPO/HMO/WC	$579.75

GRAFT PRIMATRIX AG 4X4CM

Facility

$3,865.00

Service Code	HCPCS Q4110
Hospital Charge Code	270673840
Hospital Revenue Code	278
Min. Negotiated Rate	$109.77
Max. Negotiated Rate	$935.33
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	$773.00
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	$935.33
Rate for Payer: Qualcare PPO/HMO/WC	$579.75
Rate for Payer: UnitedHealthcare Community & State	$122.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$109.77

GRAFT PRIMATRIX MESH 20X25CM

Facility

$44,740.00

Service Code	HCPCS Q4110
Hospital Charge Code	270683923
Hospital Revenue Code	278
Min. Negotiated Rate	$6,711.00
Max. Negotiated Rate	$10,827.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,948.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10,827.08
Rate for Payer: Qualcare PPO/HMO/WC	$6,711.00

GRAFT PRIMATRIX MESH 20X25CM

Facility

$44,740.00

Service Code	HCPCS Q4110
Hospital Charge Code	270683923
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$10,827.08
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	$8,948.00
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	$10,827.08
Rate for Payer: Qualcare PPO/HMO/WC	$6,711.00
Rate for Payer: UnitedHealthcare Community & State	$1,413.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,270.62

GRAFT PRIMATRIX MESH 8X8CM

Facility

$11,120.00

Service Code	HCPCS Q4110
Hospital Charge Code	270696529
Hospital Revenue Code	278
Min. Negotiated Rate	$1,668.00
Max. Negotiated Rate	$2,691.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,224.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,691.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,668.00

GRAFT PRIMATRIX MESH 8X8CM

Facility

$11,120.00

Service Code	HCPCS Q4110
Hospital Charge Code	270696529
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,691.04
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	$2,224.00
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	$2,691.04
Rate for Payer: Qualcare PPO/HMO/WC	$1,668.00
Rate for Payer: UnitedHealthcare Community & State	$351.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$315.81

GRAFT PRIMATRIX MESH AG 6X6CM

Facility

$18,295.00

Service Code	HCPCS Q4110
Hospital Charge Code	270698688
Hospital Revenue Code	278
Min. Negotiated Rate	$2,744.25
Max. Negotiated Rate	$4,427.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25

GRAFT PRIMATRIX MESH AG 6X6CM

Facility

$18,295.00

Service Code	HCPCS Q4110
Hospital Charge Code	270698688
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$4,427.39
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	$3,659.00
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	$4,427.39
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$578.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$519.58

GRAFT PRIMATRIX MESHED 6X6 CM

Facility

$7,700.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684047
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,863.40
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	$1,540.00
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	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00
Rate for Payer: UnitedHealthcare Community & State	$243.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$218.68

GRAFT PRIMATRIX MESHED 6X6 CM

Facility

$7,700.00

Service Code	HCPCS Q4110
Hospital Charge Code	270684047
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.00
Max. Negotiated Rate	$1,863.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,863.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,155.00

GRAFT PRODENSE 7CC

Facility

$22,369.00

Hospital Charge Code	270703288
Hospital Revenue Code	278
Min. Negotiated Rate	$3,355.35
Max. Negotiated Rate	$5,413.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,473.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,413.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.35

GRAFT PRODENSE 7CC

Facility

$22,369.00

Hospital Charge Code	270703288
Hospital Revenue Code	278
Min. Negotiated Rate	$635.28
Max. Negotiated Rate	$11,184.50
Rate for Payer: Aetna Commercial	$8,500.22
Rate for Payer: Aetna Medicare Advantage	$6,710.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,704.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,704.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,473.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,704.10
Rate for Payer: Cigna Commercial	$11,184.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,413.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,355.35
Rate for Payer: UnitedHealthcare Community & State	$706.86
Rate for Payer: Wellpoint Medicaid Managed Care	$635.28

GRAFT PROPATEN 7MM DIA 60x80CM

Facility

$13,635.00

Service Code	HCPCS C1768
Hospital Charge Code	270673929
Hospital Revenue Code	278
Min. Negotiated Rate	$387.23
Max. Negotiated Rate	$6,817.50
Rate for Payer: Aetna Commercial	$5,181.30
Rate for Payer: Aetna Medicare Advantage	$4,090.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,476.93
Rate for Payer: Cigna Commercial	$6,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25
Rate for Payer: UnitedHealthcare Community & State	$430.87
Rate for Payer: Wellpoint Medicaid Managed Care	$387.23

GRAFT PROPATEN 7MM DIA 60x80CM

Facility

$13,635.00

Service Code	HCPCS C1768
Hospital Charge Code	270673929
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

GRAFT PURAPLY AM 2x4

Facility

$4,750.00

Service Code	HCPCS Q4196
Hospital Charge Code	270676738
Hospital Revenue Code	636
Min. Negotiated Rate	$134.90
Max. Negotiated Rate	$1,149.50
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	$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	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50
Rate for Payer: UnitedHealthcare Community & State	$150.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$134.90

GRAFT PURAPLY AM 2x4

Facility

$4,750.00

Service Code	HCPCS Q4196
Hospital Charge Code	270676738
Hospital Revenue Code	636
Min. Negotiated Rate	$712.50
Max. Negotiated Rate	$1,149.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,149.50
Rate for Payer: Qualcare PPO/HMO/WC	$712.50

GRAFT PUTTY STIMUBLAST 10 CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688462
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

GRAFT PUTTY STIMUBLAST 10 CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270688462
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

Know your out-of-pocket cost for care.

All Charges