Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT REGENERATIVE INJECTABLE

Facility

$6,200.00

Hospital Charge Code	270644027
Hospital Revenue Code	278
Min. Negotiated Rate	$176.08
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$195.92
Rate for Payer: Wellpoint Medicaid Managed Care	$176.08

GRAFT REGENERATIVE INJECTABLE

Facility

$6,200.00

Hospital Charge Code	270644027
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,500.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

GRAFT REPAIR SPINE DEFECT

Facility

$13,276.00

Service Code	HCPCS 63710
Hospital Charge Code	1600000808
Hospital Revenue Code	360
Min. Negotiated Rate	$377.04
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,044.88
Rate for Payer: Aetna Medicare Advantage	$3,982.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,385.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,385.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,385.38
Rate for Payer: Cigna Commercial	$6,638.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,451.76
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.40
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$419.52
Rate for Payer: Wellpoint Medicaid Managed Care	$377.04

GRAFT REPAIR SPINE DEFECT

Facility

$13,276.00

Service Code	HCPCS 63710
Hospital Charge Code	1600000808
Hospital Revenue Code	360
Min. Negotiated Rate	$1,991.40
Max. Negotiated Rate	$1,991.40
Rate for Payer: Qualcare PPO/HMO/WC	$1,991.40

GRAFT RESORBABLE BEAD KIT 25CC

Facility

$6,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270644028
Hospital Revenue Code	278
Min. Negotiated Rate	$176.08
Max. Negotiated Rate	$3,100.00
Rate for Payer: Aetna Commercial	$2,356.00
Rate for Payer: Aetna Medicare Advantage	$1,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,581.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,581.00
Rate for Payer: Cigna Commercial	$3,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00
Rate for Payer: UnitedHealthcare Community & State	$195.92
Rate for Payer: Wellpoint Medicaid Managed Care	$176.08

GRAFT RESORBABLE BEAD KIT 25CC

Facility

$6,200.00

Service Code	HCPCS C1713
Hospital Charge Code	270644028
Hospital Revenue Code	278
Min. Negotiated Rate	$930.00
Max. Negotiated Rate	$1,500.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,500.40
Rate for Payer: Qualcare PPO/HMO/WC	$930.00

GRAFT RESTORE GF 2.0 CC

Facility

$8,500.00

Service Code	HCPCS Q4100
Hospital Charge Code	270694055
Hospital Revenue Code	278
Min. Negotiated Rate	$241.40
Max. Negotiated Rate	$4,250.00
Rate for Payer: Aetna Commercial	$3,230.00
Rate for Payer: Aetna Medicare Advantage	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,167.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,167.50
Rate for Payer: Cigna Commercial	$4,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00
Rate for Payer: UnitedHealthcare Community & State	$268.60
Rate for Payer: Wellpoint Medicaid Managed Care	$241.40

GRAFT RESTORE GF 2.0 CC

Facility

$8,500.00

Service Code	HCPCS Q4100
Hospital Charge Code	270694055
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,057.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,057.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.00

GRAFT SEMITENDINOSUS

Facility

$9,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270679270
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

GRAFT SEMITENDINOSUS

Facility

$9,750.00

Service Code	HCPCS C1762
Hospital Charge Code	270679270
Hospital Revenue Code	278
Min. Negotiated Rate	$276.90
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$308.10
Rate for Payer: Wellpoint Medicaid Managed Care	$276.90

GRAFT SEMITENDINOSUS 7.5x240

Facility

$9,750.00

Hospital Charge Code	270677526
Hospital Revenue Code	278
Min. Negotiated Rate	$1,462.50
Max. Negotiated Rate	$2,359.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50

GRAFT SEMITENDINOSUS 7.5x240

Facility

$9,750.00

Hospital Charge Code	270677526
Hospital Revenue Code	278
Min. Negotiated Rate	$276.90
Max. Negotiated Rate	$4,875.00
Rate for Payer: Aetna Commercial	$3,705.00
Rate for Payer: Aetna Medicare Advantage	$2,925.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,486.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,486.25
Rate for Payer: Cigna Commercial	$4,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,359.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,462.50
Rate for Payer: UnitedHealthcare Community & State	$308.10
Rate for Payer: Wellpoint Medicaid Managed Care	$276.90

GRAFT SEMITENDINOSUS TENDON FF

Facility

$10,000.00

Hospital Charge Code	270701868
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

GRAFT SEMITENDINOSUS TENDON FF

Facility

$10,000.00

Hospital Charge Code	270701868
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

GRAFT STD WALL 4/7mm 45cm

Facility

$3,480.00

Service Code	HCPCS C1768
Hospital Charge Code	270605392
Hospital Revenue Code	278
Min. Negotiated Rate	$98.83
Max. Negotiated Rate	$1,740.00
Rate for Payer: Aetna Commercial	$1,322.40
Rate for Payer: Aetna Medicare Advantage	$1,044.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$887.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$887.40
Rate for Payer: Cigna Commercial	$1,740.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: Qualcare PPO/HMO/WC	$522.00
Rate for Payer: UnitedHealthcare Community & State	$109.97
Rate for Payer: Wellpoint Medicaid Managed Care	$98.83

GRAFT STD WALL 4/7mm 45cm

Facility

$3,480.00

Service Code	HCPCS C1768
Hospital Charge Code	270605392
Hospital Revenue Code	278
Min. Negotiated Rate	$522.00
Max. Negotiated Rate	$842.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.16
Rate for Payer: Qualcare PPO/HMO/WC	$522.00

GRAFT STD WALL 8mm 70cm

Facility

$4,845.00

Hospital Charge Code	270618553
Hospital Revenue Code	278
Min. Negotiated Rate	$137.60
Max. Negotiated Rate	$2,422.50
Rate for Payer: Aetna Commercial	$1,841.10
Rate for Payer: Aetna Medicare Advantage	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,235.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,235.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$969.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,235.47
Rate for Payer: Cigna Commercial	$2,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,172.49
Rate for Payer: Qualcare PPO/HMO/WC	$726.75
Rate for Payer: UnitedHealthcare Community & State	$153.10
Rate for Payer: Wellpoint Medicaid Managed Care	$137.60

GRAFT STD WALL 8mm 70cm

Facility

$4,845.00

Hospital Charge Code	270618553
Hospital Revenue Code	278
Min. Negotiated Rate	$726.75
Max. Negotiated Rate	$1,172.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$969.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,172.49
Rate for Payer: Qualcare PPO/HMO/WC	$726.75

GRAFT STD WALL 8mm 90cm

Facility

$4,235.00

Service Code	HCPCS C1768
Hospital Charge Code	270601145
Hospital Revenue Code	278
Min. Negotiated Rate	$635.25
Max. Negotiated Rate	$1,024.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$847.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.87
Rate for Payer: Qualcare PPO/HMO/WC	$635.25

GRAFT STD WALL 8mm 90cm

Facility

$4,235.00

Service Code	HCPCS C1768
Hospital Charge Code	270601145
Hospital Revenue Code	278
Min. Negotiated Rate	$120.27
Max. Negotiated Rate	$2,117.50
Rate for Payer: Aetna Commercial	$1,609.30
Rate for Payer: Aetna Medicare Advantage	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,079.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,079.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,079.92
Rate for Payer: Cigna Commercial	$2,117.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,024.87
Rate for Payer: Qualcare PPO/HMO/WC	$635.25
Rate for Payer: UnitedHealthcare Community & State	$133.83
Rate for Payer: Wellpoint Medicaid Managed Care	$120.27

GRAFT STD WALL RINGED 8mm 70cm

Facility

$5,890.00

Hospital Charge Code	270601141
Hospital Revenue Code	278
Min. Negotiated Rate	$883.50
Max. Negotiated Rate	$1,425.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,178.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.38
Rate for Payer: Qualcare PPO/HMO/WC	$883.50

GRAFT STD WALL RINGED 8mm 70cm

Facility

$5,890.00

Hospital Charge Code	270601141
Hospital Revenue Code	278
Min. Negotiated Rate	$167.28
Max. Negotiated Rate	$2,945.00
Rate for Payer: Aetna Commercial	$2,238.20
Rate for Payer: Aetna Medicare Advantage	$1,767.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,501.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,501.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,501.95
Rate for Payer: Cigna Commercial	$2,945.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,425.38
Rate for Payer: Qualcare PPO/HMO/WC	$883.50
Rate for Payer: UnitedHealthcare Community & State	$186.12
Rate for Payer: Wellpoint Medicaid Managed Care	$167.28

GRAFT STENT 26MM OVATION IX

Facility

$12,214.90

Service Code	HCPCS C1768
Hospital Charge Code	270686736
Hospital Revenue Code	278
Min. Negotiated Rate	$346.90
Max. Negotiated Rate	$6,107.45
Rate for Payer: Aetna Commercial	$4,641.66
Rate for Payer: Aetna Medicare Advantage	$3,664.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,442.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,114.80
Rate for Payer: Cigna Commercial	$6,107.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,956.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,832.23
Rate for Payer: UnitedHealthcare Community & State	$385.99
Rate for Payer: Wellpoint Medicaid Managed Care	$346.90

GRAFT STENT 26MM OVATION IX

Facility

$12,214.90

Service Code	HCPCS C1768
Hospital Charge Code	270686736
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.23
Max. Negotiated Rate	$2,956.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,442.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,956.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,832.23

GRAFT STENT 26MM OVATION IX

Facility

$12,214.90

Service Code	HCPCS C1768
Hospital Charge Code	270686736A
Hospital Revenue Code	278
Min. Negotiated Rate	$346.90
Max. Negotiated Rate	$6,107.45
Rate for Payer: Aetna Commercial	$4,641.66
Rate for Payer: Aetna Medicare Advantage	$3,664.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,114.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,442.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,114.80
Rate for Payer: Cigna Commercial	$6,107.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,956.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,832.23
Rate for Payer: UnitedHealthcare Community & State	$385.99
Rate for Payer: Wellpoint Medicaid Managed Care	$346.90

Know your out-of-pocket cost for care.

All Charges