Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT STRETCH 4-7mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270605300
Hospital Revenue Code	278
Min. Negotiated Rate	$466.50
Max. Negotiated Rate	$752.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50

GRAFT STRETCH 4-7mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270605300
Hospital Revenue Code	278
Min. Negotiated Rate	$88.32
Max. Negotiated Rate	$1,555.00
Rate for Payer: Aetna Commercial	$1,181.80
Rate for Payer: Aetna Medicare Advantage	$933.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$793.05
Rate for Payer: Cigna Commercial	$1,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50
Rate for Payer: UnitedHealthcare Community & State	$98.28
Rate for Payer: Wellpoint Medicaid Managed Care	$88.32

GRAFT STRETCH 6mm 40cm

Facility

$2,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270601128
Hospital Revenue Code	278
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$1,327.50
Rate for Payer: Aetna Commercial	$1,008.90
Rate for Payer: Aetna Medicare Advantage	$796.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$677.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$677.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$531.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$677.02
Rate for Payer: Cigna Commercial	$1,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$642.51
Rate for Payer: Qualcare PPO/HMO/WC	$398.25
Rate for Payer: UnitedHealthcare Community & State	$83.90
Rate for Payer: Wellpoint Medicaid Managed Care	$75.40

GRAFT STRETCH 6mm 40cm

Facility

$2,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270601128
Hospital Revenue Code	278
Min. Negotiated Rate	$398.25
Max. Negotiated Rate	$642.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$531.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$642.51
Rate for Payer: Qualcare PPO/HMO/WC	$398.25

GRAFT TENDON TIBIAL 9.5x350

Facility

$9,750.00

Hospital Charge Code	270654925
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 TENDON TIBIAL 9.5x350

Facility

$9,750.00

Hospital Charge Code	270654925
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 THERAGENESIS 4CM X 3 CM

Facility

$7,000.00

Hospital Charge Code	270695637
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

GRAFT THERAGENESIS 4CM X 3 CM

Facility

$7,000.00

Hospital Charge Code	270695637
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

GRAFT THERAGENSIS 8X 12 CM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695640
Hospital Revenue Code	278
Min. Negotiated Rate	$454.40
Max. Negotiated Rate	$8,000.00
Rate for Payer: Aetna Commercial	$6,080.00
Rate for Payer: Aetna Medicare Advantage	$4,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,080.00
Rate for Payer: Cigna Commercial	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00
Rate for Payer: UnitedHealthcare Community & State	$505.60
Rate for Payer: Wellpoint Medicaid Managed Care	$454.40

GRAFT THERAGENSIS 8X 12 CM

Facility

$16,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270695640
Hospital Revenue Code	278
Min. Negotiated Rate	$2,400.00
Max. Negotiated Rate	$3,872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,872.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,400.00

GRAFT THERASKIN 3X6IN

Facility

$14,225.00

Service Code	HCPCS Q4121
Hospital Charge Code	270690262
Hospital Revenue Code	278
Min. Negotiated Rate	$2,133.75
Max. Negotiated Rate	$3,442.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,442.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75

GRAFT THERASKIN 3X6IN

Facility

$14,225.00

Service Code	HCPCS Q4121
Hospital Charge Code	270690262
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,442.45
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	$2,845.00
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	$3,442.45
Rate for Payer: Qualcare PPO/HMO/WC	$2,133.75
Rate for Payer: UnitedHealthcare Community & State	$449.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$403.99

GRAFT THINWALL 10mm70cm

Facility

$6,230.00

Service Code	HCPCS C1768
Hospital Charge Code	270640440
Hospital Revenue Code	278
Min. Negotiated Rate	$176.93
Max. Negotiated Rate	$3,115.00
Rate for Payer: Aetna Commercial	$2,367.40
Rate for Payer: Aetna Medicare Advantage	$1,869.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,588.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,588.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,588.65
Rate for Payer: Cigna Commercial	$3,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,507.66
Rate for Payer: Qualcare PPO/HMO/WC	$934.50
Rate for Payer: UnitedHealthcare Community & State	$196.87
Rate for Payer: Wellpoint Medicaid Managed Care	$176.93

GRAFT THINWALL 10mm70cm

Facility

$6,230.00

Service Code	HCPCS C1768
Hospital Charge Code	270640440
Hospital Revenue Code	278
Min. Negotiated Rate	$934.50
Max. Negotiated Rate	$1,507.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,246.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,507.66
Rate for Payer: Qualcare PPO/HMO/WC	$934.50

GRAFT THINWALL 8mm 80cm

Facility

$5,500.00

Service Code	HCPCS C1768
Hospital Charge Code	270601122
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

GRAFT THINWALL 8mm 80cm

Facility

$5,500.00

Service Code	HCPCS C1768
Hospital Charge Code	270601122
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

GRAFT VASC GORE 6MM 40-80 CM

Facility

$3,696.00

Hospital Charge Code	270339058
Hospital Revenue Code	278
Min. Negotiated Rate	$554.40
Max. Negotiated Rate	$894.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.43
Rate for Payer: Qualcare PPO/HMO/WC	$554.40

GRAFT VASC GORE 6MM 40-80 CM

Facility

$3,696.00

Hospital Charge Code	270339058
Hospital Revenue Code	278
Min. Negotiated Rate	$104.97
Max. Negotiated Rate	$1,848.00
Rate for Payer: Aetna Commercial	$1,404.48
Rate for Payer: Aetna Medicare Advantage	$1,108.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$942.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$942.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$942.48
Rate for Payer: Cigna Commercial	$1,848.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.43
Rate for Payer: Qualcare PPO/HMO/WC	$554.40
Rate for Payer: UnitedHealthcare Community & State	$116.79
Rate for Payer: Wellpoint Medicaid Managed Care	$104.97

GRAFT VASC GORE 7MM 40-80CM

Facility

$3,696.00

Hospital Charge Code	270339059
Hospital Revenue Code	278
Min. Negotiated Rate	$554.40
Max. Negotiated Rate	$894.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.43
Rate for Payer: Qualcare PPO/HMO/WC	$554.40

GRAFT VASC GORE 7MM 40-80CM

Facility

$3,696.00

Hospital Charge Code	270339059
Hospital Revenue Code	278
Min. Negotiated Rate	$104.97
Max. Negotiated Rate	$1,848.00
Rate for Payer: Aetna Commercial	$1,404.48
Rate for Payer: Aetna Medicare Advantage	$1,108.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$942.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$942.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$942.48
Rate for Payer: Cigna Commercial	$1,848.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.43
Rate for Payer: Qualcare PPO/HMO/WC	$554.40
Rate for Payer: UnitedHealthcare Community & State	$116.79
Rate for Payer: Wellpoint Medicaid Managed Care	$104.97

GRAFT VASC GORE 8MM 40-80CM

Facility

$3,696.00

Hospital Charge Code	270339060
Hospital Revenue Code	278
Min. Negotiated Rate	$554.40
Max. Negotiated Rate	$894.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.43
Rate for Payer: Qualcare PPO/HMO/WC	$554.40

GRAFT VASC GORE 8MM 40-80CM

Facility

$3,696.00

Hospital Charge Code	270339060
Hospital Revenue Code	278
Min. Negotiated Rate	$104.97
Max. Negotiated Rate	$1,848.00
Rate for Payer: Aetna Commercial	$1,404.48
Rate for Payer: Aetna Medicare Advantage	$1,108.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$942.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$942.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$739.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$942.48
Rate for Payer: Cigna Commercial	$1,848.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$894.43
Rate for Payer: Qualcare PPO/HMO/WC	$554.40
Rate for Payer: UnitedHealthcare Community & State	$116.79
Rate for Payer: Wellpoint Medicaid Managed Care	$104.97

GRAFT VASC GORE STD 4-7MMX45CM

Facility

$2,079.00

Hospital Charge Code	270339057
Hospital Revenue Code	278
Min. Negotiated Rate	$59.04
Max. Negotiated Rate	$1,039.50
Rate for Payer: Aetna Commercial	$790.02
Rate for Payer: Aetna Medicare Advantage	$623.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$530.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$530.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$415.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$530.14
Rate for Payer: Cigna Commercial	$1,039.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$503.12
Rate for Payer: Qualcare PPO/HMO/WC	$311.85
Rate for Payer: UnitedHealthcare Community & State	$65.70
Rate for Payer: Wellpoint Medicaid Managed Care	$59.04

GRAFT VASC GORE STD 4-7MMX45CM

Facility

$2,079.00

Hospital Charge Code	270339057
Hospital Revenue Code	278
Min. Negotiated Rate	$311.85
Max. Negotiated Rate	$503.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$415.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$503.12
Rate for Payer: Qualcare PPO/HMO/WC	$311.85

GRAFT VASC GORE THIN 6MMX50-90

Facility

$3,465.00

Hospital Charge Code	270339055
Hospital Revenue Code	278
Min. Negotiated Rate	$519.75
Max. Negotiated Rate	$838.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$693.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$838.53
Rate for Payer: Qualcare PPO/HMO/WC	$519.75

Know your out-of-pocket cost for care.

All Charges