Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MATRIX BILAYER MESHED 4x10

Facility

$26,845.00

Service Code	HCPCS C1781
Hospital Charge Code	270651359
Hospital Revenue Code	278
Min. Negotiated Rate	$4,026.75
Max. Negotiated Rate	$6,496.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,369.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,496.49
Rate for Payer: Qualcare PPO/HMO/WC	$4,026.75

MATRIX BILAYER MESHED 4x10

Facility

$26,845.00

Service Code	HCPCS C1781
Hospital Charge Code	270651359
Hospital Revenue Code	278
Min. Negotiated Rate	$762.40
Max. Negotiated Rate	$13,422.50
Rate for Payer: Aetna Commercial	$10,201.10
Rate for Payer: Aetna Medicare Advantage	$8,053.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,845.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,845.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,369.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,845.48
Rate for Payer: Cigna Commercial	$13,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,496.49
Rate for Payer: Qualcare PPO/HMO/WC	$4,026.75
Rate for Payer: UnitedHealthcare Community & State	$848.30
Rate for Payer: Wellpoint Medicaid Managed Care	$762.40

MATRIX BN FIB AERIDYAN 12.5CC

Facility

$27,169.20

Service Code	HCPCS C1713
Hospital Charge Code	270698973
Hospital Revenue Code	278
Min. Negotiated Rate	$771.61
Max. Negotiated Rate	$13,584.60
Rate for Payer: Aetna Commercial	$10,324.30
Rate for Payer: Aetna Medicare Advantage	$8,150.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,928.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,928.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,433.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,928.15
Rate for Payer: Cigna Commercial	$13,584.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,574.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,075.38
Rate for Payer: UnitedHealthcare Community & State	$858.55
Rate for Payer: Wellpoint Medicaid Managed Care	$771.61

MATRIX BN FIB AERIDYAN 12.5CC

Facility

$27,169.20

Service Code	HCPCS C1713
Hospital Charge Code	270698973
Hospital Revenue Code	278
Min. Negotiated Rate	$4,075.38
Max. Negotiated Rate	$6,574.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,433.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,574.95
Rate for Payer: Qualcare PPO/HMO/WC	$4,075.38

MATRIX BURN 10CM X 15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662120
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$2,559.15
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	$2,559.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25
Rate for Payer: UnitedHealthcare Community & State	$334.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$300.33

MATRIX BURN 10CM X 15CM

Facility

$10,575.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662120
Hospital Revenue Code	636
Min. Negotiated Rate	$1,586.25
Max. Negotiated Rate	$2,559.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,559.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,586.25

MATRIX BURN 5X5CM/SQCM JW

Facility

$153.00

Hospital Charge Code	270662122W
Hospital Revenue Code	636
Min. Negotiated Rate	$4.35
Max. Negotiated Rate	$76.50
Rate for Payer: Aetna Commercial	$58.14
Rate for Payer: Aetna Medicare Advantage	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.02
Rate for Payer: Cigna Commercial	$76.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Qualcare PPO/HMO/WC	$22.95
Rate for Payer: UnitedHealthcare Community & State	$4.83
Rate for Payer: Wellpoint Medicaid Managed Care	$4.35

MATRIX BURN 5X5CM/SQCM JW

Facility

$153.00

Hospital Charge Code	270662122W
Hospital Revenue Code	636
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$37.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.03
Rate for Payer: Qualcare PPO/HMO/WC	$22.95

MATRIX BURN 7CM X 10CM

Facility

$5,625.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662121
Hospital Revenue Code	636
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,361.25
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	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75
Rate for Payer: UnitedHealthcare Community & State	$177.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$159.75

MATRIX BURN 7CM X 10CM

Facility

$5,625.00

Service Code	HCPCS Q4166
Hospital Charge Code	270662121
Hospital Revenue Code	636
Min. Negotiated Rate	$843.75
Max. Negotiated Rate	$1,361.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,361.25
Rate for Payer: Qualcare PPO/HMO/WC	$843.75

MATRIX CONNECTOR 30-33MM SZ4

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691917
Hospital Revenue Code	278
Min. Negotiated Rate	$168.31
Max. Negotiated Rate	$2,963.12
Rate for Payer: Aetna Commercial	$2,251.97
Rate for Payer: Aetna Medicare Advantage	$1,777.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,511.19
Rate for Payer: Cigna Commercial	$2,963.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: Qualcare PPO/HMO/WC	$888.94
Rate for Payer: UnitedHealthcare Community & State	$187.27
Rate for Payer: Wellpoint Medicaid Managed Care	$168.31

MATRIX CONNECTOR 30-33MM SZ4

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691917
Hospital Revenue Code	278
Min. Negotiated Rate	$888.94
Max. Negotiated Rate	$1,434.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: Qualcare PPO/HMO/WC	$888.94

MATRIX CONNECTOR 38-47MM SZ6

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691918
Hospital Revenue Code	278
Min. Negotiated Rate	$168.31
Max. Negotiated Rate	$2,963.12
Rate for Payer: Aetna Commercial	$2,251.97
Rate for Payer: Aetna Medicare Advantage	$1,777.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,511.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,511.19
Rate for Payer: Cigna Commercial	$2,963.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: Qualcare PPO/HMO/WC	$888.94
Rate for Payer: UnitedHealthcare Community & State	$187.27
Rate for Payer: Wellpoint Medicaid Managed Care	$168.31

MATRIX CONNECTOR 38-47MM SZ6

Facility

$5,926.25

Service Code	HCPCS C1713
Hospital Charge Code	270691918
Hospital Revenue Code	278
Min. Negotiated Rate	$888.94
Max. Negotiated Rate	$1,434.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,185.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,434.15
Rate for Payer: Qualcare PPO/HMO/WC	$888.94

MATRIX CONNECTOR # 5

Facility

$7,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270690701
Hospital Revenue Code	278
Min. Negotiated Rate	$1,095.00
Max. Negotiated Rate	$1,766.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,095.00

MATRIX CONNECTOR # 5

Facility

$7,300.00

Service Code	HCPCS C1713
Hospital Charge Code	270690701
Hospital Revenue Code	278
Min. Negotiated Rate	$207.32
Max. Negotiated Rate	$3,650.00
Rate for Payer: Aetna Commercial	$2,774.00
Rate for Payer: Aetna Medicare Advantage	$2,190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,861.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,460.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,861.50
Rate for Payer: Cigna Commercial	$3,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,766.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,095.00
Rate for Payer: UnitedHealthcare Community & State	$230.68
Rate for Payer: Wellpoint Medicaid Managed Care	$207.32

MATRIX DEMINERALIZED BONE PUTT

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270655826
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$145.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

MATRIX DEMINERALIZED BONE PUTT

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	270655826
Hospital Revenue Code	278
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.20
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

MATRIX FENESTRATED WOUND 3x

Facility

$755.00

Hospital Charge Code	270651180
Hospital Revenue Code	278
Min. Negotiated Rate	$113.25
Max. Negotiated Rate	$182.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.71
Rate for Payer: Qualcare PPO/HMO/WC	$113.25

MATRIX FENESTRATED WOUND 3x

Facility

$755.00

Hospital Charge Code	270651180
Hospital Revenue Code	278
Min. Negotiated Rate	$21.44
Max. Negotiated Rate	$377.50
Rate for Payer: Aetna Commercial	$286.90
Rate for Payer: Aetna Medicare Advantage	$226.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$151.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.53
Rate for Payer: Cigna Commercial	$377.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.71
Rate for Payer: Qualcare PPO/HMO/WC	$113.25
Rate for Payer: UnitedHealthcare Community & State	$23.86
Rate for Payer: Wellpoint Medicaid Managed Care	$21.44

MATRIX FLWBLE WND 3CC/1CC JW

Facility

$6,525.00

Hospital Charge Code	270646968W
Hospital Revenue Code	636
Min. Negotiated Rate	$978.75
Max. Negotiated Rate	$1,579.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75

MATRIX FLWBLE WND 3CC/1CC JW

Facility

$6,525.00

Hospital Charge Code	270646968W
Hospital Revenue Code	636
Min. Negotiated Rate	$185.31
Max. Negotiated Rate	$3,262.50
Rate for Payer: Aetna Commercial	$2,479.50
Rate for Payer: Aetna Medicare Advantage	$1,957.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,663.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,663.88
Rate for Payer: Cigna Commercial	$3,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,579.05
Rate for Payer: Qualcare PPO/HMO/WC	$978.75
Rate for Payer: UnitedHealthcare Community & State	$206.19
Rate for Payer: Wellpoint Medicaid Managed Care	$185.31

MATRIX HD WND COV 10CM X 10CM

Facility

$4,050.00

Hospital Charge Code	270339112
Hospital Revenue Code	636
Min. Negotiated Rate	$607.50
Max. Negotiated Rate	$980.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$607.50

MATRIX HD WND COV 10CM X 10CM

Facility

$4,050.00

Hospital Charge Code	270339112
Hospital Revenue Code	636
Min. Negotiated Rate	$115.02
Max. Negotiated Rate	$2,025.00
Rate for Payer: Aetna Commercial	$1,539.00
Rate for Payer: Aetna Medicare Advantage	$1,215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,032.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,032.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,032.75
Rate for Payer: Cigna Commercial	$2,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$607.50
Rate for Payer: UnitedHealthcare Community & State	$127.98
Rate for Payer: Wellpoint Medicaid Managed Care	$115.02

MATRIX HD WOUND COV 2CM X 14CM

Facility

$2,400.00

Hospital Charge Code	270339111
Hospital Revenue Code	636
Min. Negotiated Rate	$360.00
Max. Negotiated Rate	$580.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$580.80
Rate for Payer: Qualcare PPO/HMO/WC	$360.00

Know your out-of-pocket cost for care.

All Charges