Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

PUTTY FIBERGRAFT BG 1CC

Facility

$2,049.00

Service Code	HCPCS C1713
Hospital Charge Code	270698988
Hospital Revenue Code	278
Min. Negotiated Rate	$307.35
Max. Negotiated Rate	$495.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$409.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$495.86
Rate for Payer: Qualcare PPO/HMO/WC	$307.35

PUTTY FIBERGRAFT BG 6ML

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270700130
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.50
Max. Negotiated Rate	$2,286.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50

PUTTY FIBERGRAFT BG 6ML

Facility

$9,450.00

Service Code	HCPCS C1713
Hospital Charge Code	270700130
Hospital Revenue Code	278
Min. Negotiated Rate	$268.38
Max. Negotiated Rate	$4,725.00
Rate for Payer: Aetna Commercial	$3,591.00
Rate for Payer: Aetna Medicare Advantage	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,409.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,409.75
Rate for Payer: Cigna Commercial	$4,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,286.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,417.50
Rate for Payer: UnitedHealthcare Community & State	$298.62
Rate for Payer: Wellpoint Medicaid Managed Care	$268.38

PUTTY GRAFTON 10c STER 343110

Facility

$5,410.00

Service Code	HCPCS C9359
Hospital Charge Code	270631283
Hospital Revenue Code	278
Min. Negotiated Rate	$153.64
Max. Negotiated Rate	$2,705.00
Rate for Payer: Aetna Commercial	$2,055.80
Rate for Payer: Aetna Medicare Advantage	$1,623.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,379.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,379.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,082.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,379.55
Rate for Payer: Cigna Commercial	$2,705.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,309.22
Rate for Payer: Qualcare PPO/HMO/WC	$811.50
Rate for Payer: UnitedHealthcare Community & State	$170.96
Rate for Payer: Wellpoint Medicaid Managed Care	$153.64

PUTTY GRAFTON 10c STER 343110

Facility

$5,410.00

Service Code	HCPCS C9359
Hospital Charge Code	270631283
Hospital Revenue Code	278
Min. Negotiated Rate	$811.50
Max. Negotiated Rate	$1,309.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,082.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,309.22
Rate for Payer: Qualcare PPO/HMO/WC	$811.50

PUTTY GRAFTON 2.5CC 123103

Facility

$2,525.00

Service Code	HCPCS C9359
Hospital Charge Code	270617953
Hospital Revenue Code	278
Min. Negotiated Rate	$71.71
Max. Negotiated Rate	$1,262.50
Rate for Payer: Aetna Commercial	$959.50
Rate for Payer: Aetna Medicare Advantage	$757.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$643.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$643.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$643.88
Rate for Payer: Cigna Commercial	$1,262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.05
Rate for Payer: Qualcare PPO/HMO/WC	$378.75
Rate for Payer: UnitedHealthcare Community & State	$79.79
Rate for Payer: Wellpoint Medicaid Managed Care	$71.71

PUTTY GRAFTON 2.5CC 123103

Facility

$2,525.00

Service Code	HCPCS C9359
Hospital Charge Code	270617953
Hospital Revenue Code	278
Min. Negotiated Rate	$378.75
Max. Negotiated Rate	$611.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$611.05
Rate for Payer: Qualcare PPO/HMO/WC	$378.75

PUTTY GRAFTON 5CC 123105

Facility

$4,585.00

Service Code	HCPCS C9359
Hospital Charge Code	270613259
Hospital Revenue Code	278
Min. Negotiated Rate	$130.21
Max. Negotiated Rate	$2,292.50
Rate for Payer: Aetna Commercial	$1,742.30
Rate for Payer: Aetna Medicare Advantage	$1,375.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,169.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,169.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$917.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,169.17
Rate for Payer: Cigna Commercial	$2,292.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.57
Rate for Payer: Qualcare PPO/HMO/WC	$687.75
Rate for Payer: UnitedHealthcare Community & State	$144.89
Rate for Payer: Wellpoint Medicaid Managed Care	$130.21

PUTTY GRAFTON 5CC 123105

Facility

$4,585.00

Service Code	HCPCS C9359
Hospital Charge Code	270613259
Hospital Revenue Code	278
Min. Negotiated Rate	$687.75
Max. Negotiated Rate	$1,109.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$917.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,109.57
Rate for Payer: Qualcare PPO/HMO/WC	$687.75

PUTTY GRAFTON 5CC PRETX 523105

Facility

$3,510.00

Service Code	HCPCS C9359
Hospital Charge Code	270622366
Hospital Revenue Code	278
Min. Negotiated Rate	$99.68
Max. Negotiated Rate	$1,755.00
Rate for Payer: Aetna Commercial	$1,333.80
Rate for Payer: Aetna Medicare Advantage	$1,053.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$895.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$895.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$702.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$895.05
Rate for Payer: Cigna Commercial	$1,755.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$849.42
Rate for Payer: Qualcare PPO/HMO/WC	$526.50
Rate for Payer: UnitedHealthcare Community & State	$110.92
Rate for Payer: Wellpoint Medicaid Managed Care	$99.68

PUTTY GRAFTON 5CC PRETX 523105

Facility

$3,510.00

Service Code	HCPCS C9359
Hospital Charge Code	270622366
Hospital Revenue Code	278
Min. Negotiated Rate	$526.50
Max. Negotiated Rate	$849.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$702.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$849.42
Rate for Payer: Qualcare PPO/HMO/WC	$526.50

PUTTY GRAFTON DBM 10CC

Facility

$7,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270692666
Hospital Revenue Code	278
Min. Negotiated Rate	$1,067.25
Max. Negotiated Rate	$1,721.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,423.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,721.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,067.25

PUTTY GRAFTON DBM 10CC

Facility

$7,115.00

Service Code	HCPCS C1713
Hospital Charge Code	270692666
Hospital Revenue Code	278
Min. Negotiated Rate	$202.07
Max. Negotiated Rate	$3,557.50
Rate for Payer: Aetna Commercial	$2,703.70
Rate for Payer: Aetna Medicare Advantage	$2,134.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,814.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,814.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,423.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,814.33
Rate for Payer: Cigna Commercial	$3,557.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,721.83
Rate for Payer: Qualcare PPO/HMO/WC	$1,067.25
Rate for Payer: UnitedHealthcare Community & State	$224.83
Rate for Payer: Wellpoint Medicaid Managed Care	$202.07

PUTTY H GENIN-2.5CC

Facility

$4,050.00

Service Code	HCPCS C1781
Hospital Charge Code	270704079
Hospital Revenue Code	278
Min. Negotiated Rate	$607.50
Max. Negotiated Rate	$980.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$980.10
Rate for Payer: Qualcare PPO/HMO/WC	$607.50

PUTTY H GENIN-2.5CC

Facility

$4,050.00

Service Code	HCPCS C1781
Hospital Charge Code	270704079
Hospital Revenue Code	278
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) NJ Health	$810.00
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

PUTTY I FACTOR 2.5 CC

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687021
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

PUTTY I FACTOR 2.5 CC

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687021
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

PUTTY I FACTOR 5.0 CC

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687022
Hospital Revenue Code	278
Min. Negotiated Rate	$227.20
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Commercial	$3,040.00
Rate for Payer: Aetna Medicare Advantage	$2,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,040.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,040.00
Rate for Payer: Cigna Commercial	$4,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$252.80
Rate for Payer: Wellpoint Medicaid Managed Care	$227.20

PUTTY I FACTOR 5.0 CC

Facility

$8,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270687022
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,936.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,936.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,200.00

PUTTY KINEX BIOACTIVE 5CC

Facility

$10,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695926
Hospital Revenue Code	278
Min. Negotiated Rate	$1,627.50
Max. Negotiated Rate	$2,625.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.50

PUTTY KINEX BIOACTIVE 5CC

Facility

$10,850.00

Service Code	HCPCS C1713
Hospital Charge Code	270695926
Hospital Revenue Code	278
Min. Negotiated Rate	$308.14
Max. Negotiated Rate	$5,425.00
Rate for Payer: Aetna Commercial	$4,123.00
Rate for Payer: Aetna Medicare Advantage	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,766.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,766.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,766.75
Rate for Payer: Cigna Commercial	$5,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,625.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,627.50
Rate for Payer: UnitedHealthcare Community & State	$342.86
Rate for Payer: Wellpoint Medicaid Managed Care	$308.14

PUTTY MAXX PER 1CC

Facility

$3,950.00

Service Code	HCPCS C9359
Hospital Charge Code	270692314
Hospital Revenue Code	278
Min. Negotiated Rate	$592.50
Max. Negotiated Rate	$955.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.90
Rate for Payer: Qualcare PPO/HMO/WC	$592.50

PUTTY MAXX PER 1CC

Facility

$3,950.00

Service Code	HCPCS C9359
Hospital Charge Code	270692314
Hospital Revenue Code	278
Min. Negotiated Rate	$112.18
Max. Negotiated Rate	$1,975.00
Rate for Payer: Aetna Commercial	$1,501.00
Rate for Payer: Aetna Medicare Advantage	$1,185.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,007.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,007.25
Rate for Payer: Cigna Commercial	$1,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$955.90
Rate for Payer: Qualcare PPO/HMO/WC	$592.50
Rate for Payer: UnitedHealthcare Community & State	$124.82
Rate for Payer: Wellpoint Medicaid Managed Care	$112.18

PUTTY NEVOS BONE 5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270679088
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

PUTTY NEVOS BONE 5CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270679089
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

Know your out-of-pocket cost for care.

All Charges