Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BONE GRAFT KIT 10CC

Facility

$10,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270688355
Hospital Revenue Code	278
Min. Negotiated Rate	$308.85
Max. Negotiated Rate	$5,437.50
Rate for Payer: Aetna Commercial	$4,132.50
Rate for Payer: Aetna Medicare Advantage	$3,262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,773.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,773.12
Rate for Payer: Cigna Commercial	$5,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25
Rate for Payer: UnitedHealthcare Community & State	$343.65
Rate for Payer: Wellpoint Medicaid Managed Care	$308.85

BONE GRAFT KIT 10CC

Facility

$10,875.00

Service Code	HCPCS C1713
Hospital Charge Code	270688355
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.25
Max. Negotiated Rate	$2,631.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,631.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,631.25

BONE GRAFT KIT 8CC

Facility

$27,845.00

Service Code	HCPCS C1763
Hospital Charge Code	270652415
Hospital Revenue Code	278
Min. Negotiated Rate	$790.80
Max. Negotiated Rate	$13,922.50
Rate for Payer: Aetna Commercial	$10,581.10
Rate for Payer: Aetna Medicare Advantage	$8,353.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,100.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,569.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,100.48
Rate for Payer: Cigna Commercial	$13,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,738.49
Rate for Payer: Qualcare PPO/HMO/WC	$4,176.75
Rate for Payer: UnitedHealthcare Community & State	$879.90
Rate for Payer: Wellpoint Medicaid Managed Care	$790.80

BONE GRAFT KIT 8CC

Facility

$27,845.00

Service Code	HCPCS C1763
Hospital Charge Code	270652415
Hospital Revenue Code	278
Min. Negotiated Rate	$4,176.75
Max. Negotiated Rate	$6,738.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,569.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,738.49
Rate for Payer: Qualcare PPO/HMO/WC	$4,176.75

BONE GRAFT KIT INFUSE XX SMALL

Facility

$4,775.00

Service Code	HCPCS L8699
Hospital Charge Code	270692241
Hospital Revenue Code	278
Min. Negotiated Rate	$135.61
Max. Negotiated Rate	$2,387.50
Rate for Payer: Aetna Commercial	$1,814.50
Rate for Payer: Aetna Medicare Advantage	$1,432.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,217.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,217.62
Rate for Payer: Cigna Commercial	$2,387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: Qualcare PPO/HMO/WC	$716.25
Rate for Payer: UnitedHealthcare Community & State	$150.89
Rate for Payer: Wellpoint Medicaid Managed Care	$135.61

BONE GRAFT KIT INFUSE XX SMALL

Facility

$4,775.00

Service Code	HCPCS L8699
Hospital Charge Code	270692241
Hospital Revenue Code	278
Min. Negotiated Rate	$716.25
Max. Negotiated Rate	$1,155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,155.55
Rate for Payer: Qualcare PPO/HMO/WC	$716.25

BONE GRAFT MATRIX 5X5CM 17.5CC

Facility

$15,665.00

Hospital Charge Code	270671746
Hospital Revenue Code	278
Min. Negotiated Rate	$444.89
Max. Negotiated Rate	$7,832.50
Rate for Payer: Aetna Commercial	$5,952.70
Rate for Payer: Aetna Medicare Advantage	$4,699.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,994.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,994.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,133.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,994.57
Rate for Payer: Cigna Commercial	$7,832.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,790.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,349.75
Rate for Payer: UnitedHealthcare Community & State	$495.01
Rate for Payer: Wellpoint Medicaid Managed Care	$444.89

BONE GRAFT MATRIX 5X5CM 17.5CC

Facility

$15,665.00

Hospital Charge Code	270671746
Hospital Revenue Code	278
Min. Negotiated Rate	$2,349.75
Max. Negotiated Rate	$3,790.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,133.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,790.93
Rate for Payer: Qualcare PPO/HMO/WC	$2,349.75

BONE GRAFT MATRIX 5X5CM 8.75CC

Facility

$9,395.00

Hospital Charge Code	270671745
Hospital Revenue Code	278
Min. Negotiated Rate	$1,409.25
Max. Negotiated Rate	$2,273.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,879.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,273.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.25

BONE GRAFT MATRIX 5X5CM 8.75CC

Facility

$9,395.00

Hospital Charge Code	270671745
Hospital Revenue Code	278
Min. Negotiated Rate	$266.82
Max. Negotiated Rate	$4,697.50
Rate for Payer: Aetna Commercial	$3,570.10
Rate for Payer: Aetna Medicare Advantage	$2,818.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,395.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,395.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,879.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,395.72
Rate for Payer: Cigna Commercial	$4,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,273.59
Rate for Payer: Qualcare PPO/HMO/WC	$1,409.25
Rate for Payer: UnitedHealthcare Community & State	$296.88
Rate for Payer: Wellpoint Medicaid Managed Care	$266.82

BONE GRAFT PASTE MIX PLUS 10CC

Facility

$9,755.00

Hospital Charge Code	270671744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.25
Max. Negotiated Rate	$2,360.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,951.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,360.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,463.25

BONE GRAFT PASTE MIX PLUS 10CC

Facility

$9,755.00

Hospital Charge Code	270671744
Hospital Revenue Code	278
Min. Negotiated Rate	$277.04
Max. Negotiated Rate	$4,877.50
Rate for Payer: Aetna Commercial	$3,706.90
Rate for Payer: Aetna Medicare Advantage	$2,926.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,487.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,487.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,951.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,487.53
Rate for Payer: Cigna Commercial	$4,877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,360.71
Rate for Payer: Qualcare PPO/HMO/WC	$1,463.25
Rate for Payer: UnitedHealthcare Community & State	$308.26
Rate for Payer: Wellpoint Medicaid Managed Care	$277.04

BONE GRAFT PASTE MIX PLUS 1.25

Facility

$2,615.00

Hospital Charge Code	270671741
Hospital Revenue Code	278
Min. Negotiated Rate	$74.27
Max. Negotiated Rate	$1,307.50
Rate for Payer: Aetna Commercial	$993.70
Rate for Payer: Aetna Medicare Advantage	$784.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$666.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$666.83
Rate for Payer: Cigna Commercial	$1,307.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.83
Rate for Payer: Qualcare PPO/HMO/WC	$392.25
Rate for Payer: UnitedHealthcare Community & State	$82.63
Rate for Payer: Wellpoint Medicaid Managed Care	$74.27

BONE GRAFT PASTE MIX PLUS 1.25

Facility

$2,615.00

Hospital Charge Code	270671741
Hospital Revenue Code	278
Min. Negotiated Rate	$392.25
Max. Negotiated Rate	$632.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$632.83
Rate for Payer: Qualcare PPO/HMO/WC	$392.25

BONE GRAFT PASTE MIX PLUS 2.5

Facility

$3,615.00

Hospital Charge Code	270671742
Hospital Revenue Code	278
Min. Negotiated Rate	$102.67
Max. Negotiated Rate	$1,807.50
Rate for Payer: Aetna Commercial	$1,373.70
Rate for Payer: Aetna Medicare Advantage	$1,084.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$921.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$921.83
Rate for Payer: Cigna Commercial	$1,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: Qualcare PPO/HMO/WC	$542.25
Rate for Payer: UnitedHealthcare Community & State	$114.23
Rate for Payer: Wellpoint Medicaid Managed Care	$102.67

BONE GRAFT PASTE MIX PLUS 2.5

Facility

$3,615.00

Hospital Charge Code	270671742
Hospital Revenue Code	278
Min. Negotiated Rate	$542.25
Max. Negotiated Rate	$874.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$723.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$874.83
Rate for Payer: Qualcare PPO/HMO/WC	$542.25

BONE GRAFT PASTE MIX PLUS 5CC

Facility

$5,845.00

Hospital Charge Code	270671743
Hospital Revenue Code	278
Min. Negotiated Rate	$876.75
Max. Negotiated Rate	$1,414.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,169.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,414.49
Rate for Payer: Qualcare PPO/HMO/WC	$876.75

BONE GRAFT PASTE MIX PLUS 5CC

Facility

$5,845.00

Hospital Charge Code	270671743
Hospital Revenue Code	278
Min. Negotiated Rate	$166.00
Max. Negotiated Rate	$2,922.50
Rate for Payer: Aetna Commercial	$2,221.10
Rate for Payer: Aetna Medicare Advantage	$1,753.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,490.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,490.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,169.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,490.47
Rate for Payer: Cigna Commercial	$2,922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,414.49
Rate for Payer: Qualcare PPO/HMO/WC	$876.75
Rate for Payer: UnitedHealthcare Community & State	$184.70
Rate for Payer: Wellpoint Medicaid Managed Care	$166.00

BONE GRAFT STRIP 12x12x12MM

Facility

$2,700.00

Hospital Charge Code	270671734
Hospital Revenue Code	278
Min. Negotiated Rate	$405.00
Max. Negotiated Rate	$653.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.40
Rate for Payer: Qualcare PPO/HMO/WC	$405.00

BONE GRAFT STRIP 12x12x12MM

Facility

$2,700.00

Hospital Charge Code	270671734
Hospital Revenue Code	278
Min. Negotiated Rate	$76.68
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$1,026.00
Rate for Payer: Aetna Medicare Advantage	$810.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$688.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$688.50
Rate for Payer: Cigna Commercial	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$653.40
Rate for Payer: Qualcare PPO/HMO/WC	$405.00
Rate for Payer: UnitedHealthcare Community & State	$85.32
Rate for Payer: Wellpoint Medicaid Managed Care	$76.68

BONE GRAFT STRIP 14x14x14MM

Facility

$3,600.00

Hospital Charge Code	270671735
Hospital Revenue Code	278
Min. Negotiated Rate	$540.00
Max. Negotiated Rate	$871.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00

BONE GRAFT STRIP 14x14x14MM

Facility

$3,600.00

Hospital Charge Code	270671735
Hospital Revenue Code	278
Min. Negotiated Rate	$102.24
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$1,368.00
Rate for Payer: Aetna Medicare Advantage	$1,080.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$918.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$720.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$918.00
Rate for Payer: Cigna Commercial	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$871.20
Rate for Payer: Qualcare PPO/HMO/WC	$540.00
Rate for Payer: UnitedHealthcare Community & State	$113.76
Rate for Payer: Wellpoint Medicaid Managed Care	$102.24

BONE GRAFT STRIP 26x19x7MM

Facility

$6,300.00

Hospital Charge Code	270671727
Hospital Revenue Code	278
Min. Negotiated Rate	$178.92
Max. Negotiated Rate	$3,150.00
Rate for Payer: Aetna Commercial	$2,394.00
Rate for Payer: Aetna Medicare Advantage	$1,890.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,606.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,606.50
Rate for Payer: Cigna Commercial	$3,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00
Rate for Payer: UnitedHealthcare Community & State	$199.08
Rate for Payer: Wellpoint Medicaid Managed Care	$178.92

BONE GRAFT STRIP 26x19x7MM

Facility

$6,300.00

Hospital Charge Code	270671727
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

BONE GRAFT STRIP 50x10x7MM

Facility

$6,300.00

Hospital Charge Code	270671726
Hospital Revenue Code	278
Min. Negotiated Rate	$945.00
Max. Negotiated Rate	$1,524.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,524.60
Rate for Payer: Qualcare PPO/HMO/WC	$945.00

Know your out-of-pocket cost for care.

All Charges