Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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

BONE GRAFT STRIP 50x15x7MM

Facility

$9,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270671728
Hospital Revenue Code	278
Min. Negotiated Rate	$265.11
Max. Negotiated Rate	$4,667.50
Rate for Payer: Aetna Commercial	$3,547.30
Rate for Payer: Aetna Medicare Advantage	$2,800.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,380.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,380.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,867.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,380.43
Rate for Payer: Cigna Commercial	$4,667.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,259.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,400.25
Rate for Payer: UnitedHealthcare Community & State	$294.99
Rate for Payer: Wellpoint Medicaid Managed Care	$265.11

BONE GRAFT STRIP 50x15x7MM

Facility

$9,335.00

Service Code	HCPCS C1713
Hospital Charge Code	270671728
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.25
Max. Negotiated Rate	$2,259.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,867.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,259.07
Rate for Payer: Qualcare PPO/HMO/WC	$1,400.25

BONE GRFT,MAJ/LG

Facility

$30,595.00

Service Code	HCPCS 20902
Hospital Charge Code	16000795
Hospital Revenue Code	360
Min. Negotiated Rate	$868.90
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,954.70
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$966.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$868.90

BONE GRFT,MAJ/LG

Facility

$30,595.00

Service Code	HCPCS 20902
Hospital Charge Code	16000795
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

BONE GRFT,MINOR/SM

Facility

$30,595.00

Service Code	HCPCS 20900
Hospital Charge Code	16000336
Hospital Revenue Code	360
Min. Negotiated Rate	$4,589.25
Max. Negotiated Rate	$4,589.25
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25

BONE GRFT,MINOR/SM

Facility

$30,595.00

Service Code	HCPCS 20900
Hospital Charge Code	16000336
Hospital Revenue Code	360
Min. Negotiated Rate	$868.90
Max. Negotiated Rate	$31,271.12
Rate for Payer: Aetna Commercial	$23,447.95
Rate for Payer: Aetna Medicare Advantage	$27,930.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$31,271.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8,620.57
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	$31,271.12
Rate for Payer: Cigna Commercial	$17,279.91
Rate for Payer: Cigna Medicare Advantage	$8,620.57
Rate for Payer: Clover Medicare Advantage	$8,189.54
Rate for Payer: EmblemHealth Commercial	$25,861.71
Rate for Payer: Humana Medicare Advantage	$8,879.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8,620.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,954.70
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,589.25
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$966.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,620.57
Rate for Payer: Wellcare Medicare Advantage	$8,620.57
Rate for Payer: Wellpoint Medicaid Managed Care	$868.90

BONE GUIDE GLENOID LT

Facility

$5,700.00

Service Code	HCPCS A4649
Hospital Charge Code	270699507
Hospital Revenue Code	272
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

BONE GUIDE GLENOID LT

Facility

$5,700.00

Service Code	HCPCS A4649
Hospital Charge Code	270699507
Hospital Revenue Code	272
Min. Negotiated Rate	$161.88
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.00
Rate for Payer: Oxford Commercial	$1,140.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$1,140.00
Rate for Payer: UnitedHealthcare Community & State	$180.12
Rate for Payer: Wellpoint Medicaid Managed Care	$161.88

BONE GUIDE MINI LT REV SHLDR

Facility

$5,700.00

Service Code	HCPCS A4649
Hospital Charge Code	270693854
Hospital Revenue Code	272
Min. Negotiated Rate	$855.00
Max. Negotiated Rate	$855.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00

BONE GUIDE MINI LT REV SHLDR

Facility

$5,700.00

Service Code	HCPCS A4649
Hospital Charge Code	270693854
Hospital Revenue Code	272
Min. Negotiated Rate	$161.88
Max. Negotiated Rate	$2,850.00
Rate for Payer: Aetna Commercial	$2,166.00
Rate for Payer: Aetna Medicare Advantage	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,453.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,453.50
Rate for Payer: Cigna Commercial	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,482.00
Rate for Payer: Oxford Commercial	$1,140.00
Rate for Payer: Qualcare PPO/HMO/WC	$855.00
Rate for Payer: UnitedHealthcare Commercial	$1,140.00
Rate for Payer: UnitedHealthcare Community & State	$180.12
Rate for Payer: Wellpoint Medicaid Managed Care	$161.88

BONE HOLDING FORCEP

Facility

$500.60

Hospital Charge Code	270655154
Hospital Revenue Code	272
Min. Negotiated Rate	$14.22
Max. Negotiated Rate	$250.30
Rate for Payer: Aetna Commercial	$190.23
Rate for Payer: Aetna Medicare Advantage	$150.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.65
Rate for Payer: Cigna Commercial	$250.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.16
Rate for Payer: Oxford Commercial	$100.12
Rate for Payer: Qualcare PPO/HMO/WC	$75.09
Rate for Payer: UnitedHealthcare Commercial	$100.12
Rate for Payer: UnitedHealthcare Community & State	$15.82
Rate for Payer: Wellpoint Medicaid Managed Care	$14.22

BONE HOLDING FORCEP

Facility

$500.60

Hospital Charge Code	270655154
Hospital Revenue Code	272
Min. Negotiated Rate	$75.09
Max. Negotiated Rate	$75.09
Rate for Payer: Qualcare PPO/HMO/WC	$75.09

BONE IMAGING LMTD AREA

Facility

$741.24

Service Code	HCPCS 78300
Hospital Charge Code	406078300
Hospital Revenue Code	341
Min. Negotiated Rate	$21.05
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$99.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,722.84
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.72
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$111.19
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$23.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$185.13
Rate for Payer: Wellpoint Medicaid Managed Care	$21.05

BONE IMAGING LMTD AREA

Facility

$741.24

Service Code	HCPCS 78300
Hospital Charge Code	406078300
Hospital Revenue Code	341
Min. Negotiated Rate	$111.19
Max. Negotiated Rate	$111.19
Rate for Payer: Qualcare PPO/HMO/WC	$111.19

BONE IMAGING MULT AREAS

Facility

$1,840.40

Service Code	HCPCS 78305
Hospital Charge Code	406078305
Hospital Revenue Code	341
Min. Negotiated Rate	$276.06
Max. Negotiated Rate	$276.06
Rate for Payer: Qualcare PPO/HMO/WC	$276.06

BONE IMAGING MULT AREAS

Facility

$1,840.40

Service Code	HCPCS 78305
Hospital Charge Code	406078305
Hospital Revenue Code	341
Min. Negotiated Rate	$52.27
Max. Negotiated Rate	$4,820.00
Rate for Payer: Aetna Commercial	$1,291.84
Rate for Payer: Aetna Medicare Advantage	$1,538.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,722.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$474.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,722.84
Rate for Payer: Cigna Commercial	$952.02
Rate for Payer: Cigna Medicare Advantage	$332.46
Rate for Payer: Clover Medicare Advantage	$451.19
Rate for Payer: EmblemHealth Commercial	$1,424.82
Rate for Payer: Humana Medicare Advantage	$489.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$474.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$478.50
Rate for Payer: Oxford Commercial	$4,820.00
Rate for Payer: Qualcare PPO/HMO/WC	$276.06
Rate for Payer: UnitedHealthcare Commercial	$4,748.00
Rate for Payer: UnitedHealthcare Community & State	$58.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$474.94
Rate for Payer: Wellcare Medicare Advantage	$474.94
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$1,205.13
Rate for Payer: Wellpoint Medicaid Managed Care	$52.27

BONE LENGTH STUDY

Facility

$5,100.00

Service Code	HCPCS 77073
Hospital Charge Code	94061195
Hospital Revenue Code	320
Min. Negotiated Rate	$21.38
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare Advantage	$402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$450.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$124.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$450.54
Rate for Payer: Cigna Commercial	$248.96
Rate for Payer: Cigna Medicare Advantage	$86.94
Rate for Payer: Clover Medicare Advantage	$117.99
Rate for Payer: EmblemHealth Commercial	$372.60
Rate for Payer: Humana Medicare Advantage	$127.93
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$124.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,326.00
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$161.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.20
Rate for Payer: Wellcare Medicare Advantage	$124.20
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$216.59
Rate for Payer: Wellpoint Medicaid Managed Care	$144.84

BONE LENGTH STUDY

Facility

$5,100.00

Service Code	HCPCS 77073
Hospital Charge Code	94061195
Hospital Revenue Code	320
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$765.00
Rate for Payer: Qualcare PPO/HMO/WC	$765.00

BONE MARROW ASPIRATE KIT

Facility

$11,475.00

Hospital Charge Code	270671802
Hospital Revenue Code	272
Min. Negotiated Rate	$325.89
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,983.50
Rate for Payer: Oxford Commercial	$2,295.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Commercial	$2,295.00
Rate for Payer: UnitedHealthcare Community & State	$362.61
Rate for Payer: Wellpoint Medicaid Managed Care	$325.89

BONE MARROW ASPIRATE KIT

Facility

$11,475.00

Hospital Charge Code	270671802
Hospital Revenue Code	272
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$1,721.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

BONE MARROW ASPIRATION

Facility

$1,457.45

Service Code	HCPCS 38220
Hospital Charge Code	93500143
Hospital Revenue Code	761
Min. Negotiated Rate	$218.62
Max. Negotiated Rate	$218.62
Rate for Payer: Qualcare PPO/HMO/WC	$218.62

BONE MARROW ASPIRATION

Facility

$1,457.45

Service Code	HCPCS 38220
Hospital Charge Code	93500143
Hospital Revenue Code	761
Min. Negotiated Rate	$41.39
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.94
Rate for Payer: Oxford Commercial	$291.49
Rate for Payer: Qualcare PPO/HMO/WC	$218.62
Rate for Payer: UnitedHealthcare Commercial	$291.49
Rate for Payer: UnitedHealthcare Community & State	$46.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$41.39

BONE MARROW ASPIRATION BL

Facility

$7,612.30

Service Code	HCPCS 38220
Hospital Charge Code	1600000754
Hospital Revenue Code	360
Min. Negotiated Rate	$1,141.85
Max. Negotiated Rate	$1,141.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85

BONE MARROW ASPIRATION BL

Facility

$7,612.30

Service Code	HCPCS 38220
Hospital Charge Code	1600000754
Hospital Revenue Code	360
Min. Negotiated Rate	$216.19
Max. Negotiated Rate	$7,117.66
Rate for Payer: Aetna Commercial	$5,337.02
Rate for Payer: Aetna Medicare Advantage	$6,357.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,117.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,962.14
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	$7,117.66
Rate for Payer: Cigna Commercial	$3,933.12
Rate for Payer: Cigna Medicare Advantage	$1,962.14
Rate for Payer: Clover Medicare Advantage	$1,864.03
Rate for Payer: EmblemHealth Commercial	$5,886.42
Rate for Payer: Humana Medicare Advantage	$2,021.00
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,962.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,979.20
Rate for Payer: Oxford Commercial	$3,505.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,141.85
Rate for Payer: UnitedHealthcare Commercial	$3,629.00
Rate for Payer: UnitedHealthcare Community & State	$240.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,962.14
Rate for Payer: Wellcare Medicare Advantage	$1,962.14
Rate for Payer: Wellpoint Medicaid Managed Care	$216.19

Know your out-of-pocket cost for care.

All Charges