Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DBM CUBE GRFT SPNGE 10X10X10MM

Facility

$19,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270691839
Hospital Revenue Code	278
Min. Negotiated Rate	$539.60
Max. Negotiated Rate	$9,500.00
Rate for Payer: Aetna Commercial	$7,220.00
Rate for Payer: Aetna Medicare Advantage	$5,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,845.00
Rate for Payer: Cigna Commercial	$9,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,598.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,850.00
Rate for Payer: UnitedHealthcare Community & State	$600.40
Rate for Payer: Wellpoint Medicaid Managed Care	$539.60

DBM EXPONENT 10 CC

Facility

$14,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270691813
Hospital Revenue Code	278
Min. Negotiated Rate	$2,137.50
Max. Negotiated Rate	$3,448.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50

DBM EXPONENT 10 CC

Facility

$14,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270691813
Hospital Revenue Code	278
Min. Negotiated Rate	$404.70
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$5,415.00
Rate for Payer: Aetna Medicare Advantage	$4,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,633.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,633.75
Rate for Payer: Cigna Commercial	$7,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,448.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,137.50
Rate for Payer: UnitedHealthcare Community & State	$450.30
Rate for Payer: Wellpoint Medicaid Managed Care	$404.70

DBM FIBER

Facility

$11,750.00

Service Code	HCPCS C9359
Hospital Charge Code	270692411
Hospital Revenue Code	278
Min. Negotiated Rate	$1,762.50
Max. Negotiated Rate	$2,843.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50

DBM FIBER

Facility

$11,750.00

Service Code	HCPCS C9359
Hospital Charge Code	270692411
Hospital Revenue Code	278
Min. Negotiated Rate	$333.70
Max. Negotiated Rate	$5,875.00
Rate for Payer: Aetna Commercial	$4,465.00
Rate for Payer: Aetna Medicare Advantage	$3,525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,996.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,996.25
Rate for Payer: Cigna Commercial	$5,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,843.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,762.50
Rate for Payer: UnitedHealthcare Community & State	$371.30
Rate for Payer: Wellpoint Medicaid Managed Care	$333.70

DBM FIBER APEX 5CC

Facility

$8,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270693091
Hospital Revenue Code	278
Min. Negotiated Rate	$1,256.25
Max. Negotiated Rate	$2,026.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25

DBM FIBER APEX 5CC

Facility

$8,375.00

Service Code	HCPCS C1713
Hospital Charge Code	270693091
Hospital Revenue Code	278
Min. Negotiated Rate	$237.85
Max. Negotiated Rate	$4,187.50
Rate for Payer: Aetna Commercial	$3,182.50
Rate for Payer: Aetna Medicare Advantage	$2,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,135.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,135.62
Rate for Payer: Cigna Commercial	$4,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,026.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,256.25
Rate for Payer: UnitedHealthcare Community & State	$264.65
Rate for Payer: Wellpoint Medicaid Managed Care	$237.85

DBM FIBER GRAFT VESUV 15CC

Facility

$11,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270699278
Hospital Revenue Code	278
Min. Negotiated Rate	$339.24
Max. Negotiated Rate	$5,972.50
Rate for Payer: Aetna Commercial	$4,539.10
Rate for Payer: Aetna Medicare Advantage	$3,583.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,045.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,045.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,389.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,045.97
Rate for Payer: Cigna Commercial	$5,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,890.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,791.75
Rate for Payer: UnitedHealthcare Community & State	$377.46
Rate for Payer: Wellpoint Medicaid Managed Care	$339.24

DBM FIBER GRAFT VESUV 15CC

Facility

$11,945.00

Service Code	HCPCS C1713
Hospital Charge Code	270699278
Hospital Revenue Code	278
Min. Negotiated Rate	$1,791.75
Max. Negotiated Rate	$2,890.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,389.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,890.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,791.75

DBM FIBER PUTTY 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682162
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

DBM FIBER PUTTY 10CC

Facility

$6,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682162
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

DBM FIBER PUTTY 5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682161
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

DBM FIBER PUTTY 5CC

Facility

$3,000.00

Service Code	HCPCS C1713
Hospital Charge Code	270682161
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

DBM GEL 1CC SEA PEARL INC

Facility

$1,175.00

Hospital Charge Code	270339549
Hospital Revenue Code	272
Min. Negotiated Rate	$176.25
Max. Negotiated Rate	$176.25
Rate for Payer: Qualcare PPO/HMO/WC	$176.25

DBM GEL 1CC SEA PEARL INC

Facility

$1,175.00

Hospital Charge Code	270339549
Hospital Revenue Code	272
Min. Negotiated Rate	$33.37
Max. Negotiated Rate	$587.50
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare Advantage	$352.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$299.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$299.62
Rate for Payer: Cigna Commercial	$587.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$305.50
Rate for Payer: Oxford Commercial	$235.00
Rate for Payer: Qualcare PPO/HMO/WC	$176.25
Rate for Payer: UnitedHealthcare Commercial	$235.00
Rate for Payer: UnitedHealthcare Community & State	$37.13
Rate for Payer: Wellpoint Medicaid Managed Care	$33.37

DBM NEVOS FIBER 2.5CC

Facility

$2,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270696099
Hospital Revenue Code	278
Min. Negotiated Rate	$396.00
Max. Negotiated Rate	$638.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: Qualcare PPO/HMO/WC	$396.00

DBM NEVOS FIBER 2.5CC

Facility

$2,640.00

Service Code	HCPCS C1713
Hospital Charge Code	270696099
Hospital Revenue Code	278
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$1,320.00
Rate for Payer: Aetna Commercial	$1,003.20
Rate for Payer: Aetna Medicare Advantage	$792.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$673.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$528.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$673.20
Rate for Payer: Cigna Commercial	$1,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$638.88
Rate for Payer: Qualcare PPO/HMO/WC	$396.00
Rate for Payer: UnitedHealthcare Community & State	$83.42
Rate for Payer: Wellpoint Medicaid Managed Care	$74.98

DBM PLUS STAGRAFT 2CC

Facility

$3,280.00

Service Code	HCPCS C1713
Hospital Charge Code	270680553
Hospital Revenue Code	278
Min. Negotiated Rate	$492.00
Max. Negotiated Rate	$793.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: Qualcare PPO/HMO/WC	$492.00

DBM PLUS STAGRAFT 2CC

Facility

$3,280.00

Service Code	HCPCS C1713
Hospital Charge Code	270680553
Hospital Revenue Code	278
Min. Negotiated Rate	$93.15
Max. Negotiated Rate	$1,640.00
Rate for Payer: Aetna Commercial	$1,246.40
Rate for Payer: Aetna Medicare Advantage	$984.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$836.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$656.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$836.40
Rate for Payer: Cigna Commercial	$1,640.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.76
Rate for Payer: Qualcare PPO/HMO/WC	$492.00
Rate for Payer: UnitedHealthcare Community & State	$103.65
Rate for Payer: Wellpoint Medicaid Managed Care	$93.15

DBM POWDER 10CC

Facility

$3,457.00

Hospital Charge Code	270332657
Hospital Revenue Code	278
Min. Negotiated Rate	$98.18
Max. Negotiated Rate	$1,728.50
Rate for Payer: Aetna Commercial	$1,313.66
Rate for Payer: Aetna Medicare Advantage	$1,037.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$881.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$881.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$691.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$881.53
Rate for Payer: Cigna Commercial	$1,728.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$836.59
Rate for Payer: Qualcare PPO/HMO/WC	$518.55
Rate for Payer: UnitedHealthcare Community & State	$109.24
Rate for Payer: Wellpoint Medicaid Managed Care	$98.18

DBM POWDER 10CC

Facility

$3,457.00

Hospital Charge Code	270332657
Hospital Revenue Code	278
Min. Negotiated Rate	$518.55
Max. Negotiated Rate	$836.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$691.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$836.59
Rate for Payer: Qualcare PPO/HMO/WC	$518.55

DBM PUTTY 1CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700323
Hospital Revenue Code	278
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

DBM PUTTY 1CC

Facility

$1,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270704103
Hospital Revenue Code	278
Min. Negotiated Rate	$40.61
Max. Negotiated Rate	$715.00
Rate for Payer: Aetna Commercial	$543.40
Rate for Payer: Aetna Medicare Advantage	$429.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$364.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$364.65
Rate for Payer: Cigna Commercial	$715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.06
Rate for Payer: Qualcare PPO/HMO/WC	$214.50
Rate for Payer: UnitedHealthcare Community & State	$45.19
Rate for Payer: Wellpoint Medicaid Managed Care	$40.61

DBM PUTTY 1CC

Facility

$1,430.00

Service Code	HCPCS C1765
Hospital Charge Code	270704103
Hospital Revenue Code	278
Min. Negotiated Rate	$214.50
Max. Negotiated Rate	$346.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.06
Rate for Payer: Qualcare PPO/HMO/WC	$214.50

DBM PUTTY 1CC

Facility

$550.00

Service Code	HCPCS C1713
Hospital Charge Code	270700323
Hospital Revenue Code	278
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$133.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.10
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

Know your out-of-pocket cost for care.

All Charges