Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GORETEX THIN WALL W/RING

Facility

$4,903.00

Hospital Charge Code	270335070
Hospital Revenue Code	278
Min. Negotiated Rate	$139.25
Max. Negotiated Rate	$2,451.50
Rate for Payer: Aetna Commercial	$1,863.14
Rate for Payer: Aetna Medicare Advantage	$1,470.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,250.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,250.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,250.27
Rate for Payer: Cigna Commercial	$2,451.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,186.53
Rate for Payer: Qualcare PPO/HMO/WC	$735.45
Rate for Payer: UnitedHealthcare Community & State	$154.93
Rate for Payer: Wellpoint Medicaid Managed Care	$139.25

GORETEX THIN WALL W/RING

Facility

$4,903.00

Hospital Charge Code	270335070
Hospital Revenue Code	278
Min. Negotiated Rate	$735.45
Max. Negotiated Rate	$1,186.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$980.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,186.53
Rate for Payer: Qualcare PPO/HMO/WC	$735.45

GORTEX CARDIO PATCH

Facility

$1,305.00

Hospital Charge Code	270335055
Hospital Revenue Code	278
Min. Negotiated Rate	$37.06
Max. Negotiated Rate	$652.50
Rate for Payer: Aetna Commercial	$495.90
Rate for Payer: Aetna Medicare Advantage	$391.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$332.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$261.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$332.77
Rate for Payer: Cigna Commercial	$652.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.81
Rate for Payer: Qualcare PPO/HMO/WC	$195.75
Rate for Payer: UnitedHealthcare Community & State	$41.24
Rate for Payer: Wellpoint Medicaid Managed Care	$37.06

GORTEX CARDIO PATCH

Facility

$1,305.00

Hospital Charge Code	270335055
Hospital Revenue Code	278
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$315.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$261.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.81
Rate for Payer: Qualcare PPO/HMO/WC	$195.75

GORTEX GRAFT W/12CM RINGS

Facility

$2,969.00

Hospital Charge Code	270335061
Hospital Revenue Code	278
Min. Negotiated Rate	$84.32
Max. Negotiated Rate	$1,484.50
Rate for Payer: Aetna Commercial	$1,128.22
Rate for Payer: Aetna Medicare Advantage	$890.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$757.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$757.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$593.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$757.10
Rate for Payer: Cigna Commercial	$1,484.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$718.50
Rate for Payer: Qualcare PPO/HMO/WC	$445.35
Rate for Payer: UnitedHealthcare Community & State	$93.82
Rate for Payer: Wellpoint Medicaid Managed Care	$84.32

GORTEX GRAFT W/12CM RINGS

Facility

$2,969.00

Hospital Charge Code	270335061
Hospital Revenue Code	278
Min. Negotiated Rate	$445.35
Max. Negotiated Rate	$718.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$593.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$718.50
Rate for Payer: Qualcare PPO/HMO/WC	$445.35

GORTEX STRAIGHT GRAFT UP TO X4

Facility

$2,240.00

Hospital Charge Code	270335058
Hospital Revenue Code	278
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$542.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00

GORTEX STRAIGHT GRAFT UP TO X4

Facility

$2,240.00

Hospital Charge Code	270335058
Hospital Revenue Code	278
Min. Negotiated Rate	$63.62
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$851.20
Rate for Payer: Aetna Medicare Advantage	$672.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$571.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$448.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$571.20
Rate for Payer: Cigna Commercial	$1,120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$542.08
Rate for Payer: Qualcare PPO/HMO/WC	$336.00
Rate for Payer: UnitedHealthcare Community & State	$70.78
Rate for Payer: Wellpoint Medicaid Managed Care	$63.62

GORTEX TAPERED GRAFT X 40CM

Facility

$2,356.00

Hospital Charge Code	270335059
Hospital Revenue Code	278
Min. Negotiated Rate	$353.40
Max. Negotiated Rate	$570.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$471.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$570.15
Rate for Payer: Qualcare PPO/HMO/WC	$353.40

GORTEX TAPERED GRAFT X 40CM

Facility

$2,356.00

Hospital Charge Code	270335059
Hospital Revenue Code	278
Min. Negotiated Rate	$66.91
Max. Negotiated Rate	$1,178.00
Rate for Payer: Aetna Commercial	$895.28
Rate for Payer: Aetna Medicare Advantage	$706.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$600.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$600.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$471.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$600.78
Rate for Payer: Cigna Commercial	$1,178.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$570.15
Rate for Payer: Qualcare PPO/HMO/WC	$353.40
Rate for Payer: UnitedHealthcare Community & State	$74.45
Rate for Payer: Wellpoint Medicaid Managed Care	$66.91

GOWN NON REINFORCED XL

Facility

$12.64

Hospital Charge Code	270649518
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Qualcare PPO/HMO/WC	$1.90

GOWN NON REINFORCED XL

Facility

$12.64

Hospital Charge Code	270649518
Hospital Revenue Code	270
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$6.32
Rate for Payer: Aetna Commercial	$4.80
Rate for Payer: Aetna Medicare Advantage	$3.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.22
Rate for Payer: Cigna Commercial	$6.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.29
Rate for Payer: Oxford Commercial	$2.53
Rate for Payer: Qualcare PPO/HMO/WC	$1.90
Rate for Payer: UnitedHealthcare Commercial	$2.53
Rate for Payer: UnitedHealthcare Community & State	$0.40
Rate for Payer: Wellpoint Medicaid Managed Care	$0.36

GPS TAP CANNULATED 5.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698380
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$1,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GPS TAP CANNULATED 5.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698380
Hospital Revenue Code	278
Min. Negotiated Rate	$175.80
Max. Negotiated Rate	$3,095.00
Rate for Payer: Aetna Commercial	$2,352.20
Rate for Payer: Aetna Medicare Advantage	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,578.45
Rate for Payer: Cigna Commercial	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50
Rate for Payer: UnitedHealthcare Community & State	$195.60
Rate for Payer: Wellpoint Medicaid Managed Care	$175.80

GPS TAP CANNULATED TAP 4.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698382
Hospital Revenue Code	278
Min. Negotiated Rate	$175.80
Max. Negotiated Rate	$3,095.00
Rate for Payer: Aetna Commercial	$2,352.20
Rate for Payer: Aetna Medicare Advantage	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,578.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,578.45
Rate for Payer: Cigna Commercial	$3,095.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50
Rate for Payer: UnitedHealthcare Community & State	$195.60
Rate for Payer: Wellpoint Medicaid Managed Care	$175.80

GPS TAP CANNULATED TAP 4.5MM

Facility

$6,190.00

Service Code	HCPCS C1713
Hospital Charge Code	270698382
Hospital Revenue Code	278
Min. Negotiated Rate	$928.50
Max. Negotiated Rate	$1,497.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,238.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,497.98
Rate for Payer: Qualcare PPO/HMO/WC	$928.50

GRACILIS TENDON IMPLANT

Facility

$1,788.00

Hospital Charge Code	270335539
Hospital Revenue Code	278
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$432.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$357.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.70
Rate for Payer: Qualcare PPO/HMO/WC	$268.20

GRACILIS TENDON IMPLANT

Facility

$1,788.00

Hospital Charge Code	270335539
Hospital Revenue Code	278
Min. Negotiated Rate	$50.78
Max. Negotiated Rate	$894.00
Rate for Payer: Aetna Commercial	$679.44
Rate for Payer: Aetna Medicare Advantage	$536.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$357.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$455.94
Rate for Payer: Cigna Commercial	$894.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$432.70
Rate for Payer: Qualcare PPO/HMO/WC	$268.20
Rate for Payer: UnitedHealthcare Community & State	$56.50
Rate for Payer: Wellpoint Medicaid Managed Care	$50.78

GRADUATED G PIN SLEEVE

Facility

$1,025.00

Hospital Charge Code	270691449
Hospital Revenue Code	272
Min. Negotiated Rate	$29.11
Max. Negotiated Rate	$512.50
Rate for Payer: Aetna Commercial	$389.50
Rate for Payer: Aetna Medicare Advantage	$307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$261.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$261.38
Rate for Payer: Cigna Commercial	$512.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$266.50
Rate for Payer: Oxford Commercial	$205.00
Rate for Payer: Qualcare PPO/HMO/WC	$153.75
Rate for Payer: UnitedHealthcare Commercial	$205.00
Rate for Payer: UnitedHealthcare Community & State	$32.39
Rate for Payer: Wellpoint Medicaid Managed Care	$29.11

GRADUATED G PIN SLEEVE

Facility

$1,025.00

Hospital Charge Code	270691449
Hospital Revenue Code	272
Min. Negotiated Rate	$153.75
Max. Negotiated Rate	$153.75
Rate for Payer: Qualcare PPO/HMO/WC	$153.75

GRAFIX PRIME/SQ CM

Facility

$684.00

Service Code	HCPCS Q4133
Hospital Charge Code	9808333
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$165.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFIX PRIME/SQ CM

Facility

$684.00

Service Code	HCPCS Q4133
Hospital Charge Code	9808333
Hospital Revenue Code	636
Min. Negotiated Rate	$19.43
Max. Negotiated Rate	$536.29
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	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60
Rate for Payer: UnitedHealthcare Community & State	$21.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$19.43

GRAFIX PRIME/SQ CM JW

Facility

$684.00

Service Code	HCPCS Q4133JW
Hospital Charge Code	9808333W
Hospital Revenue Code	636
Min. Negotiated Rate	$19.43
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna Commercial	$259.92
Rate for Payer: Aetna Medicare Advantage	$205.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.42
Rate for Payer: Cigna Commercial	$342.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60
Rate for Payer: UnitedHealthcare Community & State	$21.61
Rate for Payer: Wellpoint Medicaid Managed Care	$19.43

GRAFIX PRIME/SQ CM JW

Facility

$684.00

Service Code	HCPCS Q4133JW
Hospital Charge Code	9808333W
Hospital Revenue Code	636
Min. Negotiated Rate	$102.60
Max. Negotiated Rate	$165.53
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.53
Rate for Payer: Qualcare PPO/HMO/WC	$102.60

GRAFT 10MM X 80 CM X 70 CM RIN

Facility

$6,845.00

Service Code	HCPCS L8670
Hospital Charge Code	270690161
Hospital Revenue Code	278
Min. Negotiated Rate	$194.40
Max. Negotiated Rate	$3,422.50
Rate for Payer: Aetna Commercial	$2,601.10
Rate for Payer: Aetna Medicare Advantage	$2,053.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,745.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,745.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,745.47
Rate for Payer: Cigna Commercial	$3,422.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,656.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.75
Rate for Payer: UnitedHealthcare Community & State	$216.30
Rate for Payer: Wellpoint Medicaid Managed Care	$194.40

Know your out-of-pocket cost for care.

All Charges