Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$1,026.75
Max. Negotiated Rate	$1,656.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,369.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,656.49
Rate for Payer: Qualcare PPO/HMO/WC	$1,026.75

GRAFT 12 MM X 30 CM RING

Facility

$5,395.00

Service Code	HCPCS L8670
Hospital Charge Code	270690160
Hospital Revenue Code	278
Min. Negotiated Rate	$809.25
Max. Negotiated Rate	$1,305.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: Qualcare PPO/HMO/WC	$809.25

GRAFT 12 MM X 30 CM RING

Facility

$5,395.00

Service Code	HCPCS L8670
Hospital Charge Code	270690160
Hospital Revenue Code	278
Min. Negotiated Rate	$153.22
Max. Negotiated Rate	$2,697.50
Rate for Payer: Aetna Commercial	$2,050.10
Rate for Payer: Aetna Medicare Advantage	$1,618.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,375.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,375.72
Rate for Payer: Cigna Commercial	$2,697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,305.59
Rate for Payer: Qualcare PPO/HMO/WC	$809.25
Rate for Payer: UnitedHealthcare Community & State	$170.48
Rate for Payer: Wellpoint Medicaid Managed Care	$153.22

GRAFT 4X8CM

Facility

$15,640.00

Service Code	HCPCS Q4248
Hospital Charge Code	270694137
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$3,784.88
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	$3,128.00
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	$3,784.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00
Rate for Payer: UnitedHealthcare Community & State	$494.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$444.18

GRAFT 4X8CM

Facility

$15,640.00

Service Code	HCPCS Q4248
Hospital Charge Code	270694137
Hospital Revenue Code	278
Min. Negotiated Rate	$2,346.00
Max. Negotiated Rate	$3,784.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,784.88
Rate for Payer: Qualcare PPO/HMO/WC	$2,346.00

GRAFT 6MMX30CM FLIXENE

Facility

$5,499.65

Service Code	HCPCS C1768
Hospital Charge Code	270689835
Hospital Revenue Code	278
Min. Negotiated Rate	$824.95
Max. Negotiated Rate	$1,330.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,099.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,330.92
Rate for Payer: Qualcare PPO/HMO/WC	$824.95

GRAFT 6MMX30CM FLIXENE

Facility

$5,499.65

Service Code	HCPCS C1768
Hospital Charge Code	270689835
Hospital Revenue Code	278
Min. Negotiated Rate	$156.19
Max. Negotiated Rate	$2,749.82
Rate for Payer: Aetna Commercial	$2,089.87
Rate for Payer: Aetna Medicare Advantage	$1,649.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,099.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.41
Rate for Payer: Cigna Commercial	$2,749.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,330.92
Rate for Payer: Qualcare PPO/HMO/WC	$824.95
Rate for Payer: UnitedHealthcare Community & State	$173.79
Rate for Payer: Wellpoint Medicaid Managed Care	$156.19

GRAFT 6MMX38CM

Facility

$6,095.00

Hospital Charge Code	270686035
Hospital Revenue Code	278
Min. Negotiated Rate	$173.10
Max. Negotiated Rate	$3,047.50
Rate for Payer: Aetna Commercial	$2,316.10
Rate for Payer: Aetna Medicare Advantage	$1,828.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,554.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,554.22
Rate for Payer: Cigna Commercial	$3,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: Qualcare PPO/HMO/WC	$914.25
Rate for Payer: UnitedHealthcare Community & State	$192.60
Rate for Payer: Wellpoint Medicaid Managed Care	$173.10

GRAFT 6MMX38CM

Facility

$6,095.00

Hospital Charge Code	270686035
Hospital Revenue Code	278
Min. Negotiated Rate	$914.25
Max. Negotiated Rate	$1,474.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,219.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,474.99
Rate for Payer: Qualcare PPO/HMO/WC	$914.25

GRAFT 7MM X 50CM 40CM RINGS

Facility

$13,635.00

Service Code	HCPCS L8699
Hospital Charge Code	270700852
Hospital Revenue Code	278
Min. Negotiated Rate	$387.23
Max. Negotiated Rate	$6,817.50
Rate for Payer: Aetna Commercial	$5,181.30
Rate for Payer: Aetna Medicare Advantage	$4,090.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,476.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,476.93
Rate for Payer: Cigna Commercial	$6,817.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25
Rate for Payer: UnitedHealthcare Community & State	$430.87
Rate for Payer: Wellpoint Medicaid Managed Care	$387.23

GRAFT 7MM X 50CM 40CM RINGS

Facility

$13,635.00

Service Code	HCPCS L8699
Hospital Charge Code	270700852
Hospital Revenue Code	278
Min. Negotiated Rate	$2,045.25
Max. Negotiated Rate	$3,299.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,727.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,299.67
Rate for Payer: Qualcare PPO/HMO/WC	$2,045.25

GRAFT ACHILLES TENDON 10MM

Facility

$13,205.00

Hospital Charge Code	270675985
Hospital Revenue Code	278
Min. Negotiated Rate	$375.02
Max. Negotiated Rate	$6,602.50
Rate for Payer: Aetna Commercial	$5,017.90
Rate for Payer: Aetna Medicare Advantage	$3,961.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,367.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,367.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,641.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,367.28
Rate for Payer: Cigna Commercial	$6,602.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,195.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,980.75
Rate for Payer: UnitedHealthcare Community & State	$417.28
Rate for Payer: Wellpoint Medicaid Managed Care	$375.02

GRAFT ACHILLES TENDON 10MM

Facility

$13,205.00

Hospital Charge Code	270675985
Hospital Revenue Code	278
Min. Negotiated Rate	$1,980.75
Max. Negotiated Rate	$3,195.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,641.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,195.61
Rate for Payer: Qualcare PPO/HMO/WC	$1,980.75

GRAFT ACUSEAL 6mm X 40cm

Facility

$6,400.00

Service Code	HCPCS C1768
Hospital Charge Code	270665692
Hospital Revenue Code	278
Min. Negotiated Rate	$181.76
Max. Negotiated Rate	$3,200.00
Rate for Payer: Aetna Commercial	$2,432.00
Rate for Payer: Aetna Medicare Advantage	$1,920.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,632.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,632.00
Rate for Payer: Cigna Commercial	$3,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: Qualcare PPO/HMO/WC	$960.00
Rate for Payer: UnitedHealthcare Community & State	$202.24
Rate for Payer: Wellpoint Medicaid Managed Care	$181.76

GRAFT ACUSEAL 6mm X 40cm

Facility

$6,400.00

Service Code	HCPCS C1768
Hospital Charge Code	270665692
Hospital Revenue Code	278
Min. Negotiated Rate	$960.00
Max. Negotiated Rate	$1,548.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,548.80
Rate for Payer: Qualcare PPO/HMO/WC	$960.00

GRAFT ADVANCE 2 X 30MM

Facility

$12,125.00

Service Code	HCPCS C1768
Hospital Charge Code	270664249
Hospital Revenue Code	278
Min. Negotiated Rate	$344.35
Max. Negotiated Rate	$6,062.50
Rate for Payer: Aetna Commercial	$4,607.50
Rate for Payer: Aetna Medicare Advantage	$3,637.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,091.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,091.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,091.88
Rate for Payer: Cigna Commercial	$6,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,934.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,818.75
Rate for Payer: UnitedHealthcare Community & State	$383.15
Rate for Payer: Wellpoint Medicaid Managed Care	$344.35

GRAFT ADVANCE 2 X 30MM

Facility

$12,125.00

Service Code	HCPCS C1768
Hospital Charge Code	270664249
Hospital Revenue Code	278
Min. Negotiated Rate	$1,818.75
Max. Negotiated Rate	$2,934.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,934.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,818.75

GRAFT AFT MAIN BODY

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683899
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFT MAIN BODY

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683899
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

GRAFT AFX2 MAIN BODY 22 X 90MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683903
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

GRAFT AFX2 MAIN BODY 22 X 90MM

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270683903
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT AFX AORTIC EXT 25x25x75

Facility

$26,495.00

Hospital Charge Code	270646898
Hospital Revenue Code	278
Min. Negotiated Rate	$3,974.25
Max. Negotiated Rate	$6,411.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25

GRAFT AFX AORTIC EXT 25x25x75

Facility

$26,495.00

Hospital Charge Code	270646898
Hospital Revenue Code	278
Min. Negotiated Rate	$752.46
Max. Negotiated Rate	$13,247.50
Rate for Payer: Aetna Commercial	$10,068.10
Rate for Payer: Aetna Medicare Advantage	$7,948.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,756.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,299.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,756.23
Rate for Payer: Cigna Commercial	$13,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,411.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,974.25
Rate for Payer: UnitedHealthcare Community & State	$837.24
Rate for Payer: Wellpoint Medicaid Managed Care	$752.46

GRAFT AFX AORTIC EXT 28x75x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270647243
Hospital Revenue Code	278
Min. Negotiated Rate	$707.16
Max. Negotiated Rate	$12,450.00
Rate for Payer: Aetna Commercial	$9,462.00
Rate for Payer: Aetna Medicare Advantage	$7,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,349.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,349.50
Rate for Payer: Cigna Commercial	$12,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00
Rate for Payer: UnitedHealthcare Community & State	$786.84
Rate for Payer: Wellpoint Medicaid Managed Care	$707.16

GRAFT AFX AORTIC EXT 28x75x20

Facility

$24,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270647243
Hospital Revenue Code	278
Min. Negotiated Rate	$3,735.00
Max. Negotiated Rate	$6,025.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,980.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,025.80
Rate for Payer: Qualcare PPO/HMO/WC	$3,735.00

Know your out-of-pocket cost for care.

All Charges