Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT FEP RINGED THIN WALLED

Facility

$6,355.00

Service Code	HCPCS C1768
Hospital Charge Code	270601127
Hospital Revenue Code	278
Min. Negotiated Rate	$180.48
Max. Negotiated Rate	$3,177.50
Rate for Payer: Aetna Commercial	$2,414.90
Rate for Payer: Aetna Medicare Advantage	$1,906.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,620.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,620.53
Rate for Payer: Cigna Commercial	$3,177.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25
Rate for Payer: UnitedHealthcare Community & State	$200.82
Rate for Payer: Wellpoint Medicaid Managed Care	$180.48

GRAFT FEP RINGED THIN WALLED

Facility

$6,355.00

Service Code	HCPCS C1768
Hospital Charge Code	270601127
Hospital Revenue Code	278
Min. Negotiated Rate	$953.25
Max. Negotiated Rate	$1,537.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,271.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,537.91
Rate for Payer: Qualcare PPO/HMO/WC	$953.25

GRAFT FILLER PRO-DENSE 2CC

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270700484
Hospital Revenue Code	278
Min. Negotiated Rate	$1,039.50
Max. Negotiated Rate	$1,677.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50

GRAFT FILLER PRO-DENSE 2CC

Facility

$6,930.00

Service Code	HCPCS C1713
Hospital Charge Code	270700484
Hospital Revenue Code	278
Min. Negotiated Rate	$196.81
Max. Negotiated Rate	$3,465.00
Rate for Payer: Aetna Commercial	$2,633.40
Rate for Payer: Aetna Medicare Advantage	$2,079.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,767.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,386.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,767.15
Rate for Payer: Cigna Commercial	$3,465.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,677.06
Rate for Payer: Qualcare PPO/HMO/WC	$1,039.50
Rate for Payer: UnitedHealthcare Community & State	$218.99
Rate for Payer: Wellpoint Medicaid Managed Care	$196.81

GRAFT FLIXENE 6MMX40CM

Facility

$5,695.65

Service Code	HCPCS C1768
Hospital Charge Code	270689834
Hospital Revenue Code	278
Min. Negotiated Rate	$854.35
Max. Negotiated Rate	$1,378.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.35
Rate for Payer: Qualcare PPO/HMO/WC	$854.35

GRAFT FLIXENE 6MMX40CM

Facility

$5,695.65

Service Code	HCPCS C1768
Hospital Charge Code	270689834
Hospital Revenue Code	278
Min. Negotiated Rate	$161.76
Max. Negotiated Rate	$2,847.82
Rate for Payer: Aetna Commercial	$2,164.35
Rate for Payer: Aetna Medicare Advantage	$1,708.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,139.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,452.39
Rate for Payer: Cigna Commercial	$2,847.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,378.35
Rate for Payer: Qualcare PPO/HMO/WC	$854.35
Rate for Payer: UnitedHealthcare Community & State	$179.98
Rate for Payer: Wellpoint Medicaid Managed Care	$161.76

GRAFT GORE 10 MM 80CM

Facility

$6,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270660566
Hospital Revenue Code	278
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$3,327.50
Rate for Payer: Aetna Commercial	$2,528.90
Rate for Payer: Aetna Medicare Advantage	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,697.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,697.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,697.03
Rate for Payer: Cigna Commercial	$3,327.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,610.51
Rate for Payer: Qualcare PPO/HMO/WC	$998.25
Rate for Payer: UnitedHealthcare Community & State	$210.30
Rate for Payer: Wellpoint Medicaid Managed Care	$189.00

GRAFT GORE 10 MM 80CM

Facility

$6,655.00

Service Code	HCPCS C1768
Hospital Charge Code	270660566
Hospital Revenue Code	278
Min. Negotiated Rate	$998.25
Max. Negotiated Rate	$1,610.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,331.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,610.51
Rate for Payer: Qualcare PPO/HMO/WC	$998.25

GRAFT GORE-TEX 10MMX20CM

Facility

$4,100.00

Service Code	HCPCS C1768
Hospital Charge Code	270686063
Hospital Revenue Code	278
Min. Negotiated Rate	$615.00
Max. Negotiated Rate	$992.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$820.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$992.20
Rate for Payer: Qualcare PPO/HMO/WC	$615.00

GRAFT GORE-TEX 10MMX20CM

Facility

$4,100.00

Service Code	HCPCS C1768
Hospital Charge Code	270686063
Hospital Revenue Code	278
Min. Negotiated Rate	$116.44
Max. Negotiated Rate	$2,050.00
Rate for Payer: Aetna Commercial	$1,558.00
Rate for Payer: Aetna Medicare Advantage	$1,230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,045.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,045.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$820.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,045.50
Rate for Payer: Cigna Commercial	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$992.20
Rate for Payer: Qualcare PPO/HMO/WC	$615.00
Rate for Payer: UnitedHealthcare Community & State	$129.56
Rate for Payer: Wellpoint Medicaid Managed Care	$116.44

GRAFT GORE-TEX 12MMX30CM

Facility

$5,245.00

Service Code	HCPCS C1768
Hospital Charge Code	270640429
Hospital Revenue Code	278
Min. Negotiated Rate	$148.96
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$165.74
Rate for Payer: Wellpoint Medicaid Managed Care	$148.96

GRAFT GORE-TEX 12MMX30CM

Facility

$5,245.00

Service Code	HCPCS C1768
Hospital Charge Code	270640429
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

GRAFT GORETEX 6mm 40cm

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270656771
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$1,047.50
Rate for Payer: Aetna Commercial	$796.10
Rate for Payer: Aetna Medicare Advantage	$628.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$534.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$534.23
Rate for Payer: Cigna Commercial	$1,047.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.99
Rate for Payer: Qualcare PPO/HMO/WC	$314.25
Rate for Payer: UnitedHealthcare Community & State	$66.20
Rate for Payer: Wellpoint Medicaid Managed Care	$59.50

GRAFT GORETEX 6mm 40cm

Facility

$2,095.00

Service Code	HCPCS C1768
Hospital Charge Code	270656771
Hospital Revenue Code	278
Min. Negotiated Rate	$314.25
Max. Negotiated Rate	$506.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$506.99
Rate for Payer: Qualcare PPO/HMO/WC	$314.25

GRAFT GORETEX 6 X 20 CM

Facility

$1,615.00

Service Code	HCPCS L8670
Hospital Charge Code	270690317
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

GRAFT GORETEX 6 X 20 CM

Facility

$1,615.00

Service Code	HCPCS L8670
Hospital Charge Code	270690317
Hospital Revenue Code	278
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$613.70
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Community & State	$51.03
Rate for Payer: Wellpoint Medicaid Managed Care	$45.87

GRAFT GORE-TEX 8MM X40CM STRCH

Facility

$4,230.00

Service Code	HCPCS L8670
Hospital Charge Code	270701372
Hospital Revenue Code	278
Min. Negotiated Rate	$120.13
Max. Negotiated Rate	$2,115.00
Rate for Payer: Aetna Commercial	$1,607.40
Rate for Payer: Aetna Medicare Advantage	$1,269.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,078.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,078.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,078.65
Rate for Payer: Cigna Commercial	$2,115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.66
Rate for Payer: Qualcare PPO/HMO/WC	$634.50
Rate for Payer: UnitedHealthcare Community & State	$133.67
Rate for Payer: Wellpoint Medicaid Managed Care	$120.13

GRAFT GORE-TEX 8MM X40CM STRCH

Facility

$4,230.00

Service Code	HCPCS L8670
Hospital Charge Code	270701372
Hospital Revenue Code	278
Min. Negotiated Rate	$634.50
Max. Negotiated Rate	$1,023.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$846.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,023.66
Rate for Payer: Qualcare PPO/HMO/WC	$634.50

GRAFT GORE-TEX 8MM X70CM STRCH

Facility

$4,360.00

Service Code	HCPCS C1768
Hospital Charge Code	270658086
Hospital Revenue Code	278
Min. Negotiated Rate	$123.82
Max. Negotiated Rate	$2,180.00
Rate for Payer: Aetna Commercial	$1,656.80
Rate for Payer: Aetna Medicare Advantage	$1,308.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,111.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,111.80
Rate for Payer: Cigna Commercial	$2,180.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00
Rate for Payer: UnitedHealthcare Community & State	$137.78
Rate for Payer: Wellpoint Medicaid Managed Care	$123.82

GRAFT GORE-TEX 8MM X70CM STRCH

Facility

$4,360.00

Service Code	HCPCS C1768
Hospital Charge Code	270658086
Hospital Revenue Code	278
Min. Negotiated Rate	$654.00
Max. Negotiated Rate	$1,055.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$872.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,055.12
Rate for Payer: Qualcare PPO/HMO/WC	$654.00

GRAFT GORE-TEX LINED4-6MMX40CM

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270650758
Hospital Revenue Code	278
Min. Negotiated Rate	$357.75
Max. Negotiated Rate	$577.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$477.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.17
Rate for Payer: Qualcare PPO/HMO/WC	$357.75

GRAFT GORE-TEX LINED4-6MMX40CM

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270650758
Hospital Revenue Code	278
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$1,192.50
Rate for Payer: Aetna Commercial	$906.30
Rate for Payer: Aetna Medicare Advantage	$715.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$608.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$477.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$608.17
Rate for Payer: Cigna Commercial	$1,192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$577.17
Rate for Payer: Qualcare PPO/HMO/WC	$357.75
Rate for Payer: UnitedHealthcare Community & State	$75.37
Rate for Payer: Wellpoint Medicaid Managed Care	$67.73

GRAFT GORETEX LINED 8mm 70cm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650757
Hospital Revenue Code	278
Min. Negotiated Rate	$524.25
Max. Negotiated Rate	$845.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: Qualcare PPO/HMO/WC	$524.25

GRAFT GORETEX LINED 8mm 70cm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650757
Hospital Revenue Code	278
Min. Negotiated Rate	$99.26
Max. Negotiated Rate	$1,747.50
Rate for Payer: Aetna Commercial	$1,328.10
Rate for Payer: Aetna Medicare Advantage	$1,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$891.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$891.23
Rate for Payer: Cigna Commercial	$1,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$845.79
Rate for Payer: Qualcare PPO/HMO/WC	$524.25
Rate for Payer: UnitedHealthcare Community & State	$110.44
Rate for Payer: Wellpoint Medicaid Managed Care	$99.26

GRAFT GORETEX PROPATEN 4-7mmID

Facility

$6,165.00

Service Code	HCPCS C1768
Hospital Charge Code	270643829
Hospital Revenue Code	278
Min. Negotiated Rate	$175.09
Max. Negotiated Rate	$3,082.50
Rate for Payer: Aetna Commercial	$2,342.70
Rate for Payer: Aetna Medicare Advantage	$1,849.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,572.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,572.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,233.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,572.08
Rate for Payer: Cigna Commercial	$3,082.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,491.93
Rate for Payer: Qualcare PPO/HMO/WC	$924.75
Rate for Payer: UnitedHealthcare Community & State	$194.81
Rate for Payer: Wellpoint Medicaid Managed Care	$175.09

Know your out-of-pocket cost for care.

All Charges