Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT GORETEX PROPATEN 4-7mmID

Facility

$6,165.00

Service Code	HCPCS C1768
Hospital Charge Code	270643829
Hospital Revenue Code	278
Min. Negotiated Rate	$924.75
Max. Negotiated Rate	$1,491.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,233.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,491.93
Rate for Payer: Qualcare PPO/HMO/WC	$924.75

GRAFT GORETEX RINGED 6MM 80CM

Facility

$13,635.00

Service Code	HCPCS C1768
Hospital Charge Code	270645482
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 GORETEX RINGED 6MM 80CM

Facility

$13,635.00

Service Code	HCPCS C1768
Hospital Charge Code	270645482
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 GORETEX RINGED 8mm 70cm

Facility

$14,045.00

Service Code	HCPCS C1768
Hospital Charge Code	270642368
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.75
Max. Negotiated Rate	$3,398.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75

GRAFT GORETEX RINGED 8mm 70cm

Facility

$14,045.00

Service Code	HCPCS C1768
Hospital Charge Code	270642368
Hospital Revenue Code	278
Min. Negotiated Rate	$398.88
Max. Negotiated Rate	$7,022.50
Rate for Payer: Aetna Commercial	$5,337.10
Rate for Payer: Aetna Medicare Advantage	$4,213.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,581.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,809.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,581.47
Rate for Payer: Cigna Commercial	$7,022.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,398.89
Rate for Payer: Qualcare PPO/HMO/WC	$2,106.75
Rate for Payer: UnitedHealthcare Community & State	$443.82
Rate for Payer: Wellpoint Medicaid Managed Care	$398.88

GRAFT GORE-TEX STANDARD WALL

Facility

$4,935.00

Service Code	HCPCS C1768
Hospital Charge Code	270658088
Hospital Revenue Code	278
Min. Negotiated Rate	$740.25
Max. Negotiated Rate	$1,194.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: Qualcare PPO/HMO/WC	$740.25

GRAFT GORE-TEX STANDARD WALL

Facility

$4,935.00

Service Code	HCPCS C1768
Hospital Charge Code	270658088
Hospital Revenue Code	278
Min. Negotiated Rate	$140.15
Max. Negotiated Rate	$2,467.50
Rate for Payer: Aetna Commercial	$1,875.30
Rate for Payer: Aetna Medicare Advantage	$1,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,258.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$987.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,258.42
Rate for Payer: Cigna Commercial	$2,467.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,194.27
Rate for Payer: Qualcare PPO/HMO/WC	$740.25
Rate for Payer: UnitedHealthcare Community & State	$155.95
Rate for Payer: Wellpoint Medicaid Managed Care	$140.15

GRAFT GORETEX STRETCH 6-30x70

Facility

$5,650.00

Service Code	HCPCS C1768
Hospital Charge Code	270656011
Hospital Revenue Code	278
Min. Negotiated Rate	$847.50
Max. Negotiated Rate	$1,367.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50

GRAFT GORETEX STRETCH 6-30x70

Facility

$5,650.00

Service Code	HCPCS C1768
Hospital Charge Code	270656011
Hospital Revenue Code	278
Min. Negotiated Rate	$160.46
Max. Negotiated Rate	$2,825.00
Rate for Payer: Aetna Commercial	$2,147.00
Rate for Payer: Aetna Medicare Advantage	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,440.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,130.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,440.75
Rate for Payer: Cigna Commercial	$2,825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,367.30
Rate for Payer: Qualcare PPO/HMO/WC	$847.50
Rate for Payer: UnitedHealthcare Community & State	$178.54
Rate for Payer: Wellpoint Medicaid Managed Care	$160.46

GRAFT GORETEX STR LINED 6mm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650759
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 STR LINED 6mm

Facility

$3,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270650759
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 TH/WALL 6mm

Facility

$5,955.00

Service Code	HCPCS C1768
Hospital Charge Code	270650755
Hospital Revenue Code	278
Min. Negotiated Rate	$893.25
Max. Negotiated Rate	$1,441.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,441.11
Rate for Payer: Qualcare PPO/HMO/WC	$893.25

GRAFT GORETEX TH/WALL 6mm

Facility

$5,955.00

Service Code	HCPCS C1768
Hospital Charge Code	270650755
Hospital Revenue Code	278
Min. Negotiated Rate	$169.12
Max. Negotiated Rate	$2,977.50
Rate for Payer: Aetna Commercial	$2,262.90
Rate for Payer: Aetna Medicare Advantage	$1,786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,518.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,518.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,191.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,518.53
Rate for Payer: Cigna Commercial	$2,977.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,441.11
Rate for Payer: Qualcare PPO/HMO/WC	$893.25
Rate for Payer: UnitedHealthcare Community & State	$188.18
Rate for Payer: Wellpoint Medicaid Managed Care	$169.12

GRAFT GORETEX TH/WALL 6MM 70CM

Facility

$4,075.00

Service Code	HCPCS C1768
Hospital Charge Code	270650760
Hospital Revenue Code	278
Min. Negotiated Rate	$115.73
Max. Negotiated Rate	$2,037.50
Rate for Payer: Aetna Commercial	$1,548.50
Rate for Payer: Aetna Medicare Advantage	$1,222.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,039.12
Rate for Payer: Cigna Commercial	$2,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25
Rate for Payer: UnitedHealthcare Community & State	$128.77
Rate for Payer: Wellpoint Medicaid Managed Care	$115.73

GRAFT GORETEX TH/WALL 6MM 70CM

Facility

$4,075.00

Service Code	HCPCS C1768
Hospital Charge Code	270650760
Hospital Revenue Code	278
Min. Negotiated Rate	$611.25
Max. Negotiated Rate	$986.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25

GRAFT GORETEX TH/WALL 6MM 70CM

Facility

$4,075.00

Service Code	HCPCS C1768
Hospital Charge Code	270650761
Hospital Revenue Code	278
Min. Negotiated Rate	$115.73
Max. Negotiated Rate	$2,037.50
Rate for Payer: Aetna Commercial	$1,548.50
Rate for Payer: Aetna Medicare Advantage	$1,222.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,039.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,039.12
Rate for Payer: Cigna Commercial	$2,037.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25
Rate for Payer: UnitedHealthcare Community & State	$128.77
Rate for Payer: Wellpoint Medicaid Managed Care	$115.73

GRAFT GORETEX TH/WALL 6MM 70CM

Facility

$4,075.00

Service Code	HCPCS C1768
Hospital Charge Code	270650761
Hospital Revenue Code	278
Min. Negotiated Rate	$611.25
Max. Negotiated Rate	$986.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$815.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$986.15
Rate for Payer: Qualcare PPO/HMO/WC	$611.25

GRAFT GORETEX TH/WALL 6x70

Facility

$4,980.00

Service Code	HCPCS C1768
Hospital Charge Code	270655975
Hospital Revenue Code	278
Min. Negotiated Rate	$141.43
Max. Negotiated Rate	$2,490.00
Rate for Payer: Aetna Commercial	$1,892.40
Rate for Payer: Aetna Medicare Advantage	$1,494.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$996.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,269.90
Rate for Payer: Cigna Commercial	$2,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,205.16
Rate for Payer: Qualcare PPO/HMO/WC	$747.00
Rate for Payer: UnitedHealthcare Community & State	$157.37
Rate for Payer: Wellpoint Medicaid Managed Care	$141.43

GRAFT GORETEX TH/WALL 6x70

Facility

$4,980.00

Service Code	HCPCS C1768
Hospital Charge Code	270655975
Hospital Revenue Code	278
Min. Negotiated Rate	$747.00
Max. Negotiated Rate	$1,205.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$996.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,205.16
Rate for Payer: Qualcare PPO/HMO/WC	$747.00

GRAFT GORETEX TH/WALL 8x70

Facility

$4,980.00

Service Code	HCPCS C1768
Hospital Charge Code	270655974
Hospital Revenue Code	278
Min. Negotiated Rate	$141.43
Max. Negotiated Rate	$2,490.00
Rate for Payer: Aetna Commercial	$1,892.40
Rate for Payer: Aetna Medicare Advantage	$1,494.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,269.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$996.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,269.90
Rate for Payer: Cigna Commercial	$2,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,205.16
Rate for Payer: Qualcare PPO/HMO/WC	$747.00
Rate for Payer: UnitedHealthcare Community & State	$157.37
Rate for Payer: Wellpoint Medicaid Managed Care	$141.43

GRAFT GORETEX TH/WALL 8x70

Facility

$4,980.00

Service Code	HCPCS C1768
Hospital Charge Code	270655974
Hospital Revenue Code	278
Min. Negotiated Rate	$747.00
Max. Negotiated Rate	$1,205.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$996.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,205.16
Rate for Payer: Qualcare PPO/HMO/WC	$747.00

GRAFT GORTEX PROPATEN 4 X 6

Facility

$6,160.00

Service Code	HCPCS C1768
Hospital Charge Code	270688741
Hospital Revenue Code	278
Min. Negotiated Rate	$174.94
Max. Negotiated Rate	$3,080.00
Rate for Payer: Aetna Commercial	$2,340.80
Rate for Payer: Aetna Medicare Advantage	$1,848.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,570.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,570.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,570.80
Rate for Payer: Cigna Commercial	$3,080.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,490.72
Rate for Payer: Qualcare PPO/HMO/WC	$924.00
Rate for Payer: UnitedHealthcare Community & State	$194.66
Rate for Payer: Wellpoint Medicaid Managed Care	$174.94

GRAFT GORTEX PROPATEN 4 X 6

Facility

$6,160.00

Service Code	HCPCS C1768
Hospital Charge Code	270688741
Hospital Revenue Code	278
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,490.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,490.72
Rate for Payer: Qualcare PPO/HMO/WC	$924.00

GRAFT GRAFTJACKET 2 X 4 CM 1-2

Facility

$20,510.00

Service Code	HCPCS C17999
Hospital Charge Code	270700838
Hospital Revenue Code	278
Min. Negotiated Rate	$582.48
Max. Negotiated Rate	$10,255.00
Rate for Payer: Aetna Commercial	$7,793.80
Rate for Payer: Aetna Medicare Advantage	$6,153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,230.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,230.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,230.05
Rate for Payer: Cigna Commercial	$10,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,963.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,076.50
Rate for Payer: UnitedHealthcare Community & State	$648.12
Rate for Payer: Wellpoint Medicaid Managed Care	$582.48

GRAFT GRAFTJACKET 2 X 4 CM 1-2

Facility

$20,510.00

Service Code	HCPCS C17999
Hospital Charge Code	270700838
Hospital Revenue Code	278
Min. Negotiated Rate	$3,076.50
Max. Negotiated Rate	$4,963.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,102.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,963.42
Rate for Payer: Qualcare PPO/HMO/WC	$3,076.50

Know your out-of-pocket cost for care.

All Charges