Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT HEMASHIELD 8 X 30

Facility

$2,950.00

Service Code	HCPCS C1768
Hospital Charge Code	270686402
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$713.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$590.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$713.90
Rate for Payer: Qualcare PPO/HMO/WC	$442.50

GRAFT HEMASHIELD GOLD D 14X8MM

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270659527
Hospital Revenue Code	278
Min. Negotiated Rate	$115.37
Max. Negotiated Rate	$2,031.12
Rate for Payer: Aetna Commercial	$1,543.65
Rate for Payer: Aetna Medicare Advantage	$1,218.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,035.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,035.87
Rate for Payer: Cigna Commercial	$2,031.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: Qualcare PPO/HMO/WC	$609.34
Rate for Payer: UnitedHealthcare Community & State	$128.37
Rate for Payer: Wellpoint Medicaid Managed Care	$115.37

GRAFT HEMASHIELD GOLD D 14X8MM

Facility

$4,062.25

Service Code	HCPCS C1768
Hospital Charge Code	270659527
Hospital Revenue Code	278
Min. Negotiated Rate	$609.34
Max. Negotiated Rate	$983.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$812.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$983.06
Rate for Payer: Qualcare PPO/HMO/WC	$609.34

GRAFT HEMASHLD GOLD 22/11 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270601119
Hospital Revenue Code	278
Min. Negotiated Rate	$93.09
Max. Negotiated Rate	$1,638.88
Rate for Payer: Aetna Commercial	$1,245.55
Rate for Payer: Aetna Medicare Advantage	$983.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$835.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$835.83
Rate for Payer: Cigna Commercial	$1,638.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66
Rate for Payer: UnitedHealthcare Community & State	$103.58
Rate for Payer: Wellpoint Medicaid Managed Care	$93.09

GRAFT HEMASHLD GOLD 22/11 40cm

Facility

$3,277.75

Service Code	HCPCS C1768
Hospital Charge Code	270601119
Hospital Revenue Code	278
Min. Negotiated Rate	$491.66
Max. Negotiated Rate	$793.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$655.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$793.22
Rate for Payer: Qualcare PPO/HMO/WC	$491.66

GRAFT HEMASH PLATINUM 28MM60CM

Facility

$3,482.60

Hospital Charge Code	270678250
Hospital Revenue Code	278
Min. Negotiated Rate	$98.91
Max. Negotiated Rate	$1,741.30
Rate for Payer: Aetna Commercial	$1,323.39
Rate for Payer: Aetna Medicare Advantage	$1,044.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$888.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$888.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$888.06
Rate for Payer: Cigna Commercial	$1,741.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.79
Rate for Payer: Qualcare PPO/HMO/WC	$522.39
Rate for Payer: UnitedHealthcare Community & State	$110.05
Rate for Payer: Wellpoint Medicaid Managed Care	$98.91

GRAFT HEMASH PLATINUM 28MM60CM

Facility

$3,482.60

Hospital Charge Code	270678250
Hospital Revenue Code	278
Min. Negotiated Rate	$522.39
Max. Negotiated Rate	$842.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$696.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$842.79
Rate for Payer: Qualcare PPO/HMO/WC	$522.39

GRAFT HEMOSHILD PLATINUM 20MM

Facility

$2,575.75

Hospital Charge Code	270663695
Hospital Revenue Code	278
Min. Negotiated Rate	$73.15
Max. Negotiated Rate	$1,287.88
Rate for Payer: Aetna Commercial	$978.78
Rate for Payer: Aetna Medicare Advantage	$772.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$656.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$656.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$515.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$656.82
Rate for Payer: Cigna Commercial	$1,287.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$623.33
Rate for Payer: Qualcare PPO/HMO/WC	$386.36
Rate for Payer: UnitedHealthcare Community & State	$81.39
Rate for Payer: Wellpoint Medicaid Managed Care	$73.15

GRAFT HEMOSHILD PLATINUM 20MM

Facility

$2,575.75

Hospital Charge Code	270663695
Hospital Revenue Code	278
Min. Negotiated Rate	$386.36
Max. Negotiated Rate	$623.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$515.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$623.33
Rate for Payer: Qualcare PPO/HMO/WC	$386.36

GRAFT HYBRID 9MM X 10MM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270662871
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.00
Max. Negotiated Rate	$3,363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00

GRAFT HYBRID 9MM X 10MM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270662871
Hospital Revenue Code	278
Min. Negotiated Rate	$394.76
Max. Negotiated Rate	$6,950.00
Rate for Payer: Aetna Commercial	$5,282.00
Rate for Payer: Aetna Medicare Advantage	$4,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,544.50
Rate for Payer: Cigna Commercial	$6,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00
Rate for Payer: UnitedHealthcare Community & State	$439.24
Rate for Payer: Wellpoint Medicaid Managed Care	$394.76

GRAFT HYBRID VASCULAR 6MMX5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659996
Hospital Revenue Code	278
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Community & State	$387.10
Rate for Payer: Wellpoint Medicaid Managed Care	$347.90

GRAFT HYBRID VASCULAR 6MMX5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659996
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT HYBRID VASCULAR 8MM 5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659756
Hospital Revenue Code	272
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,185.00
Rate for Payer: Oxford Commercial	$2,450.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Commercial	$2,450.00
Rate for Payer: UnitedHealthcare Community & State	$387.10
Rate for Payer: Wellpoint Medicaid Managed Care	$347.90

GRAFT HYBRID VASCULAR 8MM 5CM

Facility

$12,250.00

Service Code	HCPCS C1768
Hospital Charge Code	270659756
Hospital Revenue Code	272
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$1,837.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

GRAFT HYBRID VASCULAR 8MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660000
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.00
Max. Negotiated Rate	$3,363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00

GRAFT HYBRID VASCULAR 8MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660000
Hospital Revenue Code	278
Min. Negotiated Rate	$394.76
Max. Negotiated Rate	$6,950.00
Rate for Payer: Aetna Commercial	$5,282.00
Rate for Payer: Aetna Medicare Advantage	$4,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,544.50
Rate for Payer: Cigna Commercial	$6,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00
Rate for Payer: UnitedHealthcare Community & State	$439.24
Rate for Payer: Wellpoint Medicaid Managed Care	$394.76

GRAFT HYBRID VASCULAR 9MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660001
Hospital Revenue Code	278
Min. Negotiated Rate	$2,085.00
Max. Negotiated Rate	$3,363.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00

GRAFT HYBRID VASCULAR 9MMX10CM

Facility

$13,900.00

Service Code	HCPCS C1768
Hospital Charge Code	270660001
Hospital Revenue Code	278
Min. Negotiated Rate	$394.76
Max. Negotiated Rate	$6,950.00
Rate for Payer: Aetna Commercial	$5,282.00
Rate for Payer: Aetna Medicare Advantage	$4,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,544.50
Rate for Payer: Cigna Commercial	$6,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,363.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,085.00
Rate for Payer: UnitedHealthcare Community & State	$439.24
Rate for Payer: Wellpoint Medicaid Managed Care	$394.76

GRAFT IFUSE TORQ

Facility

$16,125.00

Hospital Charge Code	270701375
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

GRAFT IFUSE TORQ

Facility

$16,125.00

Hospital Charge Code	270701375
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

GRAFT ILIAC LIMB 14x14x120

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270677362
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

GRAFT ILIAC LIMB 14x14x120

Facility

$23,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270677362
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

GRAFT ILIAC LIMB 14x14x140MM

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270678255
Hospital Revenue Code	278
Min. Negotiated Rate	$709.86
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$789.84
Rate for Payer: Wellpoint Medicaid Managed Care	$709.86

GRAFT ILIAC LIMB 14x14x140MM

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270678255
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

Know your out-of-pocket cost for care.

All Charges