Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT VASCULAR WOVEN DOUBLE VE

Facility

$2,483.25

Service Code	HCPCS C1768
Hospital Charge Code	270663688
Hospital Revenue Code	278
Min. Negotiated Rate	$372.49
Max. Negotiated Rate	$600.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$600.95
Rate for Payer: Qualcare PPO/HMO/WC	$372.49

GRAFT VASCULAR WOVEN DOUBLE VE

Facility

$3,336.25

Hospital Charge Code	270663689
Hospital Revenue Code	278
Min. Negotiated Rate	$500.44
Max. Negotiated Rate	$807.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$667.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$807.37
Rate for Payer: Qualcare PPO/HMO/WC	$500.44

GRAFT VG 4-7MM X 40CM LINED

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270658083
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 VG 4-7MM X 40CM LINED

Facility

$2,385.00

Service Code	HCPCS C1768
Hospital Charge Code	270658083
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 VIABAHN 7mm 5 0mm 120mm

Facility

$17,185.00

Service Code	HCPCS C1768
Hospital Charge Code	270680178
Hospital Revenue Code	278
Min. Negotiated Rate	$488.05
Max. Negotiated Rate	$8,592.50
Rate for Payer: Aetna Commercial	$6,530.30
Rate for Payer: Aetna Medicare Advantage	$5,155.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,382.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,382.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,437.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,382.18
Rate for Payer: Cigna Commercial	$8,592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,158.77
Rate for Payer: Qualcare PPO/HMO/WC	$2,577.75
Rate for Payer: UnitedHealthcare Community & State	$543.05
Rate for Payer: Wellpoint Medicaid Managed Care	$488.05

GRAFT VIABAHN 7mm 5 0mm 120mm

Facility

$17,185.00

Service Code	HCPCS C1768
Hospital Charge Code	270680178
Hospital Revenue Code	278
Min. Negotiated Rate	$2,577.75
Max. Negotiated Rate	$4,158.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,158.77
Rate for Payer: Qualcare PPO/HMO/WC	$2,577.75

GRAFT VIABAHN 7X5X120MM

Facility

$17,185.00

Service Code	HCPCS C1768
Hospital Charge Code	270680178S
Hospital Revenue Code	278
Min. Negotiated Rate	$488.05
Max. Negotiated Rate	$8,592.50
Rate for Payer: Aetna Commercial	$6,530.30
Rate for Payer: Aetna Medicare Advantage	$5,155.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,382.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,382.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,437.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,382.18
Rate for Payer: Cigna Commercial	$8,592.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,158.77
Rate for Payer: Qualcare PPO/HMO/WC	$2,577.75
Rate for Payer: UnitedHealthcare Community & State	$543.05
Rate for Payer: Wellpoint Medicaid Managed Care	$488.05

GRAFT VIABAHN 7X5X120MM

Facility

$17,185.00

Service Code	HCPCS C1768
Hospital Charge Code	270680178S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,577.75
Max. Negotiated Rate	$4,158.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,437.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,158.77
Rate for Payer: Qualcare PPO/HMO/WC	$2,577.75

GRAFT VIABAHN 8MM 5CM LOW PROF

Facility

$17,615.00

Service Code	HCPCS C1768
Hospital Charge Code	270648642
Hospital Revenue Code	278
Min. Negotiated Rate	$500.27
Max. Negotiated Rate	$8,807.50
Rate for Payer: Aetna Commercial	$6,693.70
Rate for Payer: Aetna Medicare Advantage	$5,284.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,491.82
Rate for Payer: Cigna Commercial	$8,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25
Rate for Payer: UnitedHealthcare Community & State	$556.63
Rate for Payer: Wellpoint Medicaid Managed Care	$500.27

GRAFT VIABAHN 8MM 5CM LOW PROF

Facility

$17,615.00

Service Code	HCPCS C1768
Hospital Charge Code	270648642A
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$4,262.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

GRAFT VIABAHN 8MM 5CM LOW PROF

Facility

$17,615.00

Service Code	HCPCS C1768
Hospital Charge Code	270648642A
Hospital Revenue Code	278
Min. Negotiated Rate	$500.27
Max. Negotiated Rate	$8,807.50
Rate for Payer: Aetna Commercial	$6,693.70
Rate for Payer: Aetna Medicare Advantage	$5,284.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,491.82
Rate for Payer: Cigna Commercial	$8,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25
Rate for Payer: UnitedHealthcare Community & State	$556.63
Rate for Payer: Wellpoint Medicaid Managed Care	$500.27

GRAFT VIABAHN 8MM 5CM LOW PROF

Facility

$17,615.00

Service Code	HCPCS C1768
Hospital Charge Code	270648642
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$4,262.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

GRAFT VIABAHN 8mmx15cm 120cm

Facility

$21,475.00

Service Code	HCPCS C1768
Hospital Charge Code	270678588
Hospital Revenue Code	278
Min. Negotiated Rate	$3,221.25
Max. Negotiated Rate	$5,196.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,196.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,221.25

GRAFT VIABAHN 8mmx15cm 120cm

Facility

$21,475.00

Service Code	HCPCS C1768
Hospital Charge Code	270678588
Hospital Revenue Code	278
Min. Negotiated Rate	$609.89
Max. Negotiated Rate	$10,737.50
Rate for Payer: Aetna Commercial	$8,160.50
Rate for Payer: Aetna Medicare Advantage	$6,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,476.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,476.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,476.12
Rate for Payer: Cigna Commercial	$10,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,196.95
Rate for Payer: Qualcare PPO/HMO/WC	$3,221.25
Rate for Payer: UnitedHealthcare Community & State	$678.61
Rate for Payer: Wellpoint Medicaid Managed Care	$609.89

GRAFT VIVIGEN 10 CC CRYO

Facility

$23,535.00

Service Code	HCPCS C1762
Hospital Charge Code	270686039
Hospital Revenue Code	278
Min. Negotiated Rate	$668.39
Max. Negotiated Rate	$11,767.50
Rate for Payer: Aetna Commercial	$8,943.30
Rate for Payer: Aetna Medicare Advantage	$7,060.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,001.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,707.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,001.43
Rate for Payer: Cigna Commercial	$11,767.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,695.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25
Rate for Payer: UnitedHealthcare Community & State	$743.71
Rate for Payer: Wellpoint Medicaid Managed Care	$668.39

GRAFT VIVIGEN 10 CC CRYO

Facility

$23,535.00

Service Code	HCPCS C1762
Hospital Charge Code	270686039
Hospital Revenue Code	278
Min. Negotiated Rate	$3,530.25
Max. Negotiated Rate	$5,695.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,707.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,695.47
Rate for Payer: Qualcare PPO/HMO/WC	$3,530.25

GRAFT VIVIGEN 15CC CRYO

Facility

$28,980.00

Service Code	HCPCS C1762
Hospital Charge Code	270686040
Hospital Revenue Code	278
Min. Negotiated Rate	$4,347.00
Max. Negotiated Rate	$7,013.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,796.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,013.16
Rate for Payer: Qualcare PPO/HMO/WC	$4,347.00

GRAFT VIVIGEN 15CC CRYO

Facility

$28,980.00

Service Code	HCPCS C1762
Hospital Charge Code	270686040
Hospital Revenue Code	278
Min. Negotiated Rate	$823.03
Max. Negotiated Rate	$14,490.00
Rate for Payer: Aetna Commercial	$11,012.40
Rate for Payer: Aetna Medicare Advantage	$8,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,389.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,389.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,796.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,389.90
Rate for Payer: Cigna Commercial	$14,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,013.16
Rate for Payer: Qualcare PPO/HMO/WC	$4,347.00
Rate for Payer: UnitedHealthcare Community & State	$915.77
Rate for Payer: Wellpoint Medicaid Managed Care	$823.03

GRAFT VIVIGEN 5CC CRYO

Facility

$13,020.00

Service Code	HCPCS C1762
Hospital Charge Code	270686038
Hospital Revenue Code	278
Min. Negotiated Rate	$1,953.00
Max. Negotiated Rate	$3,150.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00

GRAFT VIVIGEN 5CC CRYO

Facility

$13,020.00

Service Code	HCPCS C1762
Hospital Charge Code	270686038
Hospital Revenue Code	278
Min. Negotiated Rate	$369.77
Max. Negotiated Rate	$6,510.00
Rate for Payer: Aetna Commercial	$4,947.60
Rate for Payer: Aetna Medicare Advantage	$3,906.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,320.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,604.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,320.10
Rate for Payer: Cigna Commercial	$6,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,150.84
Rate for Payer: Qualcare PPO/HMO/WC	$1,953.00
Rate for Payer: UnitedHealthcare Community & State	$411.43
Rate for Payer: Wellpoint Medicaid Managed Care	$369.77

GRAFT VIVIGEN BONE MATRIX 10CC

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673359
Hospital Revenue Code	278
Min. Negotiated Rate	$660.30
Max. Negotiated Rate	$11,625.00
Rate for Payer: Aetna Commercial	$8,835.00
Rate for Payer: Aetna Medicare Advantage	$6,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,928.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,928.75
Rate for Payer: Cigna Commercial	$11,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50
Rate for Payer: UnitedHealthcare Community & State	$734.70
Rate for Payer: Wellpoint Medicaid Managed Care	$660.30

GRAFT VIVIGEN BONE MATRIX 10CC

Facility

$23,250.00

Service Code	HCPCS C1713
Hospital Charge Code	270673359
Hospital Revenue Code	278
Min. Negotiated Rate	$3,487.50
Max. Negotiated Rate	$5,626.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,626.50
Rate for Payer: Qualcare PPO/HMO/WC	$3,487.50

GRAFT WOUND MATRIX 5 X 5 CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696692
Hospital Revenue Code	278
Min. Negotiated Rate	$140.45
Max. Negotiated Rate	$1,535.49
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	$1,269.00
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	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75
Rate for Payer: UnitedHealthcare Community & State	$200.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.84
Rate for Payer: Wellcare Medicare Advantage	$147.84
Rate for Payer: Wellpoint Medicaid Managed Care	$180.20

GRAFT WOUND MATRIX 5 X 5 CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696692
Hospital Revenue Code	278
Min. Negotiated Rate	$951.75
Max. Negotiated Rate	$1,535.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

GRAFT WOUND MATRIX 5X5CM

Facility

$6,345.00

Service Code	HCPCS Q4166
Hospital Charge Code	270696726
Hospital Revenue Code	278
Min. Negotiated Rate	$951.75
Max. Negotiated Rate	$1,535.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,269.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,535.49
Rate for Payer: Qualcare PPO/HMO/WC	$951.75

Know your out-of-pocket cost for care.

All Charges