Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VERSAFIT CUP DM 58MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677459
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

VERSAFIT CUP DM 58MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270677459
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

VERSAFIT CUP DM CUP 56MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681573
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

VERSAFIT CUP DM CUP 56MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681573
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

VERSAFITCUP DM CUP 56MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681636
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,420.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

VERSAFITCUP DM CUP 56MM

Facility

$10,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270681636
Hospital Revenue Code	278
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,420.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

VERSAFITCUP DME SIZE 50MM

Facility

$10,000.00

Hospital Charge Code	270676060
Hospital Revenue Code	272
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00

VERSAFITCUP DME SIZE 50MM

Facility

$10,000.00

Hospital Charge Code	270676060
Hospital Revenue Code	272
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$3,800.00
Rate for Payer: Aetna Medicare Advantage	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,550.00
Rate for Payer: Cigna Commercial	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,600.00
Rate for Payer: Oxford Commercial	$2,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,500.00
Rate for Payer: UnitedHealthcare Commercial	$2,000.00
Rate for Payer: UnitedHealthcare Community & State	$316.00
Rate for Payer: Wellpoint Medicaid Managed Care	$284.00

VERSAFITCUP DM LINER HC 56/28

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681574
Hospital Revenue Code	278
Min. Negotiated Rate	$177.50
Max. Negotiated Rate	$3,125.00
Rate for Payer: Aetna Commercial	$2,375.00
Rate for Payer: Aetna Medicare Advantage	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,593.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,593.75
Rate for Payer: Cigna Commercial	$3,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50
Rate for Payer: UnitedHealthcare Community & State	$197.50
Rate for Payer: Wellpoint Medicaid Managed Care	$177.50

VERSAFITCUP DM LINER HC 56/28

Facility

$6,250.00

Service Code	HCPCS C1776
Hospital Charge Code	270681574
Hospital Revenue Code	278
Min. Negotiated Rate	$937.50
Max. Negotiated Rate	$1,512.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,512.50
Rate for Payer: Qualcare PPO/HMO/WC	$937.50

VERSAGRAFT

Facility

$6,645.00

Hospital Charge Code	270684371
Hospital Revenue Code	278
Min. Negotiated Rate	$188.72
Max. Negotiated Rate	$3,322.50
Rate for Payer: Aetna Commercial	$2,525.10
Rate for Payer: Aetna Medicare Advantage	$1,993.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,694.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,694.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,329.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,694.47
Rate for Payer: Cigna Commercial	$3,322.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,608.09
Rate for Payer: Qualcare PPO/HMO/WC	$996.75
Rate for Payer: UnitedHealthcare Community & State	$209.98
Rate for Payer: Wellpoint Medicaid Managed Care	$188.72

VERSAGRAFT

Facility

$6,645.00

Hospital Charge Code	270684371
Hospital Revenue Code	278
Min. Negotiated Rate	$996.75
Max. Negotiated Rate	$1,608.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,329.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,608.09
Rate for Payer: Qualcare PPO/HMO/WC	$996.75

VERSAJET HANDPIECE

Facility

$1,643.00

Hospital Charge Code	270332594
Hospital Revenue Code	272
Min. Negotiated Rate	$46.66
Max. Negotiated Rate	$821.50
Rate for Payer: Aetna Commercial	$624.34
Rate for Payer: Aetna Medicare Advantage	$492.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$418.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$418.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$418.96
Rate for Payer: Cigna Commercial	$821.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$427.18
Rate for Payer: Oxford Commercial	$328.60
Rate for Payer: Qualcare PPO/HMO/WC	$246.45
Rate for Payer: UnitedHealthcare Commercial	$328.60
Rate for Payer: UnitedHealthcare Community & State	$51.92
Rate for Payer: Wellpoint Medicaid Managed Care	$46.66

VERSAJET HANDPIECE

Facility

$1,643.00

Hospital Charge Code	270332594
Hospital Revenue Code	272
Min. Negotiated Rate	$246.45
Max. Negotiated Rate	$246.45
Rate for Payer: Qualcare PPO/HMO/WC	$246.45

VERSAJET II EXACT

Facility

$2,975.00

Hospital Charge Code	270673074
Hospital Revenue Code	272
Min. Negotiated Rate	$84.49
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$773.50
Rate for Payer: Oxford Commercial	$595.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Commercial	$595.00
Rate for Payer: UnitedHealthcare Community & State	$94.01
Rate for Payer: Wellpoint Medicaid Managed Care	$84.49

VERSAJET II EXACT

Facility

$2,975.00

Hospital Charge Code	270673074
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$446.25
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

VERSAJET PLUS HANDPIECE 15 DEG

Facility

$3,475.00

Hospital Charge Code	270659460
Hospital Revenue Code	272
Min. Negotiated Rate	$521.25
Max. Negotiated Rate	$521.25
Rate for Payer: Qualcare PPO/HMO/WC	$521.25

VERSAJET PLUS HANDPIECE 15 DEG

Facility

$3,475.00

Hospital Charge Code	270659460
Hospital Revenue Code	272
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$1,737.50
Rate for Payer: Aetna Commercial	$1,320.50
Rate for Payer: Aetna Medicare Advantage	$1,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$886.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$886.12
Rate for Payer: Cigna Commercial	$1,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$903.50
Rate for Payer: Oxford Commercial	$695.00
Rate for Payer: Qualcare PPO/HMO/WC	$521.25
Rate for Payer: UnitedHealthcare Commercial	$695.00
Rate for Payer: UnitedHealthcare Community & State	$109.81
Rate for Payer: Wellpoint Medicaid Managed Care	$98.69

VERSAJET PLUS HANDPIECE 45 DEG

Facility

$3,375.00

Hospital Charge Code	270659486
Hospital Revenue Code	270
Min. Negotiated Rate	$95.85
Max. Negotiated Rate	$1,687.50
Rate for Payer: Aetna Commercial	$1,282.50
Rate for Payer: Aetna Medicare Advantage	$1,012.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$860.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$860.62
Rate for Payer: Cigna Commercial	$1,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$877.50
Rate for Payer: Oxford Commercial	$675.00
Rate for Payer: Qualcare PPO/HMO/WC	$506.25
Rate for Payer: UnitedHealthcare Commercial	$675.00
Rate for Payer: UnitedHealthcare Community & State	$106.65
Rate for Payer: Wellpoint Medicaid Managed Care	$95.85

VERSAJET PLUS HANDPIECE 45 DEG

Facility

$3,375.00

Hospital Charge Code	270659486
Hospital Revenue Code	270
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Qualcare PPO/HMO/WC	$506.25

VERSAJET PLUS HANDPIECE 45DEG

Facility

$2,975.00

Hospital Charge Code	270659462
Hospital Revenue Code	272
Min. Negotiated Rate	$84.49
Max. Negotiated Rate	$1,487.50
Rate for Payer: Aetna Commercial	$1,130.50
Rate for Payer: Aetna Medicare Advantage	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$758.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$758.62
Rate for Payer: Cigna Commercial	$1,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$773.50
Rate for Payer: Oxford Commercial	$595.00
Rate for Payer: Qualcare PPO/HMO/WC	$446.25
Rate for Payer: UnitedHealthcare Commercial	$595.00
Rate for Payer: UnitedHealthcare Community & State	$94.01
Rate for Payer: Wellpoint Medicaid Managed Care	$84.49

VERSAJET PLUS HANDPIECE 45DEG

Facility

$2,975.00

Hospital Charge Code	270659462
Hospital Revenue Code	272
Min. Negotiated Rate	$446.25
Max. Negotiated Rate	$446.25
Rate for Payer: Qualcare PPO/HMO/WC	$446.25

VERSALOK

Facility

$2,055.00

Hospital Charge Code	270657369
Hospital Revenue Code	270
Min. Negotiated Rate	$308.25
Max. Negotiated Rate	$308.25
Rate for Payer: Qualcare PPO/HMO/WC	$308.25

VERSALOK

Facility

$2,055.00

Hospital Charge Code	270657369
Hospital Revenue Code	270
Min. Negotiated Rate	$58.36
Max. Negotiated Rate	$1,027.50
Rate for Payer: Aetna Commercial	$780.90
Rate for Payer: Aetna Medicare Advantage	$616.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$524.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$524.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$524.02
Rate for Payer: Cigna Commercial	$1,027.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$534.30
Rate for Payer: Oxford Commercial	$411.00
Rate for Payer: Qualcare PPO/HMO/WC	$308.25
Rate for Payer: UnitedHealthcare Commercial	$411.00
Rate for Payer: UnitedHealthcare Community & State	$64.94
Rate for Payer: Wellpoint Medicaid Managed Care	$58.36

VERSAPORT 15mm LONG 179078P

Facility

$229.50

Hospital Charge Code	270627427
Hospital Revenue Code	272
Min. Negotiated Rate	$6.52
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$87.21
Rate for Payer: Aetna Medicare Advantage	$68.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$58.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$58.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$58.52
Rate for Payer: Cigna Commercial	$114.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$59.67
Rate for Payer: Oxford Commercial	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$34.42
Rate for Payer: UnitedHealthcare Commercial	$45.90
Rate for Payer: UnitedHealthcare Community & State	$7.25
Rate for Payer: Wellpoint Medicaid Managed Care	$6.52

Know your out-of-pocket cost for care.

All Charges