Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680746
Hospital Revenue Code	278
Min. Negotiated Rate	$121.67
Max. Negotiated Rate	$2,142.00
Rate for Payer: Aetna Commercial	$1,627.92
Rate for Payer: Aetna Medicare Advantage	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.42
Rate for Payer: Cigna Commercial	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: Qualcare PPO/HMO/WC	$642.60
Rate for Payer: UnitedHealthcare Community & State	$135.37
Rate for Payer: Wellpoint Medicaid Managed Care	$121.67

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680746
Hospital Revenue Code	278
Min. Negotiated Rate	$642.60
Max. Negotiated Rate	$1,036.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: Qualcare PPO/HMO/WC	$642.60

VG LAMINOPLASTY

Facility

$4,284.00

Service Code	HCPCS C1713
Hospital Charge Code	270680747
Hospital Revenue Code	278
Min. Negotiated Rate	$121.67
Max. Negotiated Rate	$2,142.00
Rate for Payer: Aetna Commercial	$1,627.92
Rate for Payer: Aetna Medicare Advantage	$1,285.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,092.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$856.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,092.42
Rate for Payer: Cigna Commercial	$2,142.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,036.73
Rate for Payer: Qualcare PPO/HMO/WC	$642.60
Rate for Payer: UnitedHealthcare Community & State	$135.37
Rate for Payer: Wellpoint Medicaid Managed Care	$121.67

VIA 17 MICROCATH 45D TIP

Facility

$6,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270697115S
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

VIA 17 MICROCATH 45D TIP

Facility

$6,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270697115S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

VIABAHN ENDOPRIS 10 VB10101002

Facility

$12,152.00

Service Code	HCPCS C1874
Hospital Charge Code	270633881
Hospital Revenue Code	278
Min. Negotiated Rate	$345.12
Max. Negotiated Rate	$6,076.00
Rate for Payer: Aetna Commercial	$4,617.76
Rate for Payer: Aetna Medicare Advantage	$3,645.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,098.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,098.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,430.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,098.76
Rate for Payer: Cigna Commercial	$6,076.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,940.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,822.80
Rate for Payer: UnitedHealthcare Community & State	$384.00
Rate for Payer: Wellpoint Medicaid Managed Care	$345.12

VIABAHN ENDOPRIS 10 VB10101002

Facility

$12,152.00

Service Code	HCPCS C1874
Hospital Charge Code	270633881
Hospital Revenue Code	278
Min. Negotiated Rate	$1,822.80
Max. Negotiated Rate	$2,940.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,430.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,940.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,822.80

VIABAHN VBX 11X79

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406S
Hospital Revenue Code	278
Min. Negotiated Rate	$485.50
Max. Negotiated Rate	$8,547.50
Rate for Payer: Aetna Commercial	$6,496.10
Rate for Payer: Aetna Medicare Advantage	$5,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,359.23
Rate for Payer: Cigna Commercial	$8,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25
Rate for Payer: UnitedHealthcare Community & State	$540.20
Rate for Payer: Wellpoint Medicaid Managed Care	$485.50

VIABAHN VBX 11X79

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.25
Max. Negotiated Rate	$4,136.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25

VIABAHN VBX 11X79

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.25
Max. Negotiated Rate	$4,136.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25

VIABAHN VBX 11X79

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406N
Hospital Revenue Code	278
Min. Negotiated Rate	$485.50
Max. Negotiated Rate	$8,547.50
Rate for Payer: Aetna Commercial	$6,496.10
Rate for Payer: Aetna Medicare Advantage	$5,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,359.23
Rate for Payer: Cigna Commercial	$8,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25
Rate for Payer: UnitedHealthcare Community & State	$540.20
Rate for Payer: Wellpoint Medicaid Managed Care	$485.50

VIABHN VBX/LT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680299
Hospital Revenue Code	278
Min. Negotiated Rate	$473.71
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$527.09
Rate for Payer: Wellpoint Medicaid Managed Care	$473.71

VIABHN VBX/LT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680299
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

VIABHN VBX/LT EXT ILIAC STNT

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270680299N
Hospital Revenue Code	278
Min. Negotiated Rate	$462.21
Max. Negotiated Rate	$8,137.50
Rate for Payer: Aetna Commercial	$6,184.50
Rate for Payer: Aetna Medicare Advantage	$4,882.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,150.12
Rate for Payer: Cigna Commercial	$8,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25
Rate for Payer: UnitedHealthcare Community & State	$514.29
Rate for Payer: Wellpoint Medicaid Managed Care	$462.21

VIABHN VBX/LT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680299S
Hospital Revenue Code	278
Min. Negotiated Rate	$473.71
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$527.09
Rate for Payer: Wellpoint Medicaid Managed Care	$473.71

VIABHN VBX/LT EXT ILIAC STNT

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270680299N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$3,938.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

VIABHN VBX/LT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680299S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

VIABHN VBX/RT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680298
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

VIABHN VBX/RT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680298S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

VIABHN VBX/RT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680298
Hospital Revenue Code	278
Min. Negotiated Rate	$473.71
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$527.09
Rate for Payer: Wellpoint Medicaid Managed Care	$473.71

VIABHN VBX/RT EXT ILIAC STNT

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270680298N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$3,938.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

VIABHN VBX/RT EXT ILIAC STNT

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270680298S
Hospital Revenue Code	278
Min. Negotiated Rate	$473.71
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$527.09
Rate for Payer: Wellpoint Medicaid Managed Care	$473.71

VIABHN VBX/RT EXT ILIAC STNT

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270680298N
Hospital Revenue Code	278
Min. Negotiated Rate	$462.21
Max. Negotiated Rate	$8,137.50
Rate for Payer: Aetna Commercial	$6,184.50
Rate for Payer: Aetna Medicare Advantage	$4,882.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,150.12
Rate for Payer: Cigna Commercial	$8,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25
Rate for Payer: UnitedHealthcare Community & State	$514.29
Rate for Payer: Wellpoint Medicaid Managed Care	$462.21

VIABLE BONE MATRIX 1 CC BIO4

Facility

$4,125.00

Service Code	HCPCS C1762
Hospital Charge Code	270692124
Hospital Revenue Code	278
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$2,062.50
Rate for Payer: Aetna Commercial	$1,567.50
Rate for Payer: Aetna Medicare Advantage	$1,237.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,051.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,051.88
Rate for Payer: Cigna Commercial	$2,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75
Rate for Payer: UnitedHealthcare Community & State	$130.35
Rate for Payer: Wellpoint Medicaid Managed Care	$117.15

VIABLE BONE MATRIX 1 CC BIO4

Facility

$4,125.00

Service Code	HCPCS C1762
Hospital Charge Code	270692124
Hospital Revenue Code	278
Min. Negotiated Rate	$618.75
Max. Negotiated Rate	$998.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$825.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$998.25
Rate for Payer: Qualcare PPO/HMO/WC	$618.75

Know your out-of-pocket cost for care.

All Charges