Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VIAFILL DEMINE BONE FIBER 3CC

Facility

$3,750.00

Hospital Charge Code	270702355
Hospital Revenue Code	278
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

VIAFILL DEMINE BONE FIBER 3CC

Facility

$3,750.00

Hospital Charge Code	270702355
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$907.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$907.50
Rate for Payer: Qualcare PPO/HMO/WC	$562.50

VIAFILL DEMINE BONE FIBER 6CC

Facility

$7,500.00

Hospital Charge Code	270702366
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

VIAFILL DEMINE BONE FIBER 6CC

Facility

$7,500.00

Hospital Charge Code	270702366
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

VIAFLOW 1.0CC AMBIENT TISSUE

Facility

$16,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270697593
Hospital Revenue Code	278
Min. Negotiated Rate	$2,504.25
Max. Negotiated Rate	$4,040.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25

VIAFLOW 1.0CC AMBIENT TISSUE

Facility

$16,695.00

Service Code	HCPCS C1713
Hospital Charge Code	270697593
Hospital Revenue Code	278
Min. Negotiated Rate	$474.14
Max. Negotiated Rate	$8,347.50
Rate for Payer: Aetna Commercial	$6,344.10
Rate for Payer: Aetna Medicare Advantage	$5,008.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,257.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,339.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,257.23
Rate for Payer: Cigna Commercial	$8,347.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,040.19
Rate for Payer: Qualcare PPO/HMO/WC	$2,504.25
Rate for Payer: UnitedHealthcare Community & State	$527.56
Rate for Payer: Wellpoint Medicaid Managed Care	$474.14

VIAL-O-JET

Facility

$5.13

Hospital Charge Code	270060060
Hospital Revenue Code	272
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$1.95
Rate for Payer: Aetna Medicare Advantage	$1.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.31
Rate for Payer: Cigna Commercial	$2.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.33
Rate for Payer: Oxford Commercial	$1.03
Rate for Payer: Qualcare PPO/HMO/WC	$0.77
Rate for Payer: UnitedHealthcare Commercial	$1.03
Rate for Payer: UnitedHealthcare Community & State	$0.16
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

VIAL-O-JET

Facility

$5.13

Hospital Charge Code	270060060
Hospital Revenue Code	272
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$0.77
Rate for Payer: Qualcare PPO/HMO/WC	$0.77

VIASHIELD AMNION DL PTCH 4X8CM

Facility

$25,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696766
Hospital Revenue Code	278
Min. Negotiated Rate	$710.00
Max. Negotiated Rate	$12,500.00
Rate for Payer: Aetna Commercial	$9,500.00
Rate for Payer: Aetna Medicare Advantage	$7,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,375.00
Rate for Payer: Cigna Commercial	$12,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00
Rate for Payer: UnitedHealthcare Community & State	$790.00
Rate for Payer: Wellpoint Medicaid Managed Care	$710.00

VIASHIELD AMNION DL PTCH 4X8CM

Facility

$25,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696766
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$6,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,050.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,750.00

VIASHLD DUL LYR AMNI PTCH4X8CM

Facility

$15,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696329
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

VIASHLD DUL LYR AMNI PTCH4X8CM

Facility

$15,000.00

Service Code	HCPCS C1762
Hospital Charge Code	270696329
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

VIATORR ENDOPRT 10x8 PTB108275

Facility

$23,770.00

Service Code	HCPCS C1876
Hospital Charge Code	270635474
Hospital Revenue Code	278
Min. Negotiated Rate	$675.07
Max. Negotiated Rate	$11,885.00
Rate for Payer: Aetna Commercial	$9,032.60
Rate for Payer: Aetna Medicare Advantage	$7,131.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,061.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,061.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,754.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,061.35
Rate for Payer: Cigna Commercial	$11,885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,752.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,565.50
Rate for Payer: UnitedHealthcare Community & State	$751.13
Rate for Payer: Wellpoint Medicaid Managed Care	$675.07

VIATORR ENDOPRT 10x8 PTB108275

Facility

$23,770.00

Service Code	HCPCS C1876
Hospital Charge Code	270635474
Hospital Revenue Code	278
Min. Negotiated Rate	$3,565.50
Max. Negotiated Rate	$5,752.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,754.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,752.34
Rate for Payer: Qualcare PPO/HMO/WC	$3,565.50

VI BILIARY TUBE CHANGE

Facility

$1,365.00

Hospital Charge Code	5600013
Hospital Revenue Code	320
Min. Negotiated Rate	$38.77
Max. Negotiated Rate	$2,231.00
Rate for Payer: Aetna Commercial	$518.70
Rate for Payer: Aetna Medicare Advantage	$409.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$348.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$348.07
Rate for Payer: Cigna Commercial	$682.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$354.90
Rate for Payer: Oxford Commercial	$1,955.00
Rate for Payer: Qualcare PPO/HMO/WC	$204.75
Rate for Payer: UnitedHealthcare Commercial	$2,231.00
Rate for Payer: UnitedHealthcare Community & State	$43.13
Rate for Payer: Wellpoint Medicaid Managed Care	$38.77

VI BILIARY TUBE CHANGE

Facility

$1,365.00

Hospital Charge Code	5600013
Hospital Revenue Code	320
Min. Negotiated Rate	$204.75
Max. Negotiated Rate	$204.75
Rate for Payer: Qualcare PPO/HMO/WC	$204.75

VIBRAMYCIN 50MG/50ML SYRP

Facility

$4.00

Service Code	NDC 69097065
Hospital Charge Code	60634794
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.04
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.13
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

VIBRAMYCIN 50MG/50ML SYRP

Facility

$4.00

Service Code	NDC 69097065
Hospital Charge Code	60634794
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

VIBRAMYCIN 50MG/5ML SYR

Facility

$82.50

Hospital Charge Code	6063943176
Hospital Revenue Code	250
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$41.25
Rate for Payer: Aetna Commercial	$31.35
Rate for Payer: Aetna Medicare Advantage	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$21.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$21.04
Rate for Payer: Cigna Commercial	$41.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.45
Rate for Payer: Oxford Commercial	$16.50
Rate for Payer: Qualcare PPO/HMO/WC	$12.38
Rate for Payer: UnitedHealthcare Commercial	$16.50
Rate for Payer: UnitedHealthcare Community & State	$2.61
Rate for Payer: Wellpoint Medicaid Managed Care	$2.34

VIBRAMYCIN 50MG/5ML SYR

Facility

$82.50

Hospital Charge Code	6063943176
Hospital Revenue Code	250
Min. Negotiated Rate	$12.38
Max. Negotiated Rate	$12.38
Rate for Payer: Qualcare PPO/HMO/WC	$12.38

VICI Stent 14x120

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270687299
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI Stent 14x120

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270687299
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699S
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,612.50
Max. Negotiated Rate	$2,601.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699N
Hospital Revenue Code	278
Min. Negotiated Rate	$305.30
Max. Negotiated Rate	$5,375.00
Rate for Payer: Aetna Commercial	$4,085.00
Rate for Payer: Aetna Medicare Advantage	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,741.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,741.25
Rate for Payer: Cigna Commercial	$5,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,601.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,612.50
Rate for Payer: UnitedHealthcare Community & State	$339.70
Rate for Payer: Wellpoint Medicaid Managed Care	$305.30

Know your out-of-pocket cost for care.

All Charges