Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VICI VENOUS STENT SYS 14X60MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686699N
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 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696S
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 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696N
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 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696N
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 14X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686696S
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 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697N
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 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697S
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 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697N
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 16X120MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686697S
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 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698N
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 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698S
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 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698S
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 16X90MM

Facility

$10,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686698N
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

VICODIN 5/300 MG TAB

Facility

$10.94

Hospital Charge Code	606380011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$5.47
Rate for Payer: Aetna Commercial	$4.16
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.79
Rate for Payer: Cigna Commercial	$5.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.84
Rate for Payer: Oxford Commercial	$2.19
Rate for Payer: Qualcare PPO/HMO/WC	$1.64
Rate for Payer: UnitedHealthcare Commercial	$2.19
Rate for Payer: UnitedHealthcare Community & State	$0.35
Rate for Payer: Wellpoint Medicaid Managed Care	$0.31

VICODIN 5/300 MG TAB

Facility

$10.94

Hospital Charge Code	606380011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Qualcare PPO/HMO/WC	$1.64

VICRYL MESH KNITTED 6X6

Facility

$527.00

Hospital Charge Code	270334718
Hospital Revenue Code	278
Min. Negotiated Rate	$79.05
Max. Negotiated Rate	$127.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.53
Rate for Payer: Qualcare PPO/HMO/WC	$79.05

VICRYL MESH KNITTED 6X6

Facility

$527.00

Hospital Charge Code	270334718
Hospital Revenue Code	278
Min. Negotiated Rate	$14.97
Max. Negotiated Rate	$263.50
Rate for Payer: Aetna Commercial	$200.26
Rate for Payer: Aetna Medicare Advantage	$158.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.38
Rate for Payer: Cigna Commercial	$263.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.53
Rate for Payer: Qualcare PPO/HMO/WC	$79.05
Rate for Payer: UnitedHealthcare Community & State	$16.65
Rate for Payer: Wellpoint Medicaid Managed Care	$14.97

VICRYL PLUS UNDYED 8X27CT-1 CR

Facility

$62.35

Hospital Charge Code	270690394
Hospital Revenue Code	272
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$9.35
Rate for Payer: Qualcare PPO/HMO/WC	$9.35

VICRYL PLUS UNDYED 8X27CT-1 CR

Facility

$62.35

Hospital Charge Code	270690394
Hospital Revenue Code	272
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$31.18
Rate for Payer: Aetna Commercial	$23.69
Rate for Payer: Aetna Medicare Advantage	$18.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.90
Rate for Payer: Cigna Commercial	$31.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.21
Rate for Payer: Oxford Commercial	$12.47
Rate for Payer: Qualcare PPO/HMO/WC	$9.35
Rate for Payer: UnitedHealthcare Commercial	$12.47
Rate for Payer: UnitedHealthcare Community & State	$1.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1.77

VIDEX EC 125 MG

Facility

$36.18

Service Code	NDC 87667117
Hospital Charge Code	60632244
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$18.09
Rate for Payer: Aetna Commercial	$13.75
Rate for Payer: Aetna Medicare Advantage	$10.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.23
Rate for Payer: Cigna Commercial	$18.09
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.41
Rate for Payer: Oxford Commercial	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$5.43
Rate for Payer: UnitedHealthcare Commercial	$7.24
Rate for Payer: UnitedHealthcare Community & State	$1.14
Rate for Payer: Wellpoint Medicaid Managed Care	$1.03

VIDEX EC 125 MG

Facility

$36.18

Service Code	NDC 87667117
Hospital Charge Code	60632244
Hospital Revenue Code	250
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$5.43
Rate for Payer: Qualcare PPO/HMO/WC	$5.43

VIDEX EC 200MG CAP

Facility

$57.89

Service Code	NDC 87667217
Hospital Charge Code	60632268
Hospital Revenue Code	250
Min. Negotiated Rate	$8.68
Max. Negotiated Rate	$8.68
Rate for Payer: Qualcare PPO/HMO/WC	$8.68

VIDEX EC 200MG CAP

Facility

$57.89

Service Code	NDC 87667217
Hospital Charge Code	60632268
Hospital Revenue Code	250
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$28.95
Rate for Payer: Aetna Commercial	$22.00
Rate for Payer: Aetna Medicare Advantage	$17.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.76
Rate for Payer: Cigna Commercial	$28.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.05
Rate for Payer: Oxford Commercial	$11.58
Rate for Payer: Qualcare PPO/HMO/WC	$8.68
Rate for Payer: UnitedHealthcare Commercial	$11.58
Rate for Payer: UnitedHealthcare Community & State	$1.83
Rate for Payer: Wellpoint Medicaid Managed Care	$1.64

VIDEX EC 250 MG CAPS

Facility

$73.77

Service Code	NDC 87667317
Hospital Charge Code	60635345
Hospital Revenue Code	250
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$11.07
Rate for Payer: Qualcare PPO/HMO/WC	$11.07

VIDEX EC 250 MG CAPS

Facility

$73.77

Service Code	NDC 87667317
Hospital Charge Code	60635345
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$36.88
Rate for Payer: Aetna Commercial	$28.03
Rate for Payer: Aetna Medicare Advantage	$22.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.81
Rate for Payer: Cigna Commercial	$36.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.18
Rate for Payer: Oxford Commercial	$14.75
Rate for Payer: Qualcare PPO/HMO/WC	$11.07
Rate for Payer: UnitedHealthcare Commercial	$14.75
Rate for Payer: UnitedHealthcare Community & State	$2.33
Rate for Payer: Wellpoint Medicaid Managed Care	$2.10

Know your out-of-pocket cost for care.

All Charges