Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VISCOAT .05ML SYRINGE (STF)

Facility

$455.00

Hospital Charge Code	270330681
Hospital Revenue Code	250
Min. Negotiated Rate	$12.92
Max. Negotiated Rate	$227.50
Rate for Payer: Aetna Commercial	$172.90
Rate for Payer: Aetna Medicare Advantage	$136.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.03
Rate for Payer: Cigna Commercial	$227.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$118.30
Rate for Payer: Oxford Commercial	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$68.25
Rate for Payer: UnitedHealthcare Commercial	$91.00
Rate for Payer: UnitedHealthcare Community & State	$14.38
Rate for Payer: Wellpoint Medicaid Managed Care	$12.92

VISCOAT 05ML SYRINGE(STM)

Facility

$382.00

Hospital Charge Code	270332494
Hospital Revenue Code	250
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$191.00
Rate for Payer: Aetna Commercial	$145.16
Rate for Payer: Aetna Medicare Advantage	$114.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.41
Rate for Payer: Cigna Commercial	$191.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.32
Rate for Payer: Oxford Commercial	$76.40
Rate for Payer: Qualcare PPO/HMO/WC	$57.30
Rate for Payer: UnitedHealthcare Commercial	$76.40
Rate for Payer: UnitedHealthcare Community & State	$12.07
Rate for Payer: Wellpoint Medicaid Managed Care	$10.85

VISCOAT 05ML SYRINGE(STM)

Facility

$382.00

Hospital Charge Code	270332494
Hospital Revenue Code	250
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$57.30
Rate for Payer: Qualcare PPO/HMO/WC	$57.30

VISCOSITY, FLUID

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38473059
Hospital Revenue Code	305
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

VISCOSITY, FLUID

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38473059
Hospital Revenue Code	305
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$209.00
Rate for Payer: Aetna Commercial	$31.74
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare Advantage	$11.67
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Medicare Advantage	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.87

VISCOSITY,SERUM

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38479123
Hospital Revenue Code	305
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$209.00
Rate for Payer: Aetna Commercial	$31.74
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$209.00
Rate for Payer: Cigna Medicare Advantage	$11.67
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$108.68
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$62.70
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Medicare Advantage	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$11.87

VISCOSITY,SERUM

Facility

$80.20

Service Code	HCPCS 85810
Hospital Charge Code	39900186
Hospital Revenue Code	305
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$31.74
Rate for Payer: Aetna Medicare Advantage	$37.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$40.10
Rate for Payer: Cigna Medicare Advantage	$11.67
Rate for Payer: Clover Medicare Advantage	$11.09
Rate for Payer: EmblemHealth Commercial	$35.01
Rate for Payer: Humana Medicare Advantage	$12.02
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.85
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$12.03
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.67
Rate for Payer: Wellcare Medicare Advantage	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$2.28

VISCOSITY,SERUM

Facility

$80.20

Service Code	HCPCS 85810
Hospital Charge Code	39900186
Hospital Revenue Code	305
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$12.03
Rate for Payer: Qualcare PPO/HMO/WC	$12.03

VISCOSITY,SERUM

Facility

$418.00

Service Code	HCPCS 85810
Hospital Charge Code	38479123
Hospital Revenue Code	305
Min. Negotiated Rate	$62.70
Max. Negotiated Rate	$62.70
Rate for Payer: Qualcare PPO/HMO/WC	$62.70

VISION BLUE .06%

Facility

$383.33

Hospital Charge Code	270659775
Hospital Revenue Code	270
Min. Negotiated Rate	$57.50
Max. Negotiated Rate	$57.50
Rate for Payer: Qualcare PPO/HMO/WC	$57.50

VISION BLUE .06%

Facility

$383.33

Hospital Charge Code	270659775
Hospital Revenue Code	270
Min. Negotiated Rate	$10.89
Max. Negotiated Rate	$191.66
Rate for Payer: Aetna Commercial	$145.67
Rate for Payer: Aetna Medicare Advantage	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$97.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$97.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$97.75
Rate for Payer: Cigna Commercial	$191.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$99.67
Rate for Payer: Oxford Commercial	$76.67
Rate for Payer: Qualcare PPO/HMO/WC	$57.50
Rate for Payer: UnitedHealthcare Commercial	$76.67
Rate for Payer: UnitedHealthcare Community & State	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$10.89

VISIPAQUE 200ML

Facility

$944.70

Service Code	NDC 407222321
Hospital Charge Code	60635838
Hospital Revenue Code	255
Min. Negotiated Rate	$26.83
Max. Negotiated Rate	$472.35
Rate for Payer: Aetna Commercial	$358.99
Rate for Payer: Aetna Medicare Advantage	$283.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.90
Rate for Payer: Cigna Commercial	$472.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$245.62
Rate for Payer: Oxford Commercial	$188.94
Rate for Payer: Qualcare PPO/HMO/WC	$141.71
Rate for Payer: UnitedHealthcare Commercial	$188.94
Rate for Payer: UnitedHealthcare Community & State	$29.85
Rate for Payer: Wellpoint Medicaid Managed Care	$26.83

VISIPAQUE 200ML

Facility

$944.70

Service Code	NDC 407222321
Hospital Charge Code	60635838
Hospital Revenue Code	255
Min. Negotiated Rate	$141.71
Max. Negotiated Rate	$141.71
Rate for Payer: Qualcare PPO/HMO/WC	$141.71

VISIPAQUE 320MG 100ML

Facility

$6.72

Hospital Charge Code	4800875
Hospital Revenue Code	255
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.36
Rate for Payer: Aetna Commercial	$2.55
Rate for Payer: Aetna Medicare Advantage	$2.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.71
Rate for Payer: Cigna Commercial	$3.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.75
Rate for Payer: Oxford Commercial	$1.34
Rate for Payer: Qualcare PPO/HMO/WC	$1.01
Rate for Payer: UnitedHealthcare Commercial	$1.34
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.19

VISIPAQUE 320MG 100ML

Facility

$6.72

Hospital Charge Code	4800875
Hospital Revenue Code	255
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$1.01
Rate for Payer: Qualcare PPO/HMO/WC	$1.01

VISIPAQUE 320MG/50ML VIAL

Facility

$100.50

Service Code	NDC 407222301
Hospital Charge Code	60635828
Hospital Revenue Code	255
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$50.25
Rate for Payer: Aetna Commercial	$38.19
Rate for Payer: Aetna Medicare Advantage	$30.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$25.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$25.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$25.63
Rate for Payer: Cigna Commercial	$50.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.13
Rate for Payer: Oxford Commercial	$20.10
Rate for Payer: Qualcare PPO/HMO/WC	$15.07
Rate for Payer: UnitedHealthcare Commercial	$20.10
Rate for Payer: UnitedHealthcare Community & State	$3.18
Rate for Payer: Wellpoint Medicaid Managed Care	$2.85

VISIPAQUE 320MG/50ML VIAL

Facility

$100.50

Service Code	NDC 407222301
Hospital Charge Code	60635828
Hospital Revenue Code	255
Min. Negotiated Rate	$15.07
Max. Negotiated Rate	$15.07
Rate for Payer: Qualcare PPO/HMO/WC	$15.07

VISIPAQUE 320MG/ML VIAL(100ML

Facility

$261.30

Service Code	NDC 407222317
Hospital Charge Code	60631593
Hospital Revenue Code	255
Min. Negotiated Rate	$39.20
Max. Negotiated Rate	$39.20
Rate for Payer: Qualcare PPO/HMO/WC	$39.20

VISIPAQUE 320MG/ML VIAL(100ML

Facility

$261.30

Service Code	NDC 407222317
Hospital Charge Code	60631593
Hospital Revenue Code	255
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$130.65
Rate for Payer: Aetna Commercial	$99.29
Rate for Payer: Aetna Medicare Advantage	$78.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$66.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$66.63
Rate for Payer: Cigna Commercial	$130.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.94
Rate for Payer: Oxford Commercial	$52.26
Rate for Payer: Qualcare PPO/HMO/WC	$39.20
Rate for Payer: UnitedHealthcare Commercial	$52.26
Rate for Payer: UnitedHealthcare Community & State	$8.26
Rate for Payer: Wellpoint Medicaid Managed Care	$7.42

VISIPORT OPTICAL TROCAR 5-12MM

Facility

$306.00

Hospital Charge Code	270651839
Hospital Revenue Code	272
Min. Negotiated Rate	$8.69
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$116.28
Rate for Payer: Aetna Medicare Advantage	$91.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$78.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$78.03
Rate for Payer: Cigna Commercial	$153.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.56
Rate for Payer: Oxford Commercial	$61.20
Rate for Payer: Qualcare PPO/HMO/WC	$45.90
Rate for Payer: UnitedHealthcare Commercial	$61.20
Rate for Payer: UnitedHealthcare Community & State	$9.67
Rate for Payer: Wellpoint Medicaid Managed Care	$8.69

VISIPORT OPTICAL TROCAR 5-12MM

Facility

$306.00

Hospital Charge Code	270651839
Hospital Revenue Code	272
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$45.90
Rate for Payer: Qualcare PPO/HMO/WC	$45.90

VISI PRO 7X27 STENT

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270686949S
Hospital Revenue Code	278
Min. Negotiated Rate	$779.84
Max. Negotiated Rate	$1,258.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84

VISI PRO 7X27 STENT

Facility

$5,198.90

Service Code	HCPCS C1876
Hospital Charge Code	270686949S
Hospital Revenue Code	278
Min. Negotiated Rate	$147.65
Max. Negotiated Rate	$2,599.45
Rate for Payer: Aetna Commercial	$1,975.58
Rate for Payer: Aetna Medicare Advantage	$1,559.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,325.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,039.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,325.72
Rate for Payer: Cigna Commercial	$2,599.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,258.13
Rate for Payer: Qualcare PPO/HMO/WC	$779.84
Rate for Payer: UnitedHealthcare Community & State	$164.29
Rate for Payer: Wellpoint Medicaid Managed Care	$147.65

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829N
Hospital Revenue Code	278
Min. Negotiated Rate	$183.89
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$204.61
Rate for Payer: Wellpoint Medicaid Managed Care	$183.89

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829
Hospital Revenue Code	278
Min. Negotiated Rate	$183.89
Max. Negotiated Rate	$3,237.50
Rate for Payer: Aetna Commercial	$2,460.50
Rate for Payer: Aetna Medicare Advantage	$1,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,651.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,651.12
Rate for Payer: Cigna Commercial	$3,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25
Rate for Payer: UnitedHealthcare Community & State	$204.61
Rate for Payer: Wellpoint Medicaid Managed Care	$183.89

Know your out-of-pocket cost for care.

All Charges