Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

VISI-PRO BALLOON EXPANDABLE

Facility

$6,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270659829N
Hospital Revenue Code	278
Min. Negotiated Rate	$971.25
Max. Negotiated Rate	$1,566.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,566.95
Rate for Payer: Qualcare PPO/HMO/WC	$971.25

VISISHOT 2 22G

Facility

$6,216.75

Hospital Charge Code	270703013
Hospital Revenue Code	278
Min. Negotiated Rate	$176.56
Max. Negotiated Rate	$3,108.38
Rate for Payer: Aetna Commercial	$2,362.36
Rate for Payer: Aetna Medicare Advantage	$1,865.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,585.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,585.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,585.27
Rate for Payer: Cigna Commercial	$3,108.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.45
Rate for Payer: Qualcare PPO/HMO/WC	$932.51
Rate for Payer: UnitedHealthcare Community & State	$196.45
Rate for Payer: Wellpoint Medicaid Managed Care	$176.56

VISISHOT 2 22G

Facility

$6,216.75

Hospital Charge Code	270703013
Hospital Revenue Code	278
Min. Negotiated Rate	$932.51
Max. Negotiated Rate	$1,504.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,243.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,504.45
Rate for Payer: Qualcare PPO/HMO/WC	$932.51

VISISHOT 2 25G

Facility

$6,859.00

Hospital Charge Code	270703015
Hospital Revenue Code	278
Min. Negotiated Rate	$1,028.85
Max. Negotiated Rate	$1,659.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,659.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.85

VISISHOT 2 25G

Facility

$6,859.00

Hospital Charge Code	270703015
Hospital Revenue Code	278
Min. Negotiated Rate	$194.80
Max. Negotiated Rate	$3,429.50
Rate for Payer: Aetna Commercial	$2,606.42
Rate for Payer: Aetna Medicare Advantage	$2,057.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,749.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,749.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,371.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,749.05
Rate for Payer: Cigna Commercial	$3,429.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,659.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,028.85
Rate for Payer: UnitedHealthcare Community & State	$216.74
Rate for Payer: Wellpoint Medicaid Managed Care	$194.80

VISTASEAL 2MM

Facility

$602.75

Hospital Charge Code	270688739
Hospital Revenue Code	272
Min. Negotiated Rate	$90.41
Max. Negotiated Rate	$90.41
Rate for Payer: Qualcare PPO/HMO/WC	$90.41

VISTASEAL 2MM

Facility

$602.75

Hospital Charge Code	270688739
Hospital Revenue Code	272
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$301.38
Rate for Payer: Aetna Commercial	$229.04
Rate for Payer: Aetna Medicare Advantage	$180.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.70
Rate for Payer: Cigna Commercial	$301.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.72
Rate for Payer: Oxford Commercial	$120.55
Rate for Payer: Qualcare PPO/HMO/WC	$90.41
Rate for Payer: UnitedHealthcare Commercial	$120.55
Rate for Payer: UnitedHealthcare Community & State	$19.05
Rate for Payer: Wellpoint Medicaid Managed Care	$17.12

VISTASEAL FIBRIN 4 ML

Facility

$1,116.20

Hospital Charge Code	270688740
Hospital Revenue Code	272
Min. Negotiated Rate	$31.70
Max. Negotiated Rate	$558.10
Rate for Payer: Aetna Commercial	$424.16
Rate for Payer: Aetna Medicare Advantage	$334.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$284.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$284.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$284.63
Rate for Payer: Cigna Commercial	$558.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$290.21
Rate for Payer: Oxford Commercial	$223.24
Rate for Payer: Qualcare PPO/HMO/WC	$167.43
Rate for Payer: UnitedHealthcare Commercial	$223.24
Rate for Payer: UnitedHealthcare Community & State	$35.27
Rate for Payer: Wellpoint Medicaid Managed Care	$31.70

VISTASEAL FIBRIN 4 ML

Facility

$1,116.20

Hospital Charge Code	270688740
Hospital Revenue Code	272
Min. Negotiated Rate	$167.43
Max. Negotiated Rate	$167.43
Rate for Payer: Qualcare PPO/HMO/WC	$167.43

VISTASEAL, FIBRIN SEALANT 10MG

Facility

$2,567.25

Service Code	HCPCS C1765
Hospital Charge Code	270688748
Hospital Revenue Code	278
Min. Negotiated Rate	$385.09
Max. Negotiated Rate	$621.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.27
Rate for Payer: Qualcare PPO/HMO/WC	$385.09

VISTASEAL, FIBRIN SEALANT 10MG

Facility

$2,567.25

Service Code	HCPCS C1765
Hospital Charge Code	270688748
Hospital Revenue Code	278
Min. Negotiated Rate	$72.91
Max. Negotiated Rate	$1,283.62
Rate for Payer: Aetna Commercial	$975.55
Rate for Payer: Aetna Medicare Advantage	$770.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$654.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$654.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$513.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$654.65
Rate for Payer: Cigna Commercial	$1,283.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$621.27
Rate for Payer: Qualcare PPO/HMO/WC	$385.09
Rate for Payer: UnitedHealthcare Community & State	$81.13
Rate for Payer: Wellpoint Medicaid Managed Care	$72.91

VITAGEL SURG.HEMOSTAT 4.5 ML

Facility

$858.00

Hospital Charge Code	270335970
Hospital Revenue Code	272
Min. Negotiated Rate	$128.70
Max. Negotiated Rate	$128.70
Rate for Payer: Qualcare PPO/HMO/WC	$128.70

VITAGEL SURG.HEMOSTAT 4.5 ML

Facility

$858.00

Hospital Charge Code	270335970
Hospital Revenue Code	272
Min. Negotiated Rate	$24.37
Max. Negotiated Rate	$429.00
Rate for Payer: Aetna Commercial	$326.04
Rate for Payer: Aetna Medicare Advantage	$257.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.79
Rate for Payer: Cigna Commercial	$429.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.08
Rate for Payer: Oxford Commercial	$171.60
Rate for Payer: Qualcare PPO/HMO/WC	$128.70
Rate for Payer: UnitedHealthcare Commercial	$171.60
Rate for Payer: UnitedHealthcare Community & State	$27.11
Rate for Payer: Wellpoint Medicaid Managed Care	$24.37

VITAL UTERINE SCISSON

Facility

$1,845.00

Hospital Charge Code	270665620
Hospital Revenue Code	272
Min. Negotiated Rate	$276.75
Max. Negotiated Rate	$276.75
Rate for Payer: Qualcare PPO/HMO/WC	$276.75

VITAL UTERINE SCISSON

Facility

$1,845.00

Hospital Charge Code	270665620
Hospital Revenue Code	272
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$922.50
Rate for Payer: Aetna Commercial	$701.10
Rate for Payer: Aetna Medicare Advantage	$553.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$470.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$470.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$470.48
Rate for Payer: Cigna Commercial	$922.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$479.70
Rate for Payer: Oxford Commercial	$369.00
Rate for Payer: Qualcare PPO/HMO/WC	$276.75
Rate for Payer: UnitedHealthcare Commercial	$369.00
Rate for Payer: UnitedHealthcare Community & State	$58.30
Rate for Payer: Wellpoint Medicaid Managed Care	$52.40

VITAMIN A

Facility

$390.00

Service Code	HCPCS 84590
Hospital Charge Code	39900149
Hospital Revenue Code	301
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$31.58
Rate for Payer: Aetna Medicare Advantage	$37.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.12
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$11.61
Rate for Payer: Clover Medicare Advantage	$11.03
Rate for Payer: EmblemHealth Commercial	$34.83
Rate for Payer: Humana Medicare Advantage	$11.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.61
Rate for Payer: Wellcare Medicare Advantage	$11.61
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VITAMIN A

Facility

$390.00

Service Code	HCPCS 84590
Hospital Charge Code	39900149
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VITAMIN A & D OINT

Facility

$13.80

Service Code	NDC 54162000002
Hospital Charge Code	6063943308
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$6.90
Rate for Payer: Aetna Commercial	$5.24
Rate for Payer: Aetna Medicare Advantage	$4.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.52
Rate for Payer: Cigna Commercial	$6.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.59
Rate for Payer: Oxford Commercial	$2.76
Rate for Payer: Qualcare PPO/HMO/WC	$2.07
Rate for Payer: UnitedHealthcare Commercial	$2.76
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.39

VITAMIN A & D OINT

Facility

$13.80

Service Code	NDC 54162000002
Hospital Charge Code	6063943308
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Qualcare PPO/HMO/WC	$2.07

VITAMIN A & D OINTMENT 4 OZ

Facility

$38.79

Service Code	NDC 168003504
Hospital Charge Code	606390235
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$19.39
Rate for Payer: Aetna Commercial	$14.74
Rate for Payer: Aetna Medicare Advantage	$11.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.89
Rate for Payer: Cigna Commercial	$19.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.09
Rate for Payer: Oxford Commercial	$7.76
Rate for Payer: Qualcare PPO/HMO/WC	$5.82
Rate for Payer: UnitedHealthcare Commercial	$7.76
Rate for Payer: UnitedHealthcare Community & State	$1.23
Rate for Payer: Wellpoint Medicaid Managed Care	$1.10

VITAMIN A & D OINTMENT 4 OZ

Facility

$38.79

Service Code	NDC 168003504
Hospital Charge Code	606390235
Hospital Revenue Code	250
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$5.82
Rate for Payer: Qualcare PPO/HMO/WC	$5.82

VITAMIN A (RETINOL)

Facility

$236.00

Service Code	HCPCS 84590
Hospital Charge Code	38472680
Hospital Revenue Code	301
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

VITAMIN A (RETINOL)

Facility

$236.00

Service Code	HCPCS 84590
Hospital Charge Code	38472680
Hospital Revenue Code	301
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$31.58
Rate for Payer: Aetna Medicare Advantage	$37.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.12
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: Cigna Medicare Advantage	$11.61
Rate for Payer: Clover Medicare Advantage	$11.03
Rate for Payer: EmblemHealth Commercial	$34.83
Rate for Payer: Humana Medicare Advantage	$11.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.61
Rate for Payer: Wellcare Medicare Advantage	$11.61
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

VITAMIN B12

Facility

$380.80

Service Code	HCPCS 82607
Hospital Charge Code	38472692
Hospital Revenue Code	301
Min. Negotiated Rate	$57.12
Max. Negotiated Rate	$57.12
Rate for Payer: Qualcare PPO/HMO/WC	$57.12

Know your out-of-pocket cost for care.

All Charges