Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VITOSS BA2X FOAM PACK 10CC

Facility

$19,922.35

Service Code	HCPCS C1713
Hospital Charge Code	270656479
Hospital Revenue Code	278
Min. Negotiated Rate	$565.79
Max. Negotiated Rate	$9,961.17
Rate for Payer: Aetna Commercial	$7,570.49
Rate for Payer: Aetna Medicare Advantage	$5,976.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,080.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,080.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,984.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,080.20
Rate for Payer: Cigna Commercial	$9,961.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,821.21
Rate for Payer: Qualcare PPO/HMO/WC	$2,988.35
Rate for Payer: UnitedHealthcare Community & State	$629.55
Rate for Payer: Wellpoint Medicaid Managed Care	$565.79

VITOSS BA2X FOAM PACK 10CC

Facility

$19,922.35

Service Code	HCPCS C1713
Hospital Charge Code	270656479
Hospital Revenue Code	278
Min. Negotiated Rate	$2,988.35
Max. Negotiated Rate	$4,821.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,984.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,821.21
Rate for Payer: Qualcare PPO/HMO/WC	$2,988.35

VITOSS BB FOAM PACK 5 CC

Facility

$11,100.40

Service Code	HCPCS C1713
Hospital Charge Code	270680168
Hospital Revenue Code	278
Min. Negotiated Rate	$1,665.06
Max. Negotiated Rate	$2,686.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,220.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,686.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,665.06

VITOSS BB FOAM PACK 5 CC

Facility

$11,100.40

Service Code	HCPCS C1713
Hospital Charge Code	270680168
Hospital Revenue Code	278
Min. Negotiated Rate	$315.25
Max. Negotiated Rate	$5,550.20
Rate for Payer: Aetna Commercial	$4,218.15
Rate for Payer: Aetna Medicare Advantage	$3,330.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,830.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,830.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,220.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,830.60
Rate for Payer: Cigna Commercial	$5,550.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,686.30
Rate for Payer: Qualcare PPO/HMO/WC	$1,665.06
Rate for Payer: UnitedHealthcare Community & State	$350.77
Rate for Payer: Wellpoint Medicaid Managed Care	$315.25

VITOSS BB TRAUMA FOAM PACK

Facility

$5,920.20

Service Code	HCPCS C1713
Hospital Charge Code	270671169
Hospital Revenue Code	278
Min. Negotiated Rate	$168.13
Max. Negotiated Rate	$2,960.10
Rate for Payer: Aetna Commercial	$2,249.68
Rate for Payer: Aetna Medicare Advantage	$1,776.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,509.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,509.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,509.65
Rate for Payer: Cigna Commercial	$2,960.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.69
Rate for Payer: Qualcare PPO/HMO/WC	$888.03
Rate for Payer: UnitedHealthcare Community & State	$187.08
Rate for Payer: Wellpoint Medicaid Managed Care	$168.13

VITOSS BB TRAUMA FOAM PACK

Facility

$5,920.20

Service Code	HCPCS C1713
Hospital Charge Code	270671169
Hospital Revenue Code	278
Min. Negotiated Rate	$888.03
Max. Negotiated Rate	$1,432.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,184.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,432.69
Rate for Payer: Qualcare PPO/HMO/WC	$888.03

VITOSS BIMODAL 10CC

Facility

$23,895.30

Service Code	HCPCS C1713
Hospital Charge Code	270697908
Hospital Revenue Code	278
Min. Negotiated Rate	$3,584.30
Max. Negotiated Rate	$5,782.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,779.06
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,782.66
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.30

VITOSS BIMODAL 10CC

Facility

$23,895.30

Service Code	HCPCS C1713
Hospital Charge Code	270697908
Hospital Revenue Code	278
Min. Negotiated Rate	$678.63
Max. Negotiated Rate	$11,947.65
Rate for Payer: Aetna Commercial	$9,080.21
Rate for Payer: Aetna Medicare Advantage	$7,168.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,093.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,093.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,779.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,093.30
Rate for Payer: Cigna Commercial	$11,947.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,782.66
Rate for Payer: Qualcare PPO/HMO/WC	$3,584.30
Rate for Payer: UnitedHealthcare Community & State	$755.09
Rate for Payer: Wellpoint Medicaid Managed Care	$678.63

VITOSS BIMODAL 5ML

Facility

$17,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270699423
Hospital Revenue Code	278
Min. Negotiated Rate	$2,643.00
Max. Negotiated Rate	$4,264.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,524.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,264.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.00

VITOSS BIMODAL 5ML

Facility

$17,620.00

Service Code	HCPCS C1713
Hospital Charge Code	270699423
Hospital Revenue Code	278
Min. Negotiated Rate	$500.41
Max. Negotiated Rate	$8,810.00
Rate for Payer: Aetna Commercial	$6,695.60
Rate for Payer: Aetna Medicare Advantage	$5,286.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,493.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,493.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,524.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,493.10
Rate for Payer: Cigna Commercial	$8,810.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,264.04
Rate for Payer: Qualcare PPO/HMO/WC	$2,643.00
Rate for Payer: UnitedHealthcare Community & State	$556.79
Rate for Payer: Wellpoint Medicaid Managed Care	$500.41

VITOSS SYBTH BONE GRAFT 5CC

Facility

$1,848.00

Hospital Charge Code	270335303
Hospital Revenue Code	278
Min. Negotiated Rate	$52.48
Max. Negotiated Rate	$924.00
Rate for Payer: Aetna Commercial	$702.24
Rate for Payer: Aetna Medicare Advantage	$554.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$471.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$471.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$369.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$471.24
Rate for Payer: Cigna Commercial	$924.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$447.22
Rate for Payer: Qualcare PPO/HMO/WC	$277.20
Rate for Payer: UnitedHealthcare Community & State	$58.40
Rate for Payer: Wellpoint Medicaid Managed Care	$52.48

VITOSS SYBTH BONE GRAFT 5CC

Facility

$1,848.00

Hospital Charge Code	270335303
Hospital Revenue Code	278
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$447.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$369.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$447.22
Rate for Payer: Qualcare PPO/HMO/WC	$277.20

VITOSS SYNTH BONE GRAFT 10CC

Facility

$3,234.00

Hospital Charge Code	270335302
Hospital Revenue Code	278
Min. Negotiated Rate	$485.10
Max. Negotiated Rate	$782.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$646.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$782.63
Rate for Payer: Qualcare PPO/HMO/WC	$485.10

VITOSS SYNTH BONE GRAFT 10CC

Facility

$3,234.00

Hospital Charge Code	270335302
Hospital Revenue Code	278
Min. Negotiated Rate	$91.85
Max. Negotiated Rate	$1,617.00
Rate for Payer: Aetna Commercial	$1,228.92
Rate for Payer: Aetna Medicare Advantage	$970.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$824.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$824.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$646.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$824.67
Rate for Payer: Cigna Commercial	$1,617.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$782.63
Rate for Payer: Qualcare PPO/HMO/WC	$485.10
Rate for Payer: UnitedHealthcare Community & State	$102.19
Rate for Payer: Wellpoint Medicaid Managed Care	$91.85

VITOSS SYNTH CALLELOUS GRAFT

Facility

$1,239.00

Hospital Charge Code	270335553
Hospital Revenue Code	278
Min. Negotiated Rate	$185.85
Max. Negotiated Rate	$299.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.84
Rate for Payer: Qualcare PPO/HMO/WC	$185.85

VITOSS SYNTH CALLELOUS GRAFT

Facility

$1,239.00

Hospital Charge Code	270335553
Hospital Revenue Code	278
Min. Negotiated Rate	$35.19
Max. Negotiated Rate	$619.50
Rate for Payer: Aetna Commercial	$470.82
Rate for Payer: Aetna Medicare Advantage	$371.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$315.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$315.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$247.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$315.94
Rate for Payer: Cigna Commercial	$619.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.84
Rate for Payer: Qualcare PPO/HMO/WC	$185.85
Rate for Payer: UnitedHealthcare Community & State	$39.15
Rate for Payer: Wellpoint Medicaid Managed Care	$35.19

VIVACIT-E DM BEAR LNR 28X42MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689981
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

VIVACIT-E DM BEAR LNR 28X42MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270689981
Hospital Revenue Code	278
Min. Negotiated Rate	$383.40
Max. Negotiated Rate	$6,750.00
Rate for Payer: Aetna Commercial	$5,130.00
Rate for Payer: Aetna Medicare Advantage	$4,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,442.50
Rate for Payer: Cigna Commercial	$6,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00
Rate for Payer: UnitedHealthcare Community & State	$426.60
Rate for Payer: Wellpoint Medicaid Managed Care	$383.40

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689502
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689502
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689592
Hospital Revenue Code	278
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$1,452.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

VIVACIT POLY ARTICLAR SURFACE

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270689592
Hospital Revenue Code	278
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,452.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

VIVATROL ER INJ 380MG

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390234
Hospital Revenue Code	636
Min. Negotiated Rate	$4.04
Max. Negotiated Rate	$2,472.96
Rate for Payer: Aetna Commercial	$11.56
Rate for Payer: Aetna Medicare Advantage	$13.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$4.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.42
Rate for Payer: Cigna Medicare Advantage	$4.25
Rate for Payer: Clover Medicare Advantage	$4.04
Rate for Payer: EmblemHealth Commercial	$12.75
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$4.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83
Rate for Payer: UnitedHealthcare Community & State	$322.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.25
Rate for Payer: Wellcare Medicare Advantage	$4.25
Rate for Payer: Wellpoint Medicaid Managed Care	$290.22

VIVATROL ER INJ 380MG

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390234
Hospital Revenue Code	636
Min. Negotiated Rate	$1,532.83
Max. Negotiated Rate	$2,472.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,472.96
Rate for Payer: Qualcare PPO/HMO/WC	$1,532.83

VIVIGEN GRAFT 1CC

Facility

$2,715.00

Service Code	HCPCS C1762
Hospital Charge Code	270679087
Hospital Revenue Code	278
Min. Negotiated Rate	$77.11
Max. Negotiated Rate	$1,357.50
Rate for Payer: Aetna Commercial	$1,031.70
Rate for Payer: Aetna Medicare Advantage	$814.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$692.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$692.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$692.33
Rate for Payer: Cigna Commercial	$1,357.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.03
Rate for Payer: Qualcare PPO/HMO/WC	$407.25
Rate for Payer: UnitedHealthcare Community & State	$85.79
Rate for Payer: Wellpoint Medicaid Managed Care	$77.11

Know your out-of-pocket cost for care.

All Charges