Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

VIVIGEN GRAFT 1CC

Facility

$2,855.00

Service Code	HCPCS C1762
Hospital Charge Code	270685524
Hospital Revenue Code	278
Min. Negotiated Rate	$81.08
Max. Negotiated Rate	$1,427.50
Rate for Payer: Aetna Commercial	$1,084.90
Rate for Payer: Aetna Medicare Advantage	$856.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$728.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$728.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$728.02
Rate for Payer: Cigna Commercial	$1,427.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.91
Rate for Payer: Qualcare PPO/HMO/WC	$428.25
Rate for Payer: UnitedHealthcare Community & State	$90.22
Rate for Payer: Wellpoint Medicaid Managed Care	$81.08

VIVIGEN GRAFT 1CC

Facility

$2,715.00

Service Code	HCPCS C1762
Hospital Charge Code	270679087
Hospital Revenue Code	278
Min. Negotiated Rate	$407.25
Max. Negotiated Rate	$657.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$657.03
Rate for Payer: Qualcare PPO/HMO/WC	$407.25

VIVIGEN GRAFT 1CC

Facility

$2,855.00

Service Code	HCPCS C1762
Hospital Charge Code	270685524
Hospital Revenue Code	278
Min. Negotiated Rate	$428.25
Max. Negotiated Rate	$690.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$571.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$690.91
Rate for Payer: Qualcare PPO/HMO/WC	$428.25

VIVIGEN GRAFT 5CC

Facility

$12,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270679086
Hospital Revenue Code	278
Min. Negotiated Rate	$1,837.50
Max. Negotiated Rate	$2,964.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50

VIVIGEN GRAFT 5CC

Facility

$12,250.00

Service Code	HCPCS C1762
Hospital Charge Code	270679086
Hospital Revenue Code	278
Min. Negotiated Rate	$347.90
Max. Negotiated Rate	$6,125.00
Rate for Payer: Aetna Commercial	$4,655.00
Rate for Payer: Aetna Medicare Advantage	$3,675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,123.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,123.75
Rate for Payer: Cigna Commercial	$6,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,964.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,837.50
Rate for Payer: UnitedHealthcare Community & State	$387.10
Rate for Payer: Wellpoint Medicaid Managed Care	$347.90

Vivitrol 380mg inj

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390242
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

Vivitrol 380mg inj

Facility

$10,218.84

Service Code	HCPCS J2315
Hospital Charge Code	606390242
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

Vivitrol 380mg Susp Syrg

Facility

$6,600.00

Hospital Charge Code	606380006
Hospital Revenue Code	636
Min. Negotiated Rate	$990.00
Max. Negotiated Rate	$1,597.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00

Vivitrol 380mg Susp Syrg

Facility

$6,600.00

Hospital Charge Code	606380006
Hospital Revenue Code	636
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$3,300.00
Rate for Payer: Aetna Commercial	$2,508.00
Rate for Payer: Aetna Medicare Advantage	$1,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,683.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,683.00
Rate for Payer: Cigna Commercial	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,597.20
Rate for Payer: Qualcare PPO/HMO/WC	$990.00
Rate for Payer: UnitedHealthcare Community & State	$208.56
Rate for Payer: Wellpoint Medicaid Managed Care	$187.44

VIVONEX JEJUNOSTOMY KIT

Facility

$389.00

Hospital Charge Code	270332052
Hospital Revenue Code	272
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$194.50
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: Aetna Medicare Advantage	$116.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.19
Rate for Payer: Cigna Commercial	$194.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.14
Rate for Payer: Oxford Commercial	$77.80
Rate for Payer: Qualcare PPO/HMO/WC	$58.35
Rate for Payer: UnitedHealthcare Commercial	$77.80
Rate for Payer: UnitedHealthcare Community & State	$12.29
Rate for Payer: Wellpoint Medicaid Managed Care	$11.05

VIVONEX JEJUNOSTOMY KIT

Facility

$389.00

Hospital Charge Code	270332052
Hospital Revenue Code	272
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$58.35
Rate for Payer: Qualcare PPO/HMO/WC	$58.35

VIZADISC 2 PK REPLACEMENT KIT

Facility

$170.00

Hospital Charge Code	270668075
Hospital Revenue Code	272
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.20
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$34.00
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

VIZADISC 2 PK REPLACEMENT KIT

Facility

$170.00

Hospital Charge Code	270668075
Hospital Revenue Code	272
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

VIZADISC KNEE TRACE KIT

Facility

$1,140.75

Hospital Charge Code	270668479
Hospital Revenue Code	272
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$570.38
Rate for Payer: Aetna Commercial	$433.49
Rate for Payer: Aetna Medicare Advantage	$342.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.89
Rate for Payer: Cigna Commercial	$570.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$296.60
Rate for Payer: Oxford Commercial	$228.15
Rate for Payer: Qualcare PPO/HMO/WC	$171.11
Rate for Payer: UnitedHealthcare Commercial	$228.15
Rate for Payer: UnitedHealthcare Community & State	$36.05
Rate for Payer: Wellpoint Medicaid Managed Care	$32.40

VIZADISC KNEE TRACE KIT

Facility

$1,140.75

Hospital Charge Code	270668479
Hospital Revenue Code	272
Min. Negotiated Rate	$171.11
Max. Negotiated Rate	$171.11
Rate for Payer: Qualcare PPO/HMO/WC	$171.11

VIZISHOT FLEX

Facility

$1,586.20

Hospital Charge Code	270678497
Hospital Revenue Code	272
Min. Negotiated Rate	$237.93
Max. Negotiated Rate	$237.93
Rate for Payer: Qualcare PPO/HMO/WC	$237.93

VIZISHOT FLEX

Facility

$1,586.20

Hospital Charge Code	270678497
Hospital Revenue Code	272
Min. Negotiated Rate	$45.05
Max. Negotiated Rate	$793.10
Rate for Payer: Aetna Commercial	$602.76
Rate for Payer: Aetna Medicare Advantage	$475.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$404.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$404.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$404.48
Rate for Payer: Cigna Commercial	$793.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$412.41
Rate for Payer: Oxford Commercial	$317.24
Rate for Payer: Qualcare PPO/HMO/WC	$237.93
Rate for Payer: UnitedHealthcare Commercial	$317.24
Rate for Payer: UnitedHealthcare Community & State	$50.12
Rate for Payer: Wellpoint Medicaid Managed Care	$45.05

V-LOC 180 3-0 ENDO STITCH

Facility

$296.25

Hospital Charge Code	270692038
Hospital Revenue Code	272
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$148.12
Rate for Payer: Aetna Commercial	$112.58
Rate for Payer: Aetna Medicare Advantage	$88.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.54
Rate for Payer: Cigna Commercial	$148.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.03
Rate for Payer: Oxford Commercial	$59.25
Rate for Payer: Qualcare PPO/HMO/WC	$44.44
Rate for Payer: UnitedHealthcare Commercial	$59.25
Rate for Payer: UnitedHealthcare Community & State	$9.36
Rate for Payer: Wellpoint Medicaid Managed Care	$8.41

V-LOC 180 3-0 ENDO STITCH

Facility

$296.25

Hospital Charge Code	270692038
Hospital Revenue Code	272
Min. Negotiated Rate	$44.44
Max. Negotiated Rate	$44.44
Rate for Payer: Qualcare PPO/HMO/WC	$44.44

VLOK ADULT BP INFL SYST

Facility

$146.67

Hospital Charge Code	270650039
Hospital Revenue Code	272
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$73.33
Rate for Payer: Aetna Commercial	$55.73
Rate for Payer: Aetna Medicare Advantage	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$37.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$37.40
Rate for Payer: Cigna Commercial	$73.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.13
Rate for Payer: Oxford Commercial	$29.33
Rate for Payer: Qualcare PPO/HMO/WC	$22.00
Rate for Payer: UnitedHealthcare Commercial	$29.33
Rate for Payer: UnitedHealthcare Community & State	$4.63
Rate for Payer: Wellpoint Medicaid Managed Care	$4.17

VLOK ADULT BP INFL SYST

Facility

$146.67

Hospital Charge Code	270650039
Hospital Revenue Code	272
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$22.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.00

VMA 24 HR W/O CREATININE

Facility

$390.00

Service Code	HCPCS 84585
Hospital Charge Code	39900147
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

VMA 24 HR W/O CREATININE

Facility

$390.00

Service Code	HCPCS 84585
Hospital Charge Code	39900147
Hospital Revenue Code	301
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$42.16
Rate for Payer: Aetna Medicare Advantage	$50.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.23
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$15.50
Rate for Payer: Clover Medicare Advantage	$14.72
Rate for Payer: EmblemHealth Commercial	$46.50
Rate for Payer: Humana Medicare Advantage	$15.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.50
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	$12.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.50
Rate for Payer: Wellcare Medicare Advantage	$15.50
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VMA,URINE I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39990067A
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$14.09
Rate for Payer: Aetna Medicare Advantage	$16.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.79
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$5.18
Rate for Payer: Clover Medicare Advantage	$4.92
Rate for Payer: EmblemHealth Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$5.34
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$5.18
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	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.18
Rate for Payer: Wellcare Medicare Advantage	$5.18
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

VMA,URINE I

Facility

$390.00

Service Code	HCPCS 82570
Hospital Charge Code	39990067A
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

Know your out-of-pocket cost for care.

All Charges