Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

GRAFT STENT 26MM OVATION IX

Facility

$12,214.90

Service Code	HCPCS C1768
Hospital Charge Code	270686736A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.23
Max. Negotiated Rate	$2,956.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,442.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,956.01
Rate for Payer: Qualcare PPO/HMO/WC	$1,832.23

GRAFT STENT 38X100MM

Facility

$112,500.00

Service Code	HCPCS L8699
Hospital Charge Code	270697990
Hospital Revenue Code	278
Min. Negotiated Rate	$3,195.00
Max. Negotiated Rate	$56,250.00
Rate for Payer: Aetna Commercial	$42,750.00
Rate for Payer: Aetna Medicare Advantage	$33,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28,687.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28,687.50
Rate for Payer: Cigna Commercial	$56,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00
Rate for Payer: UnitedHealthcare Community & State	$3,555.00
Rate for Payer: Wellpoint Medicaid Managed Care	$3,195.00

GRAFT STENT 38X100MM

Facility

$112,500.00

Service Code	HCPCS L8699
Hospital Charge Code	270697990
Hospital Revenue Code	278
Min. Negotiated Rate	$16,875.00
Max. Negotiated Rate	$27,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,225.00
Rate for Payer: Qualcare PPO/HMO/WC	$16,875.00

GRAFT STENT AAA AFX 28x90/20x3

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270680043
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

GRAFT STENT AAA AFX 28x90/20x3

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270680043
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STENT ALTO ABD 34 MM

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690647
Hospital Revenue Code	278
Min. Negotiated Rate	$10,499.25
Max. Negotiated Rate	$16,938.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25

GRAFT STENT ALTO ABD 34 MM

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690647
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.86
Max. Negotiated Rate	$34,997.50
Rate for Payer: Aetna Commercial	$26,598.10
Rate for Payer: Aetna Medicare Advantage	$20,998.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,848.72
Rate for Payer: Cigna Commercial	$34,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25
Rate for Payer: UnitedHealthcare Community & State	$2,211.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,987.86

GRAFT STENT AORTIC BODY 23MM X

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690650
Hospital Revenue Code	278
Min. Negotiated Rate	$1,987.86
Max. Negotiated Rate	$34,997.50
Rate for Payer: Aetna Commercial	$26,598.10
Rate for Payer: Aetna Medicare Advantage	$20,998.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17,848.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17,848.72
Rate for Payer: Cigna Commercial	$34,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25
Rate for Payer: UnitedHealthcare Community & State	$2,211.84
Rate for Payer: Wellpoint Medicaid Managed Care	$1,987.86

GRAFT STENT AORTIC BODY 23MM X

Facility

$69,995.00

Service Code	HCPCS C1874
Hospital Charge Code	270690650
Hospital Revenue Code	278
Min. Negotiated Rate	$10,499.25
Max. Negotiated Rate	$16,938.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,938.79
Rate for Payer: Qualcare PPO/HMO/WC	$10,499.25

GRAFT STENT BIF 28x90/16x30mm

Facility

$65,795.00

Hospital Charge Code	270680053
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STENT BIF 28x90/16x30mm

Facility

$65,795.00

Hospital Charge Code	270680053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

GRAFT STENT ILIAC 14X14120

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690574
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

GRAFT STENT ILIAC 14X14120

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690574
Hospital Revenue Code	278
Min. Negotiated Rate	$809.26
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$10,828.10
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25
Rate for Payer: UnitedHealthcare Community & State	$900.44
Rate for Payer: Wellpoint Medicaid Managed Care	$809.26

GRAFT STENT ILIAC 14X16X160MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690576
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

GRAFT STENT ILIAC 14X16X160MM

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690576
Hospital Revenue Code	278
Min. Negotiated Rate	$809.26
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$10,828.10
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25
Rate for Payer: UnitedHealthcare Community & State	$900.44
Rate for Payer: Wellpoint Medicaid Managed Care	$809.26

GRAFT STENT ILIAC LIMB14X10X16

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690575
Hospital Revenue Code	278
Min. Negotiated Rate	$4,274.25
Max. Negotiated Rate	$6,895.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25

GRAFT STENT ILIAC LIMB14X10X16

Facility

$28,495.00

Service Code	HCPCS C1874
Hospital Charge Code	270690575
Hospital Revenue Code	278
Min. Negotiated Rate	$809.26
Max. Negotiated Rate	$14,247.50
Rate for Payer: Aetna Commercial	$10,828.10
Rate for Payer: Aetna Medicare Advantage	$8,548.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,266.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,266.23
Rate for Payer: Cigna Commercial	$14,247.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,895.79
Rate for Payer: Qualcare PPO/HMO/WC	$4,274.25
Rate for Payer: UnitedHealthcare Community & State	$900.44
Rate for Payer: Wellpoint Medicaid Managed Care	$809.26

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

GRAFT STENT MAIN BODY 40x120

Facility

$65,795.00

Service Code	HCPCS C1768
Hospital Charge Code	270686385C
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

GRAFT STRETCH 4-6mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270601149
Hospital Revenue Code	278
Min. Negotiated Rate	$466.50
Max. Negotiated Rate	$752.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50

GRAFT STRETCH 4-6mm 45cm

Facility

$3,110.00

Service Code	HCPCS C1768
Hospital Charge Code	270601149
Hospital Revenue Code	278
Min. Negotiated Rate	$88.32
Max. Negotiated Rate	$1,555.00
Rate for Payer: Aetna Commercial	$1,181.80
Rate for Payer: Aetna Medicare Advantage	$933.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$793.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$793.05
Rate for Payer: Cigna Commercial	$1,555.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$752.62
Rate for Payer: Qualcare PPO/HMO/WC	$466.50
Rate for Payer: UnitedHealthcare Community & State	$98.28
Rate for Payer: Wellpoint Medicaid Managed Care	$88.32

GRAFT STRETCH 4-7MM 40CM

Facility

$2,885.00

Service Code	HCPCS C1768
Hospital Charge Code	270691573
Hospital Revenue Code	278
Min. Negotiated Rate	$432.75
Max. Negotiated Rate	$698.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$577.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$698.17
Rate for Payer: Qualcare PPO/HMO/WC	$432.75

GRAFT STRETCH 4-7MM 40CM

Facility

$2,885.00

Service Code	HCPCS C1768
Hospital Charge Code	270691573
Hospital Revenue Code	278
Min. Negotiated Rate	$81.93
Max. Negotiated Rate	$1,442.50
Rate for Payer: Aetna Commercial	$1,096.30
Rate for Payer: Aetna Medicare Advantage	$865.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$735.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$735.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$577.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$735.67
Rate for Payer: Cigna Commercial	$1,442.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$698.17
Rate for Payer: Qualcare PPO/HMO/WC	$432.75
Rate for Payer: UnitedHealthcare Community & State	$91.17
Rate for Payer: Wellpoint Medicaid Managed Care	$81.93

Know your out-of-pocket cost for care.

All Charges