Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ILIAC STENT W/PTA-BI

Facility

$62,620.72

Service Code	HCPCS 3722150
Hospital Charge Code	2690500
Hospital Revenue Code	361
Min. Negotiated Rate	$9,393.11
Max. Negotiated Rate	$9,393.11
Rate for Payer: Qualcare PPO/HMO/WC	$9,393.11

ILIAC STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	321037221L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	2691330
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	2691330
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC STENT W/PTA-LT

Facility

$61,616.39

Service Code	HCPCS 37221LT
Hospital Charge Code	321037221L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	2691335
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	2691335
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	321037221R
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

ILIAC STENT W/PTA-RT

Facility

$61,616.39

Service Code	HCPCS 37221RT
Hospital Charge Code	321037221R
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

ILIAC STENT W/PTA UNI

Facility

$15,877.00

Service Code	HCPCS 37258
Hospital Charge Code	411037221
Hospital Revenue Code	361
Min. Negotiated Rate	$450.91
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,128.02
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55
Rate for Payer: UnitedHealthcare Community & State	$501.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$450.91

ILIAC STENT W/PTA UNI

Facility

$15,877.00

Service Code	HCPCS 37258
Hospital Charge Code	411037221
Hospital Revenue Code	361
Min. Negotiated Rate	$2,381.55
Max. Negotiated Rate	$2,381.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,381.55

ILIAC WEDGE (18MM X 20MM)IMPLT

Facility

$1,835.00

Hospital Charge Code	270335501
Hospital Revenue Code	278
Min. Negotiated Rate	$275.25
Max. Negotiated Rate	$444.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$367.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.07
Rate for Payer: Qualcare PPO/HMO/WC	$275.25

ILIAC WEDGE (18MM X 20MM)IMPLT

Facility

$1,835.00

Hospital Charge Code	270335501
Hospital Revenue Code	278
Min. Negotiated Rate	$52.11
Max. Negotiated Rate	$917.50
Rate for Payer: Aetna Commercial	$697.30
Rate for Payer: Aetna Medicare Advantage	$550.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$467.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$467.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$367.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$467.93
Rate for Payer: Cigna Commercial	$917.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$444.07
Rate for Payer: Qualcare PPO/HMO/WC	$275.25
Rate for Payer: UnitedHealthcare Community & State	$57.99
Rate for Payer: Wellpoint Medicaid Managed Care	$52.11

ILIUM TRICORTICAL STRIP

Facility

$3,527.00

Hospital Charge Code	270335483
Hospital Revenue Code	278
Min. Negotiated Rate	$100.17
Max. Negotiated Rate	$1,763.50
Rate for Payer: Aetna Commercial	$1,340.26
Rate for Payer: Aetna Medicare Advantage	$1,058.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$899.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$899.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$705.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$899.38
Rate for Payer: Cigna Commercial	$1,763.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.53
Rate for Payer: Qualcare PPO/HMO/WC	$529.05
Rate for Payer: UnitedHealthcare Community & State	$111.45
Rate for Payer: Wellpoint Medicaid Managed Care	$100.17

ILIUM TRICORTICAL STRIP

Facility

$3,527.00

Hospital Charge Code	270335483
Hospital Revenue Code	278
Min. Negotiated Rate	$529.05
Max. Negotiated Rate	$853.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$705.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$853.53
Rate for Payer: Qualcare PPO/HMO/WC	$529.05

ILLIAC LIMB 10X 100MM

Facility

$23,495.00

Hospital Charge Code	270683416
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

ILLIAC LIMB 10X 100MM

Facility

$23,495.00

Hospital Charge Code	270683416
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

ILLIAC LIMB 22 X 140 MM

Facility

$23,495.00

Hospital Charge Code	270683418
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

ILLIAC LIMB 22 X 140 MM

Facility

$23,495.00

Hospital Charge Code	270683418
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

IL LMB SYS OVAT iXPMA14-28-140

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679786
Hospital Revenue Code	278
Min. Negotiated Rate	$709.86
Max. Negotiated Rate	$12,497.50
Rate for Payer: Aetna Commercial	$9,498.10
Rate for Payer: Aetna Medicare Advantage	$7,498.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,373.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,373.73
Rate for Payer: Cigna Commercial	$12,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25
Rate for Payer: UnitedHealthcare Community & State	$789.84
Rate for Payer: Wellpoint Medicaid Managed Care	$709.86

IL LMB SYS OVAT iXPMA14-28-140

Facility

$24,995.00

Service Code	HCPCS C1768
Hospital Charge Code	270679786
Hospital Revenue Code	278
Min. Negotiated Rate	$3,749.25
Max. Negotiated Rate	$6,048.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,999.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,048.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,749.25

ILLUMINATOR POST 26MM

Facility

$3,005.00

Hospital Charge Code	270703130
Hospital Revenue Code	278
Min. Negotiated Rate	$450.75
Max. Negotiated Rate	$727.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75

ILLUMINATOR POST 26MM

Facility

$3,005.00

Hospital Charge Code	270703130
Hospital Revenue Code	278
Min. Negotiated Rate	$85.34
Max. Negotiated Rate	$1,502.50
Rate for Payer: Aetna Commercial	$1,141.90
Rate for Payer: Aetna Medicare Advantage	$901.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$766.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$601.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$766.27
Rate for Payer: Cigna Commercial	$1,502.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$727.21
Rate for Payer: Qualcare PPO/HMO/WC	$450.75
Rate for Payer: UnitedHealthcare Community & State	$94.96
Rate for Payer: Wellpoint Medicaid Managed Care	$85.34

ILUMYA (TILDRAKIZUMAB) 1MG/ML

Facility

$111,876.60

Service Code	HCPCS J3245
Hospital Charge Code	606390483
Hospital Revenue Code	636
Min. Negotiated Rate	$112.29
Max. Negotiated Rate	$27,074.14
Rate for Payer: Aetna Commercial	$321.50
Rate for Payer: Aetna Medicare Advantage	$382.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$428.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$428.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$118.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$428.77
Rate for Payer: Cigna Medicare Advantage	$118.20
Rate for Payer: Clover Medicare Advantage	$112.29
Rate for Payer: EmblemHealth Commercial	$354.60
Rate for Payer: Humana Medicare Advantage	$121.75
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$118.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,074.14
Rate for Payer: Qualcare PPO/HMO/WC	$16,781.49
Rate for Payer: UnitedHealthcare Community & State	$3,535.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$118.20
Rate for Payer: Wellcare Medicare Advantage	$118.20
Rate for Payer: Wellpoint Medicaid Managed Care	$3,177.30

ILUMYA (TILDRAKIZUMAB) 1MG/ML

Facility

$111,876.60

Service Code	HCPCS J3245
Hospital Charge Code	606390483
Hospital Revenue Code	636
Min. Negotiated Rate	$16,781.49
Max. Negotiated Rate	$27,074.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27,074.14
Rate for Payer: Qualcare PPO/HMO/WC	$16,781.49

Know your out-of-pocket cost for care.

All Charges