Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STEM ECHO B-MTRC MP FP

Facility

$30,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270691088
Hospital Revenue Code	278
Min. Negotiated Rate	$4,621.50
Max. Negotiated Rate	$7,456.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,456.02
Rate for Payer: Qualcare PPO/HMO/WC	$4,621.50

STEM ECHO B-MTRC MP FP

Facility

$30,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270691088
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,405.00
Rate for Payer: Aetna Commercial	$11,707.80
Rate for Payer: Aetna Medicare Advantage	$9,243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,856.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,856.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,856.55
Rate for Payer: Cigna Commercial	$15,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,456.02
Rate for Payer: Qualcare PPO/HMO/WC	$4,621.50
Rate for Payer: UnitedHealthcare Community & State	$973.60
Rate for Payer: Wellpoint Medicaid Managed Care	$875.00

STEM ECHO MTRC 7 X 94

Facility

$30,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270691943
Hospital Revenue Code	278
Min. Negotiated Rate	$4,621.50
Max. Negotiated Rate	$7,456.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,456.02
Rate for Payer: Qualcare PPO/HMO/WC	$4,621.50

STEM ECHO MTRC 7 X 94

Facility

$30,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270691943
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,405.00
Rate for Payer: Aetna Commercial	$11,707.80
Rate for Payer: Aetna Medicare Advantage	$9,243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,856.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,856.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,856.55
Rate for Payer: Cigna Commercial	$15,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,456.02
Rate for Payer: Qualcare PPO/HMO/WC	$4,621.50
Rate for Payer: UnitedHealthcare Community & State	$973.60
Rate for Payer: Wellpoint Medicaid Managed Care	$875.00

STEM ECHO POR FMRL RPP SZ 9

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690981
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

STEM ECHO POR FMRL RPP SZ 9

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690981
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

STEM ELEOS EXT CEMENTED 14 MM

Facility

$5,490.00

Service Code	HCPCS C1776
Hospital Charge Code	2706828402
Hospital Revenue Code	278
Min. Negotiated Rate	$823.50
Max. Negotiated Rate	$1,328.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,098.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.58
Rate for Payer: Qualcare PPO/HMO/WC	$823.50

STEM ELEOS EXT CEMENTED 14 MM

Facility

$5,490.00

Service Code	HCPCS C1776
Hospital Charge Code	2706828402
Hospital Revenue Code	278
Min. Negotiated Rate	$155.92
Max. Negotiated Rate	$2,745.00
Rate for Payer: Aetna Commercial	$2,086.20
Rate for Payer: Aetna Medicare Advantage	$1,647.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,399.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,399.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,098.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,399.95
Rate for Payer: Cigna Commercial	$2,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.58
Rate for Payer: Qualcare PPO/HMO/WC	$823.50
Rate for Payer: UnitedHealthcare Community & State	$173.48
Rate for Payer: Wellpoint Medicaid Managed Care	$155.92

STEM ELEOS EXT CEMENTED 14 MM

Facility

$5,490.00

Service Code	HCPCS C1776
Hospital Charge Code	270682840
Hospital Revenue Code	278
Min. Negotiated Rate	$155.92
Max. Negotiated Rate	$2,745.00
Rate for Payer: Aetna Commercial	$2,086.20
Rate for Payer: Aetna Medicare Advantage	$1,647.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,399.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,399.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,098.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,399.95
Rate for Payer: Cigna Commercial	$2,745.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.58
Rate for Payer: Qualcare PPO/HMO/WC	$823.50
Rate for Payer: UnitedHealthcare Community & State	$173.48
Rate for Payer: Wellpoint Medicaid Managed Care	$155.92

STEM ELEOS EXT CEMENTED 14 MM

Facility

$5,490.00

Service Code	HCPCS C1776
Hospital Charge Code	270682840
Hospital Revenue Code	278
Min. Negotiated Rate	$823.50
Max. Negotiated Rate	$1,328.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,098.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,328.58
Rate for Payer: Qualcare PPO/HMO/WC	$823.50

STEM EMPOWER LEFT COATED SZ 7

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270691776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,835.00
Max. Negotiated Rate	$4,573.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,780.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,835.00

STEM EMPOWER LEFT COATED SZ 7

Facility

$18,900.00

Service Code	HCPCS C1776
Hospital Charge Code	270691776
Hospital Revenue Code	278
Min. Negotiated Rate	$536.76
Max. Negotiated Rate	$9,450.00
Rate for Payer: Aetna Commercial	$7,182.00
Rate for Payer: Aetna Medicare Advantage	$5,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,819.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,819.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,780.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,819.50
Rate for Payer: Cigna Commercial	$9,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,573.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,835.00
Rate for Payer: UnitedHealthcare Community & State	$597.24
Rate for Payer: Wellpoint Medicaid Managed Care	$536.76

STEM EXPLOR RADIAL 8x28mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680736
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

STEM EXPLOR RADIAL 8x28mm

Facility

$15,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270680736
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STEM EXT 10 MM

Facility

$19,430.00

Hospital Charge Code	270703332
Hospital Revenue Code	278
Min. Negotiated Rate	$551.81
Max. Negotiated Rate	$9,715.00
Rate for Payer: Aetna Commercial	$7,383.40
Rate for Payer: Aetna Medicare Advantage	$5,829.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,954.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,954.65
Rate for Payer: Cigna Commercial	$9,715.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50
Rate for Payer: UnitedHealthcare Community & State	$613.99
Rate for Payer: Wellpoint Medicaid Managed Care	$551.81

STEM EXT 10 MM

Facility

$19,430.00

Hospital Charge Code	270703332
Hospital Revenue Code	278
Min. Negotiated Rate	$2,914.50
Max. Negotiated Rate	$4,702.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,886.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,702.06
Rate for Payer: Qualcare PPO/HMO/WC	$2,914.50

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683942
Hospital Revenue Code	278
Min. Negotiated Rate	$312.68
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$4,183.80
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50
Rate for Payer: UnitedHealthcare Community & State	$347.92
Rate for Payer: Wellpoint Medicaid Managed Care	$312.68

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683937
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683937
Hospital Revenue Code	278
Min. Negotiated Rate	$312.68
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$4,183.80
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50
Rate for Payer: UnitedHealthcare Community & State	$347.92
Rate for Payer: Wellpoint Medicaid Managed Care	$312.68

STEM EXTEN FEM AND TI 14X40MM

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270683942
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXTEN. FEM AND TIB 14X80m

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270682016
Hospital Revenue Code	278
Min. Negotiated Rate	$312.68
Max. Negotiated Rate	$5,505.00
Rate for Payer: Aetna Commercial	$4,183.80
Rate for Payer: Aetna Medicare Advantage	$3,303.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,807.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,807.55
Rate for Payer: Cigna Commercial	$5,505.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50
Rate for Payer: UnitedHealthcare Community & State	$347.92
Rate for Payer: Wellpoint Medicaid Managed Care	$312.68

STEM EXTEN. FEM AND TIB 14X80m

Facility

$11,010.00

Service Code	HCPCS C1776
Hospital Charge Code	270682016
Hospital Revenue Code	278
Min. Negotiated Rate	$1,651.50
Max. Negotiated Rate	$2,664.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,202.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,664.42
Rate for Payer: Qualcare PPO/HMO/WC	$1,651.50

STEM EXTENSION 15MM X 30MM

Facility

$5,245.00

Hospital Charge Code	270667171
Hospital Revenue Code	278
Min. Negotiated Rate	$786.75
Max. Negotiated Rate	$1,269.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75

STEM EXTENSION 15MM X 30MM

Facility

$5,245.00

Hospital Charge Code	270667171
Hospital Revenue Code	278
Min. Negotiated Rate	$148.96
Max. Negotiated Rate	$2,622.50
Rate for Payer: Aetna Commercial	$1,993.10
Rate for Payer: Aetna Medicare Advantage	$1,573.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,337.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,049.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,337.47
Rate for Payer: Cigna Commercial	$2,622.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,269.29
Rate for Payer: Qualcare PPO/HMO/WC	$786.75
Rate for Payer: UnitedHealthcare Community & State	$165.74
Rate for Payer: Wellpoint Medicaid Managed Care	$148.96

STEM EXTENSION FEM TIB 12x80MM

Facility

$4,164.75

Hospital Charge Code	270675508
Hospital Revenue Code	278
Min. Negotiated Rate	$624.71
Max. Negotiated Rate	$1,007.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$832.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,007.87
Rate for Payer: Qualcare PPO/HMO/WC	$624.71

Know your out-of-pocket cost for care.

All Charges