Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STEM V40 132 DEG 30 MM SZ 8

Facility

$11,954.55

Service Code	HCPCS C1776
Hospital Charge Code	270691036
Hospital Revenue Code	278
Min. Negotiated Rate	$339.51
Max. Negotiated Rate	$5,977.27
Rate for Payer: Aetna Commercial	$4,542.73
Rate for Payer: Aetna Medicare Advantage	$3,586.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,048.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,048.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,048.41
Rate for Payer: Cigna Commercial	$5,977.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,893.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.18
Rate for Payer: UnitedHealthcare Community & State	$377.76
Rate for Payer: Wellpoint Medicaid Managed Care	$339.51

STEM V40 132 DEG 30 MM SZ 8

Facility

$11,954.55

Service Code	HCPCS C1776
Hospital Charge Code	270691036
Hospital Revenue Code	278
Min. Negotiated Rate	$1,793.18
Max. Negotiated Rate	$2,893.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,893.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,793.18

STEM VERSA DIAL 6MM GLEN

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697934
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

STEM VERSA DIAL 6MM GLEN

Facility

$6,000.00

Service Code	HCPCS C1776
Hospital Charge Code	270697934
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

STEM VIVACIT-E HIGHLY CROSSED

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690938
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

STEM VIVACIT-E HIGHLY CROSSED

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690938
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

STEM ZIM FEM 14 140MM 7841-14

Facility

$20,300.20

Service Code	HCPCS C1776
Hospital Charge Code	270613461
Hospital Revenue Code	278
Min. Negotiated Rate	$3,045.03
Max. Negotiated Rate	$4,912.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,060.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,912.65
Rate for Payer: Qualcare PPO/HMO/WC	$3,045.03

STEM ZIM FEM 14 140MM 7841-14

Facility

$20,300.20

Service Code	HCPCS C1776
Hospital Charge Code	270613461
Hospital Revenue Code	278
Min. Negotiated Rate	$576.53
Max. Negotiated Rate	$10,150.10
Rate for Payer: Aetna Commercial	$7,714.08
Rate for Payer: Aetna Medicare Advantage	$6,090.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,176.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,176.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,060.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,176.55
Rate for Payer: Cigna Commercial	$10,150.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,912.65
Rate for Payer: Qualcare PPO/HMO/WC	$3,045.03
Rate for Payer: UnitedHealthcare Community & State	$641.49
Rate for Payer: Wellpoint Medicaid Managed Care	$576.53

STENT 10X60X80 1012532-60

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647802C
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

STENT 10X60X80 1012532-60

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647802C
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT 10X80X80 1012532-80

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647804C
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

STENT 10X80X80 1012532-80

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647804C
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT 3.0X34 DES RSINT30034UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661702C
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

STENT 3.0X34 DES RSINT30034UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661702C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT 3.0X38 DES RSINT30038UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661420C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT 3.0X38 DES RSINT30038UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661420C
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

STENT 3.0X38 DES RSINT30038UX

Facility

$7,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270661420N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

STENT 3.0X38 DES RSINT30038UX

Facility

$7,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270661420N
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

STENT 3.5X34 DES RSINT35034UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661701C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT 3.5X34 DES RSINT35034UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661701C
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

STENT 3.5X38 DES RSINT35038UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661700C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT 3.5X38 DES RSINT35038UX

Facility

$7,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270661700N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,087.50
Max. Negotiated Rate	$1,754.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50

STENT 3.5X38 DES RSINT35038UX

Facility

$7,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270661700N
Hospital Revenue Code	278
Min. Negotiated Rate	$205.90
Max. Negotiated Rate	$3,625.00
Rate for Payer: Aetna Commercial	$2,755.00
Rate for Payer: Aetna Medicare Advantage	$2,175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,848.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,848.75
Rate for Payer: Cigna Commercial	$3,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,754.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,087.50
Rate for Payer: UnitedHealthcare Community & State	$229.10
Rate for Payer: Wellpoint Medicaid Managed Care	$205.90

STENT 3.5X38 DES RSINT35038UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661700C
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

STENT 4.0X38 DES RSINT40034UX

Facility

$5,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270661699C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

Know your out-of-pocket cost for care.

All Charges