Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT ABRE 20MMX120MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695858Z
Hospital Revenue Code	278
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

STENT ABRE 20MMX120MMX90CM

Facility

$0.01

Service Code	HCPCS C1876
Hospital Charge Code	270695858Z
Hospital Revenue Code	278
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$0.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

STENT ABRE VEN 035 10x120x90

Facility

$7,975.00

Hospital Charge Code	270705328
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT ABRE VEN 035 10x120x90

Facility

$7,975.00

Hospital Charge Code	270705328
Hospital Revenue Code	272
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,073.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

STENT ABRE VEN 035 12x100x90

Facility

$7,975.00

Hospital Charge Code	270705329
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT ABRE VEN 035 12x100x90

Facility

$7,975.00

Hospital Charge Code	270705329
Hospital Revenue Code	272
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,073.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

STENT ABRE VEN 035 12x150x90

Facility

$9,125.00

Hospital Charge Code	270705330
Hospital Revenue Code	272
Min. Negotiated Rate	$259.15
Max. Negotiated Rate	$4,562.50
Rate for Payer: Aetna Commercial	$3,467.50
Rate for Payer: Aetna Medicare Advantage	$2,737.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,326.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,326.88
Rate for Payer: Cigna Commercial	$4,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,372.50
Rate for Payer: Oxford Commercial	$1,825.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75
Rate for Payer: UnitedHealthcare Commercial	$1,825.00
Rate for Payer: UnitedHealthcare Community & State	$288.35
Rate for Payer: Wellpoint Medicaid Managed Care	$259.15

STENT ABRE VEN 035 12x150x90

Facility

$9,125.00

Hospital Charge Code	270705330
Hospital Revenue Code	272
Min. Negotiated Rate	$1,368.75
Max. Negotiated Rate	$1,368.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,368.75

STENT ABRE VENOUS035 12x120x90

Facility

$7,975.00

Hospital Charge Code	270705317
Hospital Revenue Code	272
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,073.50
Rate for Payer: Oxford Commercial	$1,595.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Commercial	$1,595.00
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

STENT ABRE VENOUS035 12x120x90

Facility

$7,975.00

Hospital Charge Code	270705317
Hospital Revenue Code	272
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,196.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT ABRE VENOUS 18X120MM

Facility

$7,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270697268S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,196.25
Max. Negotiated Rate	$1,929.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25

STENT ABRE VENOUS 18X120MM

Facility

$7,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270697268S
Hospital Revenue Code	278
Min. Negotiated Rate	$226.49
Max. Negotiated Rate	$3,987.50
Rate for Payer: Aetna Commercial	$3,030.50
Rate for Payer: Aetna Medicare Advantage	$2,392.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,033.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,033.62
Rate for Payer: Cigna Commercial	$3,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,929.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,196.25
Rate for Payer: UnitedHealthcare Community & State	$252.01
Rate for Payer: Wellpoint Medicaid Managed Care	$226.49

STENT ABSOLUTE 6x60mm 135cm

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647807
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 ABSOLUTE 6x60mm 135cm

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270647807
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 ADVANIX BILIARY 10FR12cm

Facility

$651.90

Hospital Charge Code	270675944
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT ADVANIX BILIARY 10FR12cm

Facility

$651.90

Hospital Charge Code	270675944
Hospital Revenue Code	278
Min. Negotiated Rate	$18.51
Max. Negotiated Rate	$325.95
Rate for Payer: Aetna Commercial	$247.72
Rate for Payer: Aetna Medicare Advantage	$195.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.23
Rate for Payer: Cigna Commercial	$325.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78
Rate for Payer: UnitedHealthcare Community & State	$20.60
Rate for Payer: Wellpoint Medicaid Managed Care	$18.51

STENT ADVANIX BILIARY 10FR 5CM

Facility

$661.00

Hospital Charge Code	270675169
Hospital Revenue Code	278
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$330.50
Rate for Payer: Aetna Commercial	$251.18
Rate for Payer: Aetna Medicare Advantage	$198.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.56
Rate for Payer: Cigna Commercial	$330.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.15
Rate for Payer: UnitedHealthcare Community & State	$20.89
Rate for Payer: Wellpoint Medicaid Managed Care	$18.77

STENT ADVANIX BILIARY 10FR 5CM

Facility

$661.00

Hospital Charge Code	270675169
Hospital Revenue Code	278
Min. Negotiated Rate	$99.15
Max. Negotiated Rate	$159.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.15

STENT ADVANIX BILIARY 10FR 7CM

Facility

$661.00

Service Code	HCPCS C2625
Hospital Charge Code	270669218
Hospital Revenue Code	278
Min. Negotiated Rate	$99.15
Max. Negotiated Rate	$159.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.15

STENT ADVANIX BILIARY 10FR 7CM

Facility

$661.00

Service Code	HCPCS C2625
Hospital Charge Code	270669218
Hospital Revenue Code	278
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$330.50
Rate for Payer: Aetna Commercial	$251.18
Rate for Payer: Aetna Medicare Advantage	$198.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.56
Rate for Payer: Cigna Commercial	$330.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.96
Rate for Payer: Qualcare PPO/HMO/WC	$99.15
Rate for Payer: UnitedHealthcare Community & State	$20.89
Rate for Payer: Wellpoint Medicaid Managed Care	$18.77

STENT ADVANIX BILIARY 10FR 9CM

Facility

$651.90

Service Code	HCPCS C2625
Hospital Charge Code	270675170
Hospital Revenue Code	278
Min. Negotiated Rate	$97.78
Max. Negotiated Rate	$157.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78

STENT ADVANIX BILIARY 10FR 9CM

Facility

$651.90

Service Code	HCPCS C2625
Hospital Charge Code	270675170
Hospital Revenue Code	278
Min. Negotiated Rate	$18.51
Max. Negotiated Rate	$325.95
Rate for Payer: Aetna Commercial	$247.72
Rate for Payer: Aetna Medicare Advantage	$195.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$166.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$166.23
Rate for Payer: Cigna Commercial	$325.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$157.76
Rate for Payer: Qualcare PPO/HMO/WC	$97.78
Rate for Payer: UnitedHealthcare Community & State	$20.60
Rate for Payer: Wellpoint Medicaid Managed Care	$18.51

STENT ADVANIX BILIARY 1 OF 7CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663636
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT ADVANIX BILIARY 1 OF 7CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663636
Hospital Revenue Code	278
Min. Negotiated Rate	$19.03
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Community & State	$21.17
Rate for Payer: Wellpoint Medicaid Managed Care	$19.03

STENT ADVANIX BILIARY 1 OF 9CM

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663637
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

Know your out-of-pocket cost for care.

All Charges