Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167
Hospital Revenue Code	278
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

STENT ADVANIX PANC STR 4FR 5CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677167N
Hospital Revenue Code	278
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

STENT ADVANIX PANC STR 4FR 7CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677168N
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 7CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677168
Hospital Revenue Code	278
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

STENT ADVANIX PANC STR 4FR 7CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677168
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT ADVANIX PANC STR 4FR 7CM

Facility

$425.00

Service Code	HCPCS C2625
Hospital Charge Code	270677168N
Hospital Revenue Code	278
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

STENT ADVANIX PANC STR 5FR 4CM

Facility

$385.00

Service Code	HCPCS C2617
Hospital Charge Code	270677006
Hospital Revenue Code	278
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$192.50
Rate for Payer: Aetna Commercial	$146.30
Rate for Payer: Aetna Medicare Advantage	$115.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.17
Rate for Payer: Cigna Commercial	$192.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75
Rate for Payer: UnitedHealthcare Community & State	$12.17
Rate for Payer: Wellpoint Medicaid Managed Care	$10.93

STENT ADVANIX PANC STR 5FR 4CM

Facility

$385.00

Service Code	HCPCS C2617
Hospital Charge Code	270677006
Hospital Revenue Code	278
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$93.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.17
Rate for Payer: Qualcare PPO/HMO/WC	$57.75

STENT ADVANIX PUSHER 4&5FRSTEN

Facility

$245.75

Hospital Charge Code	270676451
Hospital Revenue Code	272
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$122.88
Rate for Payer: Aetna Commercial	$93.39
Rate for Payer: Aetna Medicare Advantage	$73.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$62.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$62.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$62.67
Rate for Payer: Cigna Commercial	$122.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$63.90
Rate for Payer: Oxford Commercial	$49.15
Rate for Payer: Qualcare PPO/HMO/WC	$36.86
Rate for Payer: UnitedHealthcare Commercial	$49.15
Rate for Payer: UnitedHealthcare Community & State	$7.77
Rate for Payer: Wellpoint Medicaid Managed Care	$6.98

STENT ADVANIX PUSHER 4&5FRSTEN

Facility

$245.75

Hospital Charge Code	270676451
Hospital Revenue Code	272
Min. Negotiated Rate	$36.86
Max. Negotiated Rate	$36.86
Rate for Payer: Qualcare PPO/HMO/WC	$36.86

STENT ADVANTIX PANCRE 10FR 5cm

Facility

$435.00

Hospital Charge Code	270675434
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$105.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

STENT ADVANTIX PANCRE 10FR 5cm

Facility

$435.00

Hospital Charge Code	270675434
Hospital Revenue Code	278
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$165.30
Rate for Payer: Aetna Medicare Advantage	$130.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.92
Rate for Payer: Cigna Commercial	$217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
Rate for Payer: UnitedHealthcare Community & State	$13.75
Rate for Payer: Wellpoint Medicaid Managed Care	$12.35

STENT ADVANTIX PANCRE 10FR 7cm

Facility

$435.00

Hospital Charge Code	270675435
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$105.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

STENT ADVANTIX PANCRE 10FR 7cm

Facility

$435.00

Hospital Charge Code	270675435
Hospital Revenue Code	278
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$165.30
Rate for Payer: Aetna Medicare Advantage	$130.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.92
Rate for Payer: Cigna Commercial	$217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
Rate for Payer: UnitedHealthcare Community & State	$13.75
Rate for Payer: Wellpoint Medicaid Managed Care	$12.35

STENT ADVANTIX PANCRE 10FR 9cm

Facility

$435.00

Hospital Charge Code	270675436
Hospital Revenue Code	278
Min. Negotiated Rate	$65.25
Max. Negotiated Rate	$105.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25

STENT ADVANTIX PANCRE 10FR 9cm

Facility

$435.00

Hospital Charge Code	270675436
Hospital Revenue Code	278
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$165.30
Rate for Payer: Aetna Medicare Advantage	$130.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.92
Rate for Payer: Cigna Commercial	$217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.27
Rate for Payer: Qualcare PPO/HMO/WC	$65.25
Rate for Payer: UnitedHealthcare Community & State	$13.75
Rate for Payer: Wellpoint Medicaid Managed Care	$12.35

STENT ANCILLARY COVER

Facility

$35,590.00

Hospital Charge Code	270686467
Hospital Revenue Code	272
Min. Negotiated Rate	$1,010.76
Max. Negotiated Rate	$17,795.00
Rate for Payer: Aetna Commercial	$13,524.20
Rate for Payer: Aetna Medicare Advantage	$10,677.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,075.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,075.45
Rate for Payer: Cigna Commercial	$17,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,253.40
Rate for Payer: Oxford Commercial	$7,118.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,338.50
Rate for Payer: UnitedHealthcare Commercial	$7,118.00
Rate for Payer: UnitedHealthcare Community & State	$1,124.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1,010.76

STENT ANCILLARY COVER

Facility

$35,590.00

Hospital Charge Code	270686467
Hospital Revenue Code	272
Min. Negotiated Rate	$5,338.50
Max. Negotiated Rate	$5,338.50
Rate for Payer: Qualcare PPO/HMO/WC	$5,338.50

STENT AXIOS SYSTEM 10x10MM

Facility

$24,650.00

Service Code	HCPCS C1874
Hospital Charge Code	270677310
Hospital Revenue Code	278
Min. Negotiated Rate	$700.06
Max. Negotiated Rate	$12,325.00
Rate for Payer: Aetna Commercial	$9,367.00
Rate for Payer: Aetna Medicare Advantage	$7,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,285.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,285.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,285.75
Rate for Payer: Cigna Commercial	$12,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,965.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,697.50
Rate for Payer: UnitedHealthcare Community & State	$778.94
Rate for Payer: Wellpoint Medicaid Managed Care	$700.06

STENT AXIOS SYSTEM 10x10MM

Facility

$24,650.00

Service Code	HCPCS C1874
Hospital Charge Code	270677310
Hospital Revenue Code	278
Min. Negotiated Rate	$3,697.50
Max. Negotiated Rate	$5,965.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,965.30
Rate for Payer: Qualcare PPO/HMO/WC	$3,697.50

STENT AXIOS SYSTEM 15x10MM

Facility

$22,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270677311
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$5,324.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00

STENT AXIOS SYSTEM 15x10MM

Facility

$22,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270677311
Hospital Revenue Code	278
Min. Negotiated Rate	$624.80
Max. Negotiated Rate	$11,000.00
Rate for Payer: Aetna Commercial	$8,360.00
Rate for Payer: Aetna Medicare Advantage	$6,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,610.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,610.00
Rate for Payer: Cigna Commercial	$11,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,324.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,300.00
Rate for Payer: UnitedHealthcare Community & State	$695.20
Rate for Payer: Wellpoint Medicaid Managed Care	$624.80

STENT AXIOS SYSTEM 15 X 15MM

Facility

$24,977.50

Service Code	HCPCS C1874
Hospital Charge Code	270693213
Hospital Revenue Code	278
Min. Negotiated Rate	$709.36
Max. Negotiated Rate	$12,488.75
Rate for Payer: Aetna Commercial	$9,491.45
Rate for Payer: Aetna Medicare Advantage	$7,493.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,369.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,369.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,369.26
Rate for Payer: Cigna Commercial	$12,488.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,044.56
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.62
Rate for Payer: UnitedHealthcare Community & State	$789.29
Rate for Payer: Wellpoint Medicaid Managed Care	$709.36

Know your out-of-pocket cost for care.

All Charges