Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$3,746.62
Max. Negotiated Rate	$6,044.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,995.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,044.56
Rate for Payer: Qualcare PPO/HMO/WC	$3,746.62

STENT BALLOON AORTIC 65MM

Facility

$3,995.00

Service Code	HCPCS C1725
Hospital Charge Code	270697993C
Hospital Revenue Code	278
Min. Negotiated Rate	$599.25
Max. Negotiated Rate	$966.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.79
Rate for Payer: Qualcare PPO/HMO/WC	$599.25

STENT BALLOON AORTIC 65MM

Facility

$3,995.00

Service Code	HCPCS C1725
Hospital Charge Code	270697993C
Hospital Revenue Code	278
Min. Negotiated Rate	$113.46
Max. Negotiated Rate	$1,997.50
Rate for Payer: Aetna Commercial	$1,518.10
Rate for Payer: Aetna Medicare Advantage	$1,198.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,018.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,018.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$799.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,018.73
Rate for Payer: Cigna Commercial	$1,997.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$966.79
Rate for Payer: Qualcare PPO/HMO/WC	$599.25
Rate for Payer: UnitedHealthcare Community & State	$126.24
Rate for Payer: Wellpoint Medicaid Managed Care	$113.46

STENT BIL-GORE V 8MM X 40 MM

Facility

$4,043.00

Hospital Charge Code	270326004
Hospital Revenue Code	278
Min. Negotiated Rate	$606.45
Max. Negotiated Rate	$978.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.41
Rate for Payer: Qualcare PPO/HMO/WC	$606.45

STENT BIL-GORE V 8MM X 40 MM

Facility

$4,043.00

Hospital Charge Code	270326004
Hospital Revenue Code	278
Min. Negotiated Rate	$114.82
Max. Negotiated Rate	$2,021.50
Rate for Payer: Aetna Commercial	$1,536.34
Rate for Payer: Aetna Medicare Advantage	$1,212.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,030.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,030.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,030.96
Rate for Payer: Cigna Commercial	$2,021.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.41
Rate for Payer: Qualcare PPO/HMO/WC	$606.45
Rate for Payer: UnitedHealthcare Community & State	$127.76
Rate for Payer: Wellpoint Medicaid Managed Care	$114.82

STENT BILIARY MCV 10Fx7c 5461

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270628066
Hospital Revenue Code	278
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: Qualcare PPO/HMO/WC	$96.00

STENT BILIARY MCV 10Fx7c 5461

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270628066
Hospital Revenue Code	278
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$320.00
Rate for Payer: Aetna Commercial	$243.20
Rate for Payer: Aetna Medicare Advantage	$192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.20
Rate for Payer: Cigna Commercial	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: Qualcare PPO/HMO/WC	$96.00
Rate for Payer: UnitedHealthcare Community & State	$20.22
Rate for Payer: Wellpoint Medicaid Managed Care	$18.18

STENT BILIARY RX 7FR 12cm 4558

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270636840
Hospital Revenue Code	278
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: Qualcare PPO/HMO/WC	$96.00

STENT BILIARY RX 7FR 12cm 4558

Facility

$640.00

Service Code	HCPCS C2625
Hospital Charge Code	270636840
Hospital Revenue Code	278
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$320.00
Rate for Payer: Aetna Commercial	$243.20
Rate for Payer: Aetna Medicare Advantage	$192.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$128.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.20
Rate for Payer: Cigna Commercial	$320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$154.88
Rate for Payer: Qualcare PPO/HMO/WC	$96.00
Rate for Payer: UnitedHealthcare Community & State	$20.22
Rate for Payer: Wellpoint Medicaid Managed Care	$18.18

STENT BILIARY RX 7FR 5CM 4555

Facility

$455.60

Service Code	HCPCS C2625
Hospital Charge Code	270636466
Hospital Revenue Code	278
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$227.80
Rate for Payer: Aetna Commercial	$173.13
Rate for Payer: Aetna Medicare Advantage	$136.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$116.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$116.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$116.18
Rate for Payer: Cigna Commercial	$227.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.26
Rate for Payer: Qualcare PPO/HMO/WC	$68.34
Rate for Payer: UnitedHealthcare Community & State	$14.40
Rate for Payer: Wellpoint Medicaid Managed Care	$12.94

STENT BILIARY RX 7FR 5CM 4555

Facility

$455.60

Service Code	HCPCS C2625
Hospital Charge Code	270636466
Hospital Revenue Code	278
Min. Negotiated Rate	$68.34
Max. Negotiated Rate	$110.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$91.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$110.26
Rate for Payer: Qualcare PPO/HMO/WC	$68.34

STENT BILIARY RX COVER RMV 10X

Facility

$12,999.50

Service Code	HCPCS C2625
Hospital Charge Code	270680141
Hospital Revenue Code	278
Min. Negotiated Rate	$369.19
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$4,939.81
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92
Rate for Payer: UnitedHealthcare Community & State	$410.78
Rate for Payer: Wellpoint Medicaid Managed Care	$369.19

STENT BILIARY RX COVER RMV 10X

Facility

$12,999.50

Service Code	HCPCS C2625
Hospital Charge Code	270680141
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT BILIARY ZIMMON ZEBD-7-4

Facility

$685.00

Service Code	HCPCS C2617
Hospital Charge Code	270609869
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$165.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILIARY ZIMMON ZEBD-7-4

Facility

$685.00

Service Code	HCPCS C2617
Hospital Charge Code	270609869
Hospital Revenue Code	278
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$342.50
Rate for Payer: Aetna Commercial	$260.30
Rate for Payer: Aetna Medicare Advantage	$205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.68
Rate for Payer: Cigna Commercial	$342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75
Rate for Payer: UnitedHealthcare Community & State	$21.65
Rate for Payer: Wellpoint Medicaid Managed Care	$19.45

STENT BILIARY ZIMMON ZEBD-7-7

Facility

$685.00

Service Code	HCPCS C2625
Hospital Charge Code	270600972
Hospital Revenue Code	278
Min. Negotiated Rate	$19.45
Max. Negotiated Rate	$342.50
Rate for Payer: Aetna Commercial	$260.30
Rate for Payer: Aetna Medicare Advantage	$205.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$174.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$174.68
Rate for Payer: Cigna Commercial	$342.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75
Rate for Payer: UnitedHealthcare Community & State	$21.65
Rate for Payer: Wellpoint Medicaid Managed Care	$19.45

STENT BILIARY ZIMMON ZEBD-7-7

Facility

$685.00

Service Code	HCPCS C2625
Hospital Charge Code	270600972
Hospital Revenue Code	278
Min. Negotiated Rate	$102.75
Max. Negotiated Rate	$165.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$137.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$165.77
Rate for Payer: Qualcare PPO/HMO/WC	$102.75

STENT BILLARY ADVANIX 10X7

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663474
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 BILLARY ADVANIX 10X7

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663474
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 CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404
Hospital Revenue Code	278
Min. Negotiated Rate	$365.65
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$406.85
Rate for Payer: Wellpoint Medicaid Managed Care	$365.65

STENT CAST COV.9MM X 38MMX80CM

Facility

$12,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270653404N
Hospital Revenue Code	278
Min. Negotiated Rate	$365.65
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$406.85
Rate for Payer: Wellpoint Medicaid Managed Care	$365.65

STENT CENTER BEND STR SZ 10-5

Facility

$266.50

Hospital Charge Code	270673446
Hospital Revenue Code	278
Min. Negotiated Rate	$39.98
Max. Negotiated Rate	$64.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98

STENT CENTER BEND STR SZ 10-5

Facility

$266.50

Hospital Charge Code	270673446
Hospital Revenue Code	278
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$101.27
Rate for Payer: Aetna Medicare Advantage	$79.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$67.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$53.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$67.96
Rate for Payer: Cigna Commercial	$133.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$64.49
Rate for Payer: Qualcare PPO/HMO/WC	$39.98
Rate for Payer: UnitedHealthcare Community & State	$8.42
Rate for Payer: Wellpoint Medicaid Managed Care	$7.57

Know your out-of-pocket cost for care.

All Charges