Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT DRUG-ELUT PERIPH 6x80MM

Facility

$8,975.00

Hospital Charge Code	270667654
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

STENT DRUG-ELUT PERIPH 6x80MM

Facility

$8,975.00

Hospital Charge Code	270667654
Hospital Revenue Code	278
Min. Negotiated Rate	$254.89
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$283.61
Rate for Payer: Wellpoint Medicaid Managed Care	$254.89

STENT EMBOL PIPLINE 4X12MM

Facility

$89,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270696541S
Hospital Revenue Code	278
Min. Negotiated Rate	$13,395.00
Max. Negotiated Rate	$21,610.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00

STENT EMBOL PIPLINE 4X12MM

Facility

$89,300.00

Service Code	HCPCS C1884
Hospital Charge Code	270696541S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,536.12
Max. Negotiated Rate	$44,650.00
Rate for Payer: Aetna Commercial	$33,934.00
Rate for Payer: Aetna Medicare Advantage	$26,790.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,771.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,860.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,771.50
Rate for Payer: Cigna Commercial	$44,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21,610.60
Rate for Payer: Qualcare PPO/HMO/WC	$13,395.00
Rate for Payer: UnitedHealthcare Community & State	$2,821.88
Rate for Payer: Wellpoint Medicaid Managed Care	$2,536.12

STENT ENDOMAXX 23MM 120 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688794
Hospital Revenue Code	278
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$442.40
Rate for Payer: Wellpoint Medicaid Managed Care	$397.60

STENT ENDOMAXX 23MM 120 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688794
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STENT ENDOMAXX 23MM 150 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688795
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,388.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STENT ENDOMAXX 23MM 150 MM

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688795
Hospital Revenue Code	278
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,388.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Community & State	$442.40
Rate for Payer: Wellpoint Medicaid Managed Care	$397.60

STENT ENDOPROSTH GFT 8X7.6MM

Facility

$19,230.00

Service Code	HCPCS C1874
Hospital Charge Code	270689581S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,884.50
Max. Negotiated Rate	$4,653.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,846.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,653.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50

STENT ENDOPROSTH GFT 8X7.6MM

Facility

$19,230.00

Service Code	HCPCS C1874
Hospital Charge Code	270689581S
Hospital Revenue Code	278
Min. Negotiated Rate	$546.13
Max. Negotiated Rate	$9,615.00
Rate for Payer: Aetna Commercial	$7,307.40
Rate for Payer: Aetna Medicare Advantage	$5,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,846.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,903.65
Rate for Payer: Cigna Commercial	$9,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,653.66
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50
Rate for Payer: UnitedHealthcare Community & State	$607.67
Rate for Payer: Wellpoint Medicaid Managed Care	$546.13

STENT EPIC VASC 6FR 8x60x75

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594
Hospital Revenue Code	278
Min. Negotiated Rate	$806.25
Max. Negotiated Rate	$1,300.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25

STENT EPIC VASC 6FR 8x60x75

Facility

$6,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594N
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

STENT EPIC VASC 6FR 8x60x75

Facility

$5,375.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594
Hospital Revenue Code	278
Min. Negotiated Rate	$152.65
Max. Negotiated Rate	$2,687.50
Rate for Payer: Aetna Commercial	$2,042.50
Rate for Payer: Aetna Medicare Advantage	$1,612.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,370.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,370.62
Rate for Payer: Cigna Commercial	$2,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,300.75
Rate for Payer: Qualcare PPO/HMO/WC	$806.25
Rate for Payer: UnitedHealthcare Community & State	$169.85
Rate for Payer: Wellpoint Medicaid Managed Care	$152.65

STENT EPIC VASC 6FR 8x60x75

Facility

$6,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270677594N
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

STENT ESOPH FULL COVER 19X120

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688531
Hospital Revenue Code	272
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00

STENT ESOPH FULL COVER 19X120

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688531
Hospital Revenue Code	272
Min. Negotiated Rate	$397.60
Max. Negotiated Rate	$7,000.00
Rate for Payer: Aetna Commercial	$5,320.00
Rate for Payer: Aetna Medicare Advantage	$4,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,570.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,570.00
Rate for Payer: Cigna Commercial	$7,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,640.00
Rate for Payer: Oxford Commercial	$2,800.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,100.00
Rate for Payer: UnitedHealthcare Commercial	$2,800.00
Rate for Payer: UnitedHealthcare Community & State	$442.40
Rate for Payer: Wellpoint Medicaid Managed Care	$397.60

STENT,ESO.ULTRAFLEX ESO STENT

Facility

$5,158.00

Hospital Charge Code	270335396
Hospital Revenue Code	278
Min. Negotiated Rate	$146.49
Max. Negotiated Rate	$2,579.00
Rate for Payer: Aetna Commercial	$1,960.04
Rate for Payer: Aetna Medicare Advantage	$1,547.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,315.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,315.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,031.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,315.29
Rate for Payer: Cigna Commercial	$2,579.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,248.24
Rate for Payer: Qualcare PPO/HMO/WC	$773.70
Rate for Payer: UnitedHealthcare Community & State	$162.99
Rate for Payer: Wellpoint Medicaid Managed Care	$146.49

STENT,ESO.ULTRAFLEX ESO STENT

Facility

$5,158.00

Hospital Charge Code	270335396
Hospital Revenue Code	278
Min. Negotiated Rate	$773.70
Max. Negotiated Rate	$1,248.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,031.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,248.24
Rate for Payer: Qualcare PPO/HMO/WC	$773.70

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103A
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103N
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103A
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103N
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

STENT EVERFLEX 5MMx80MM 120CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270640103S
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

Know your out-of-pocket cost for care.

All Charges