Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT EVER PROT 8 0X20

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662303
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

STENT EVER PROT 8 0X20

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662303S
Hospital Revenue Code	278
Min. Negotiated Rate	$208.74
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$2,793.00
Rate for Payer: Aetna Medicare Advantage	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.25
Rate for Payer: Cigna Commercial	$3,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50
Rate for Payer: UnitedHealthcare Community & State	$232.26
Rate for Payer: Wellpoint Medicaid Managed Care	$208.74

STENT EVER PROT 8 0X20

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662303S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

STENT EXCLUDER

Facility

$23,695.00

Hospital Charge Code	270681917
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$5,734.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25

STENT EXCLUDER

Facility

$23,695.00

Hospital Charge Code	270681917
Hospital Revenue Code	278
Min. Negotiated Rate	$672.94
Max. Negotiated Rate	$11,847.50
Rate for Payer: Aetna Commercial	$9,004.10
Rate for Payer: Aetna Medicare Advantage	$7,108.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,042.23
Rate for Payer: Cigna Commercial	$11,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25
Rate for Payer: UnitedHealthcare Community & State	$748.76
Rate for Payer: Wellpoint Medicaid Managed Care	$672.94

STENT EXCLUDER 16MM 16 9.5CM

Facility

$23,695.00

Hospital Charge Code	270682803
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$5,734.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25

STENT EXCLUDER 16MM 16 9.5CM

Facility

$23,695.00

Hospital Charge Code	270682803
Hospital Revenue Code	278
Min. Negotiated Rate	$672.94
Max. Negotiated Rate	$11,847.50
Rate for Payer: Aetna Commercial	$9,004.10
Rate for Payer: Aetna Medicare Advantage	$7,108.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,042.23
Rate for Payer: Cigna Commercial	$11,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25
Rate for Payer: UnitedHealthcare Community & State	$748.76
Rate for Payer: Wellpoint Medicaid Managed Care	$672.94

STENT EXCLUDER 16MM16x13.5CM

Facility

$23,695.00

Hospital Charge Code	270682804
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$5,734.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25

STENT EXCLUDER 16MM16x13.5CM

Facility

$23,695.00

Hospital Charge Code	270682804
Hospital Revenue Code	278
Min. Negotiated Rate	$672.94
Max. Negotiated Rate	$11,847.50
Rate for Payer: Aetna Commercial	$9,004.10
Rate for Payer: Aetna Medicare Advantage	$7,108.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,042.23
Rate for Payer: Cigna Commercial	$11,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25
Rate for Payer: UnitedHealthcare Community & State	$748.76
Rate for Payer: Wellpoint Medicaid Managed Care	$672.94

STENT EXCLUDER 31MM 14.5 13CM

Facility

$57,785.00

Hospital Charge Code	270682805
Hospital Revenue Code	278
Min. Negotiated Rate	$1,641.09
Max. Negotiated Rate	$28,892.50
Rate for Payer: Aetna Commercial	$21,958.30
Rate for Payer: Aetna Medicare Advantage	$17,335.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,735.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,735.17
Rate for Payer: Cigna Commercial	$28,892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75
Rate for Payer: UnitedHealthcare Community & State	$1,826.01
Rate for Payer: Wellpoint Medicaid Managed Care	$1,641.09

STENT EXCLUDER 31MM 14.5 13CM

Facility

$57,785.00

Hospital Charge Code	270682805
Hospital Revenue Code	278
Min. Negotiated Rate	$8,667.75
Max. Negotiated Rate	$13,983.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,983.97
Rate for Payer: Qualcare PPO/HMO/WC	$8,667.75

STENT EXCLUDER AAA16MM 23 14CM

Facility

$23,695.00

Hospital Charge Code	270682800
Hospital Revenue Code	278
Min. Negotiated Rate	$3,554.25
Max. Negotiated Rate	$5,734.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25

STENT EXCLUDER AAA16MM 23 14CM

Facility

$23,695.00

Hospital Charge Code	270682800
Hospital Revenue Code	278
Min. Negotiated Rate	$672.94
Max. Negotiated Rate	$11,847.50
Rate for Payer: Aetna Commercial	$9,004.10
Rate for Payer: Aetna Medicare Advantage	$7,108.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,042.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,739.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,042.23
Rate for Payer: Cigna Commercial	$11,847.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,734.19
Rate for Payer: Qualcare PPO/HMO/WC	$3,554.25
Rate for Payer: UnitedHealthcare Community & State	$748.76
Rate for Payer: Wellpoint Medicaid Managed Care	$672.94

STENT EXCLUDER AAA32MM 4.5CM

Facility

$16,675.00

Hospital Charge Code	270682802
Hospital Revenue Code	278
Min. Negotiated Rate	$2,501.25
Max. Negotiated Rate	$4,035.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,035.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,501.25

STENT EXCLUDER AAA32MM 4.5CM

Facility

$16,675.00

Hospital Charge Code	270682802
Hospital Revenue Code	278
Min. Negotiated Rate	$473.57
Max. Negotiated Rate	$8,337.50
Rate for Payer: Aetna Commercial	$6,336.50
Rate for Payer: Aetna Medicare Advantage	$5,002.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,252.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,252.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,335.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,252.12
Rate for Payer: Cigna Commercial	$8,337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,035.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,501.25
Rate for Payer: UnitedHealthcare Community & State	$526.93
Rate for Payer: Wellpoint Medicaid Managed Care	$473.57

STENT EXPRESS 10x37 75cm

Facility

$5,942.30

Hospital Charge Code	270632830
Hospital Revenue Code	278
Min. Negotiated Rate	$168.76
Max. Negotiated Rate	$2,971.15
Rate for Payer: Aetna Commercial	$2,258.07
Rate for Payer: Aetna Medicare Advantage	$1,782.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,515.29
Rate for Payer: Cigna Commercial	$2,971.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35
Rate for Payer: UnitedHealthcare Community & State	$187.78
Rate for Payer: Wellpoint Medicaid Managed Care	$168.76

STENT EXPRESS 10x37 75cm

Facility

$5,942.30

Hospital Charge Code	270632830
Hospital Revenue Code	278
Min. Negotiated Rate	$891.35
Max. Negotiated Rate	$1,438.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35

STENT EXPRESS 4x15 150cm

Facility

$5,942.30

Hospital Charge Code	270644094
Hospital Revenue Code	278
Min. Negotiated Rate	$891.35
Max. Negotiated Rate	$1,438.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35

STENT EXPRESS 4x15 150cm

Facility

$5,942.30

Hospital Charge Code	270644094
Hospital Revenue Code	278
Min. Negotiated Rate	$168.76
Max. Negotiated Rate	$2,971.15
Rate for Payer: Aetna Commercial	$2,258.07
Rate for Payer: Aetna Medicare Advantage	$1,782.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,515.29
Rate for Payer: Cigna Commercial	$2,971.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35
Rate for Payer: UnitedHealthcare Community & State	$187.78
Rate for Payer: Wellpoint Medicaid Managed Care	$168.76

STENT EXPRESS 5x15 150cm

Facility

$5,942.30

Hospital Charge Code	270634526
Hospital Revenue Code	278
Min. Negotiated Rate	$168.76
Max. Negotiated Rate	$2,971.15
Rate for Payer: Aetna Commercial	$2,258.07
Rate for Payer: Aetna Medicare Advantage	$1,782.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,515.29
Rate for Payer: Cigna Commercial	$2,971.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35
Rate for Payer: UnitedHealthcare Community & State	$187.78
Rate for Payer: Wellpoint Medicaid Managed Care	$168.76

STENT EXPRESS 5x15 150cm

Facility

$5,942.30

Hospital Charge Code	270634526
Hospital Revenue Code	278
Min. Negotiated Rate	$891.35
Max. Negotiated Rate	$1,438.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35

STENT EXPRESS 5x15 90cm

Facility

$5,942.30

Hospital Charge Code	270633192
Hospital Revenue Code	278
Min. Negotiated Rate	$168.76
Max. Negotiated Rate	$2,971.15
Rate for Payer: Aetna Commercial	$2,258.07
Rate for Payer: Aetna Medicare Advantage	$1,782.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,515.29
Rate for Payer: Cigna Commercial	$2,971.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35
Rate for Payer: UnitedHealthcare Community & State	$187.78
Rate for Payer: Wellpoint Medicaid Managed Care	$168.76

STENT EXPRESS 5x15 90cm

Facility

$5,942.30

Hospital Charge Code	270633192
Hospital Revenue Code	278
Min. Negotiated Rate	$891.35
Max. Negotiated Rate	$1,438.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35

STENT EXPRESS 6x14 90cm

Facility

$5,942.30

Hospital Charge Code	270634342
Hospital Revenue Code	278
Min. Negotiated Rate	$891.35
Max. Negotiated Rate	$1,438.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35

STENT EXPRESS 6x14 90cm

Facility

$5,942.30

Hospital Charge Code	270634342
Hospital Revenue Code	278
Min. Negotiated Rate	$168.76
Max. Negotiated Rate	$2,971.15
Rate for Payer: Aetna Commercial	$2,258.07
Rate for Payer: Aetna Medicare Advantage	$1,782.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,515.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,188.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,515.29
Rate for Payer: Cigna Commercial	$2,971.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,438.04
Rate for Payer: Qualcare PPO/HMO/WC	$891.35
Rate for Payer: UnitedHealthcare Community & State	$187.78
Rate for Payer: Wellpoint Medicaid Managed Care	$168.76

Know your out-of-pocket cost for care.

All Charges