Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT EXPRESS LD ILIAC/BILIARY

Facility

$5,942.30

Hospital Charge Code	270653630
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 FG PROMUS ELEMENT PLUS 2

Facility

$8,750.00

Hospital Charge Code	270665003
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT FG PROMUS ELEMENT PLUS 2

Facility

$8,750.00

Hospital Charge Code	270665003
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$276.50
Rate for Payer: Wellpoint Medicaid Managed Care	$248.50

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667N
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$144.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$227.24
Rate for Payer: Aetna Medicare Advantage	$179.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.49
Rate for Payer: Cigna Commercial	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70
Rate for Payer: UnitedHealthcare Community & State	$18.90
Rate for Payer: Wellpoint Medicaid Managed Care	$16.98

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$144.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667
Hospital Revenue Code	278
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$227.24
Rate for Payer: Aetna Medicare Advantage	$179.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.49
Rate for Payer: Cigna Commercial	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70
Rate for Payer: UnitedHealthcare Community & State	$18.90
Rate for Payer: Wellpoint Medicaid Managed Care	$16.98

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667S
Hospital Revenue Code	278
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$299.00
Rate for Payer: Aetna Commercial	$227.24
Rate for Payer: Aetna Medicare Advantage	$179.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$152.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$152.49
Rate for Payer: Cigna Commercial	$299.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70
Rate for Payer: UnitedHealthcare Community & State	$18.90
Rate for Payer: Wellpoint Medicaid Managed Care	$16.98

STENT FLEXIMA URETERAL 8 X 22

Facility

$598.00

Service Code	HCPCS C2617
Hospital Charge Code	270661667S
Hospital Revenue Code	278
Min. Negotiated Rate	$89.70
Max. Negotiated Rate	$144.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$119.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$144.72
Rate for Payer: Qualcare PPO/HMO/WC	$89.70

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633
Hospital Revenue Code	278
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$362.05
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91
Rate for Payer: UnitedHealthcare Community & State	$30.11
Rate for Payer: Wellpoint Medicaid Managed Care	$27.06

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633S
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633N
Hospital Revenue Code	278
Min. Negotiated Rate	$142.91
Max. Negotiated Rate	$230.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633S
Hospital Revenue Code	278
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$362.05
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91
Rate for Payer: UnitedHealthcare Community & State	$30.11
Rate for Payer: Wellpoint Medicaid Managed Care	$27.06

STENT FLEXIMA URETERAL 8 X 24

Facility

$952.75

Service Code	HCPCS C2617
Hospital Charge Code	270661633N
Hospital Revenue Code	278
Min. Negotiated Rate	$27.06
Max. Negotiated Rate	$476.38
Rate for Payer: Aetna Commercial	$362.05
Rate for Payer: Aetna Medicare Advantage	$285.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$242.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$190.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$242.95
Rate for Payer: Cigna Commercial	$476.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$230.57
Rate for Payer: Qualcare PPO/HMO/WC	$142.91
Rate for Payer: UnitedHealthcare Community & State	$30.11
Rate for Payer: Wellpoint Medicaid Managed Care	$27.06

STENT FLUENCY PLUS 8 X 60 X 8

Facility

$15,715.00

Service Code	HCPCS C1874
Hospital Charge Code	270637894
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8 X 60 X 8

Facility

$15,715.00

Service Code	HCPCS C1874
Hospital Charge Code	270637894
Hospital Revenue Code	278
Min. Negotiated Rate	$446.31
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$5,971.70
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25
Rate for Payer: UnitedHealthcare Community & State	$496.59
Rate for Payer: Wellpoint Medicaid Managed Care	$446.31

STENT FLUENCY PLUS 8 X 60 X 80

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,357.25
Max. Negotiated Rate	$3,803.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25

STENT FLUENCY PLUS 8 X 60 X 80

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894S
Hospital Revenue Code	278
Min. Negotiated Rate	$446.31
Max. Negotiated Rate	$7,857.50
Rate for Payer: Aetna Commercial	$5,971.70
Rate for Payer: Aetna Medicare Advantage	$4,714.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,007.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,143.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,007.32
Rate for Payer: Cigna Commercial	$7,857.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,803.03
Rate for Payer: Qualcare PPO/HMO/WC	$2,357.25
Rate for Payer: UnitedHealthcare Community & State	$496.59
Rate for Payer: Wellpoint Medicaid Managed Care	$446.31

STENT FULLY COVERD 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270678265
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 FULLY COVERD 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270678265
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 FULLY COVERED .035 X 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688581
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 FULLY COVERED .035 X 100

Facility

$14,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270688581
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 GLIDEX 8FR 26CM

Facility

$618.00

Hospital Charge Code	270665950
Hospital Revenue Code	278
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$149.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

STENT GLIDEX 8FR 26CM

Facility

$618.00

Hospital Charge Code	270665950
Hospital Revenue Code	278
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$309.00
Rate for Payer: Aetna Commercial	$234.84
Rate for Payer: Aetna Medicare Advantage	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.59
Rate for Payer: Cigna Commercial	$309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Community & State	$19.53
Rate for Payer: Wellpoint Medicaid Managed Care	$17.55

Know your out-of-pocket cost for care.

All Charges