Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT GORE TEX GRAFT 6MMX 30MM

Facility

$1,785.00

Service Code	HCPCS C1768
Hospital Charge Code	270688611
Hospital Revenue Code	278
Min. Negotiated Rate	$267.75
Max. Negotiated Rate	$431.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$357.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$431.97
Rate for Payer: Qualcare PPO/HMO/WC	$267.75

STENT GORE TEX GRAFT 6MMX 30MM

Facility

$1,785.00

Service Code	HCPCS C1768
Hospital Charge Code	270688611
Hospital Revenue Code	278
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$892.50
Rate for Payer: Aetna Commercial	$678.30
Rate for Payer: Aetna Medicare Advantage	$535.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$455.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$455.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$455.18
Rate for Payer: Cigna Commercial	$892.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$431.97
Rate for Payer: Qualcare PPO/HMO/WC	$267.75
Rate for Payer: UnitedHealthcare Community & State	$56.41
Rate for Payer: Wellpoint Medicaid Managed Care	$50.69

STENT GPS 12MMx40MM, 80CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998
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 GPS 12MMx40MM, 80CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998
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 GPS 12MMx40MM, 80CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998S
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 GPS 12MMx40MM, 80CM

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636998S
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 GPS 12MMx60MM, 80CM

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270636999
Hospital Revenue Code	278
Min. Negotiated Rate	$993.72
Max. Negotiated Rate	$1,603.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72

STENT GPS 12MMx60MM, 80CM

Facility

$6,624.80

Service Code	HCPCS C1876
Hospital Charge Code	270636999
Hospital Revenue Code	278
Min. Negotiated Rate	$188.14
Max. Negotiated Rate	$3,312.40
Rate for Payer: Aetna Commercial	$2,517.42
Rate for Payer: Aetna Medicare Advantage	$1,987.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,689.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,324.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,689.32
Rate for Payer: Cigna Commercial	$3,312.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,603.20
Rate for Payer: Qualcare PPO/HMO/WC	$993.72
Rate for Payer: UnitedHealthcare Community & State	$209.34
Rate for Payer: Wellpoint Medicaid Managed Care	$188.14

STENT GPS 14MMx30MM, 120CM

Facility

$4,500.00

Hospital Charge Code	270643090
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 GPS 14MMx30MM, 120CM

Facility

$4,500.00

Hospital Charge Code	270643090
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 GPS 9MMx40MM, 80CM

Facility

$4,500.00

Hospital Charge Code	270637012
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 GPS 9MMx40MM, 80CM

Facility

$4,500.00

Hospital Charge Code	270637012
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 GRAFT 10FR 11MM X 10CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692118
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$4,948.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 10FR 11MM X 10CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692118
Hospital Revenue Code	278
Min. Negotiated Rate	$580.78
Max. Negotiated Rate	$10,225.00
Rate for Payer: Aetna Commercial	$7,771.00
Rate for Payer: Aetna Medicare Advantage	$6,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,214.75
Rate for Payer: Cigna Commercial	$10,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50
Rate for Payer: UnitedHealthcare Community & State	$646.22
Rate for Payer: Wellpoint Medicaid Managed Care	$580.78

STENT GRAFT 10FR 13MM X 10 CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692120
Hospital Revenue Code	278
Min. Negotiated Rate	$3,067.50
Max. Negotiated Rate	$4,948.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50

STENT GRAFT 10FR 13MM X 10 CM

Facility

$20,450.00

Service Code	HCPCS C1874
Hospital Charge Code	270692120
Hospital Revenue Code	278
Min. Negotiated Rate	$580.78
Max. Negotiated Rate	$10,225.00
Rate for Payer: Aetna Commercial	$7,771.00
Rate for Payer: Aetna Medicare Advantage	$6,135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,214.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,090.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,214.75
Rate for Payer: Cigna Commercial	$10,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,948.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,067.50
Rate for Payer: UnitedHealthcare Community & State	$646.22
Rate for Payer: Wellpoint Medicaid Managed Care	$580.78

STENT GRAFT 20-13x88

Facility

$17,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270672011
Hospital Revenue Code	278
Min. Negotiated Rate	$496.86
Max. Negotiated Rate	$8,747.50
Rate for Payer: Aetna Commercial	$6,648.10
Rate for Payer: Aetna Medicare Advantage	$5,248.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,461.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,461.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,499.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,461.23
Rate for Payer: Cigna Commercial	$8,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,233.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,624.25
Rate for Payer: UnitedHealthcare Community & State	$552.84
Rate for Payer: Wellpoint Medicaid Managed Care	$496.86

STENT GRAFT 20-13x88

Facility

$17,495.00

Service Code	HCPCS C1768
Hospital Charge Code	270672011
Hospital Revenue Code	278
Min. Negotiated Rate	$2,624.25
Max. Negotiated Rate	$4,233.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,499.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,233.79
Rate for Payer: Qualcare PPO/HMO/WC	$2,624.25

STENT GRAFT BALLOOM Q50X

Facility

$4,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270689534
Hospital Revenue Code	278
Min. Negotiated Rate	$637.50
Max. Negotiated Rate	$1,028.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50

STENT GRAFT BALLOOM Q50X

Facility

$4,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270689534
Hospital Revenue Code	278
Min. Negotiated Rate	$120.70
Max. Negotiated Rate	$2,125.00
Rate for Payer: Aetna Commercial	$1,615.00
Rate for Payer: Aetna Medicare Advantage	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,083.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,083.75
Rate for Payer: Cigna Commercial	$2,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,028.50
Rate for Payer: Qualcare PPO/HMO/WC	$637.50
Rate for Payer: UnitedHealthcare Community & State	$134.30
Rate for Payer: Wellpoint Medicaid Managed Care	$120.70

STENTGRAFTBEA28-60/I16-40AFX2

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061V
Hospital Revenue Code	278
Min. Negotiated Rate	$1,868.58
Max. Negotiated Rate	$32,897.50
Rate for Payer: Aetna Commercial	$25,002.10
Rate for Payer: Aetna Medicare Advantage	$19,738.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,777.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,777.72
Rate for Payer: Cigna Commercial	$32,897.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25
Rate for Payer: UnitedHealthcare Community & State	$2,079.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1,868.58

STENTGRAFTBEA28-60/I16-40AFX2

Facility

$65,795.00

Service Code	HCPCS C1889
Hospital Charge Code	270684061V
Hospital Revenue Code	278
Min. Negotiated Rate	$9,869.25
Max. Negotiated Rate	$15,922.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13,159.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15,922.39
Rate for Payer: Qualcare PPO/HMO/WC	$9,869.25

STENT GRAFT FLUENCY 10X40MM

Facility

$9,250.00

Hospital Charge Code	270669231
Hospital Revenue Code	278
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$2,238.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50

STENT GRAFT FLUENCY 10X40MM

Facility

$9,250.00

Hospital Charge Code	270669231
Hospital Revenue Code	278
Min. Negotiated Rate	$262.70
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$292.30
Rate for Payer: Wellpoint Medicaid Managed Care	$262.70

STENT GRAFT FLUENCY 8X40MM

Facility

$9,250.00

Hospital Charge Code	270669232
Hospital Revenue Code	278
Min. Negotiated Rate	$262.70
Max. Negotiated Rate	$4,625.00
Rate for Payer: Aetna Commercial	$3,515.00
Rate for Payer: Aetna Medicare Advantage	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,358.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,358.75
Rate for Payer: Cigna Commercial	$4,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,238.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,387.50
Rate for Payer: UnitedHealthcare Community & State	$292.30
Rate for Payer: Wellpoint Medicaid Managed Care	$262.70

Know your out-of-pocket cost for care.

All Charges