Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT GRAFT FLUENCY 8X40MM

Facility

$9,250.00

Hospital Charge Code	270669232
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 PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894C
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 GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894N
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 GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894C
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 GRAFT FLUENCY PLUS 8X60

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270637894N
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 GRAFT ILIAC EX 12mmX12mm

Facility

$23,495.00

Service Code	HCPCS C1763
Hospital Charge Code	270680927
Hospital Revenue Code	278
Min. Negotiated Rate	$667.26
Max. Negotiated Rate	$11,747.50
Rate for Payer: Aetna Commercial	$8,928.10
Rate for Payer: Aetna Medicare Advantage	$7,048.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,991.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,991.23
Rate for Payer: Cigna Commercial	$11,747.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25
Rate for Payer: UnitedHealthcare Community & State	$742.44
Rate for Payer: Wellpoint Medicaid Managed Care	$667.26

STENT GRAFT ILIAC EX 12mmX12mm

Facility

$23,495.00

Service Code	HCPCS C1763
Hospital Charge Code	270680927
Hospital Revenue Code	278
Min. Negotiated Rate	$3,524.25
Max. Negotiated Rate	$5,685.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,699.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,685.79
Rate for Payer: Qualcare PPO/HMO/WC	$3,524.25

STENT GRAFT MASTER 2.8MMX16MM

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270691783
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFT MASTER 2.8MMX16MM

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270691783
Hospital Revenue Code	278
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$378.41
Rate for Payer: Wellpoint Medicaid Managed Care	$340.09

STENT GRAFTMASTER 2.8x19mm

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270668169
Hospital Revenue Code	278
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$378.41
Rate for Payer: Wellpoint Medicaid Managed Care	$340.09

STENT GRAFTMASTER 2.8x19mm

Facility

$11,975.00

Service Code	HCPCS C1874
Hospital Charge Code	270668169
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT GRAFT MASTER 3.5MMX16MM

Facility

$11,625.00

Service Code	HCPCS C1874
Hospital Charge Code	270691785
Hospital Revenue Code	278
Min. Negotiated Rate	$330.15
Max. Negotiated Rate	$5,812.50
Rate for Payer: Aetna Commercial	$4,417.50
Rate for Payer: Aetna Medicare Advantage	$3,487.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,964.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,964.38
Rate for Payer: Cigna Commercial	$5,812.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75
Rate for Payer: UnitedHealthcare Community & State	$367.35
Rate for Payer: Wellpoint Medicaid Managed Care	$330.15

STENT GRAFT MASTER 3.5MMX16MM

Facility

$12,910.00

Service Code	HCPCS C1874
Hospital Charge Code	270691784
Hospital Revenue Code	278
Min. Negotiated Rate	$366.64
Max. Negotiated Rate	$6,455.00
Rate for Payer: Aetna Commercial	$4,905.80
Rate for Payer: Aetna Medicare Advantage	$3,873.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,292.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,292.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,582.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,292.05
Rate for Payer: Cigna Commercial	$6,455.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,124.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,936.50
Rate for Payer: UnitedHealthcare Community & State	$407.96
Rate for Payer: Wellpoint Medicaid Managed Care	$366.64

STENT GRAFT MASTER 3.5MMX16MM

Facility

$11,625.00

Service Code	HCPCS C1874
Hospital Charge Code	270691785
Hospital Revenue Code	278
Min. Negotiated Rate	$1,743.75
Max. Negotiated Rate	$2,813.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,813.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,743.75

STENT GRAFT MASTER 3.5MMX16MM

Facility

$12,910.00

Service Code	HCPCS C1874
Hospital Charge Code	270691784
Hospital Revenue Code	278
Min. Negotiated Rate	$1,936.50
Max. Negotiated Rate	$3,124.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,582.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,124.22
Rate for Payer: Qualcare PPO/HMO/WC	$1,936.50

STENT GR FLCY PL80x40 FTM08040

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270635691
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 GR FLCY PL80x40 FTM08040

Facility

$15,715.00

Service Code	HCPCS C1876
Hospital Charge Code	270635691
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 HERCULINK 5X18X80CM

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644560C
Hospital Revenue Code	278
Min. Negotiated Rate	$132.06
Max. Negotiated Rate	$2,325.00
Rate for Payer: Aetna Commercial	$1,767.00
Rate for Payer: Aetna Medicare Advantage	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,185.75
Rate for Payer: Cigna Commercial	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50
Rate for Payer: UnitedHealthcare Community & State	$146.94
Rate for Payer: Wellpoint Medicaid Managed Care	$132.06

STENT HERCULINK 5X18X80CM

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644560C
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$1,125.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50

STENT HERCULINK RX 5x15x80cm

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644559
Hospital Revenue Code	278
Min. Negotiated Rate	$132.06
Max. Negotiated Rate	$2,325.00
Rate for Payer: Aetna Commercial	$1,767.00
Rate for Payer: Aetna Medicare Advantage	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,185.75
Rate for Payer: Cigna Commercial	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50
Rate for Payer: UnitedHealthcare Community & State	$146.94
Rate for Payer: Wellpoint Medicaid Managed Care	$132.06

STENT HERCULINK RX 5x15x80cm

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644559
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$1,125.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50

STENT HERCULINK RX 6X15X80CM

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644282C
Hospital Revenue Code	278
Min. Negotiated Rate	$132.06
Max. Negotiated Rate	$2,325.00
Rate for Payer: Aetna Commercial	$1,767.00
Rate for Payer: Aetna Medicare Advantage	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,185.75
Rate for Payer: Cigna Commercial	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50
Rate for Payer: UnitedHealthcare Community & State	$146.94
Rate for Payer: Wellpoint Medicaid Managed Care	$132.06

STENT HERCULINK RX 6X15X80CM

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644282C
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$1,125.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50

STENT HRCLNK7X15X80 1011504-15

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270646392C
Hospital Revenue Code	278
Min. Negotiated Rate	$697.50
Max. Negotiated Rate	$1,125.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50

STENT HRCLNK7X15X80 1011504-15

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270646392C
Hospital Revenue Code	278
Min. Negotiated Rate	$132.06
Max. Negotiated Rate	$2,325.00
Rate for Payer: Aetna Commercial	$1,767.00
Rate for Payer: Aetna Medicare Advantage	$1,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,185.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$930.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,185.75
Rate for Payer: Cigna Commercial	$2,325.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,125.30
Rate for Payer: Qualcare PPO/HMO/WC	$697.50
Rate for Payer: UnitedHealthcare Community & State	$146.94
Rate for Payer: Wellpoint Medicaid Managed Care	$132.06

Know your out-of-pocket cost for care.

All Charges