Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT HRCLNK7X15X80 1011504-18

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270646393A
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 1011504-18

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270646393C
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 1011504-18

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270646393C
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 HRCLNK7X15X80 1011504-18

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270646393A
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 HRK RX 6X18X80 100802018

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644203C
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 HRK RX 6X18X80 100802018

Facility

$4,650.00

Service Code	HCPCS C1876
Hospital Charge Code	270644203C
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 I-CAST 6x22MM 120CM

Facility

$12,575.00

Service Code	HCPCS C1874
Hospital Charge Code	270647293
Hospital Revenue Code	278
Min. Negotiated Rate	$357.13
Max. Negotiated Rate	$6,287.50
Rate for Payer: Aetna Commercial	$4,778.50
Rate for Payer: Aetna Medicare Advantage	$3,772.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,206.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,206.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,206.62
Rate for Payer: Cigna Commercial	$6,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,043.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,886.25
Rate for Payer: UnitedHealthcare Community & State	$397.37
Rate for Payer: Wellpoint Medicaid Managed Care	$357.13

STENT I-CAST 6x22MM 120CM

Facility

$12,575.00

Service Code	HCPCS C1874
Hospital Charge Code	270647293
Hospital Revenue Code	278
Min. Negotiated Rate	$1,886.25
Max. Negotiated Rate	$3,043.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,043.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,886.25

STENT I-CAST 6x22MM 80CM

Facility

$12,575.00

Hospital Charge Code	270678107
Hospital Revenue Code	278
Min. Negotiated Rate	$357.13
Max. Negotiated Rate	$6,287.50
Rate for Payer: Aetna Commercial	$4,778.50
Rate for Payer: Aetna Medicare Advantage	$3,772.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,206.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,206.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,515.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,206.62
Rate for Payer: Cigna Commercial	$6,287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,043.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,886.25
Rate for Payer: UnitedHealthcare Community & State	$397.37
Rate for Payer: Wellpoint Medicaid Managed Care	$357.13

STENT I-CAST 6x22MM 80CM

Facility

$12,575.00

Hospital Charge Code	270678107
Hospital Revenue Code	278
Min. Negotiated Rate	$1,886.25
Max. Negotiated Rate	$3,043.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,515.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,043.15
Rate for Payer: Qualcare PPO/HMO/WC	$1,886.25

STENT ICAST COV 6MMx38MMx80CM

Facility

$13,875.00

Hospital Charge Code	270653399
Hospital Revenue Code	278
Min. Negotiated Rate	$2,081.25
Max. Negotiated Rate	$3,357.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,357.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25

STENT ICAST COV 6MMx38MMx80CM

Facility

$13,875.00

Hospital Charge Code	270653399
Hospital Revenue Code	278
Min. Negotiated Rate	$394.05
Max. Negotiated Rate	$6,937.50
Rate for Payer: Aetna Commercial	$5,272.50
Rate for Payer: Aetna Medicare Advantage	$4,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,538.12
Rate for Payer: Cigna Commercial	$6,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,357.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25
Rate for Payer: UnitedHealthcare Community & State	$438.45
Rate for Payer: Wellpoint Medicaid Managed Care	$394.05

STENT ICAST COV 7MMx59MMx80CM

Facility

$13,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270653401
Hospital Revenue Code	278
Min. Negotiated Rate	$2,081.25
Max. Negotiated Rate	$3,357.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,357.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25

STENT ICAST COV 7MMx59MMx80CM

Facility

$13,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270653401
Hospital Revenue Code	278
Min. Negotiated Rate	$394.05
Max. Negotiated Rate	$6,937.50
Rate for Payer: Aetna Commercial	$5,272.50
Rate for Payer: Aetna Medicare Advantage	$4,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,538.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,538.12
Rate for Payer: Cigna Commercial	$6,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,357.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,081.25
Rate for Payer: UnitedHealthcare Community & State	$438.45
Rate for Payer: Wellpoint Medicaid Managed Care	$394.05

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855
Hospital Revenue Code	278
Min. Negotiated Rate	$1,931.25
Max. Negotiated Rate	$3,115.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855
Hospital Revenue Code	278
Min. Negotiated Rate	$365.65
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$406.85
Rate for Payer: Wellpoint Medicaid Managed Care	$365.65

STENT ICAST COVERED 5MMX38MM

Facility

$12,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270659855N
Hospital Revenue Code	278
Min. Negotiated Rate	$365.65
Max. Negotiated Rate	$6,437.50
Rate for Payer: Aetna Commercial	$4,892.50
Rate for Payer: Aetna Medicare Advantage	$3,862.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,283.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,283.12
Rate for Payer: Cigna Commercial	$6,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,115.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,931.25
Rate for Payer: UnitedHealthcare Community & State	$406.85
Rate for Payer: Wellpoint Medicaid Managed Care	$365.65

Stent INLAY 6 FR 22-32 cm

Facility

$295.00

Service Code	HCPCS C1725
Hospital Charge Code	270626655
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

Stent INLAY 6 FR 22-32 cm

Facility

$295.00

Service Code	HCPCS C1725
Hospital Charge Code	270626655
Hospital Revenue Code	278
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Community & State	$9.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.38

STENT INLAY 7FR 22-32CM

Facility

$295.00

Hospital Charge Code	270682457
Hospital Revenue Code	278
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Community & State	$9.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.38

STENT INLAY 7FR 22-32CM

Facility

$295.00

Hospital Charge Code	270682457
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT INLAY 7 FR 22 CM

Facility

$295.00

Hospital Charge Code	270682458
Hospital Revenue Code	278
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Community & State	$9.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.38

STENT INLAY 7 FR 22 CM

Facility

$295.00

Hospital Charge Code	270682458
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT INLAY 7 FR 24 CM

Facility

$295.00

Hospital Charge Code	270682459
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

Know your out-of-pocket cost for care.

All Charges