Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT INT RX3.50X22 INT35022UX

Facility

$3,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270651063C
Hospital Revenue Code	278
Min. Negotiated Rate	$92.30
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$102.70
Rate for Payer: Wellpoint Medicaid Managed Care	$92.30

STENT INT RX4.0X12 INT40012UX

Facility

$3,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270651069C
Hospital Revenue Code	278
Min. Negotiated Rate	$92.30
Max. Negotiated Rate	$1,625.00
Rate for Payer: Aetna Commercial	$1,235.00
Rate for Payer: Aetna Medicare Advantage	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$828.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$828.75
Rate for Payer: Cigna Commercial	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50
Rate for Payer: UnitedHealthcare Community & State	$102.70
Rate for Payer: Wellpoint Medicaid Managed Care	$92.30

STENT INT RX4.0X12 INT40012UX

Facility

$3,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270651069C
Hospital Revenue Code	278
Min. Negotiated Rate	$487.50
Max. Negotiated Rate	$786.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$786.50
Rate for Payer: Qualcare PPO/HMO/WC	$487.50

STENT KIT 7FR X 5CM (PIGTAIL

Facility

$635.00

Hospital Charge Code	270330640
Hospital Revenue Code	278
Min. Negotiated Rate	$18.03
Max. Negotiated Rate	$317.50
Rate for Payer: Aetna Commercial	$241.30
Rate for Payer: Aetna Medicare Advantage	$190.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$161.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$161.93
Rate for Payer: Cigna Commercial	$317.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: Qualcare PPO/HMO/WC	$95.25
Rate for Payer: UnitedHealthcare Community & State	$20.07
Rate for Payer: Wellpoint Medicaid Managed Care	$18.03

STENT KIT 7FR X 5CM (PIGTAIL

Facility

$635.00

Hospital Charge Code	270330640
Hospital Revenue Code	278
Min. Negotiated Rate	$95.25
Max. Negotiated Rate	$153.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$127.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$153.67
Rate for Payer: Qualcare PPO/HMO/WC	$95.25

STENT KIT ADVANIX STR 5FR 4CM

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270677007
Hospital Revenue Code	278
Min. Negotiated Rate	$127.82
Max. Negotiated Rate	$206.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: Qualcare PPO/HMO/WC	$127.82

STENT KIT ADVANIX STR 5FR 4CM

Facility

$852.15

Service Code	HCPCS C2625
Hospital Charge Code	270677007
Hospital Revenue Code	278
Min. Negotiated Rate	$24.20
Max. Negotiated Rate	$426.07
Rate for Payer: Aetna Commercial	$323.82
Rate for Payer: Aetna Medicare Advantage	$255.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$217.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$217.30
Rate for Payer: Cigna Commercial	$426.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$206.22
Rate for Payer: Qualcare PPO/HMO/WC	$127.82
Rate for Payer: UnitedHealthcare Community & State	$26.93
Rate for Payer: Wellpoint Medicaid Managed Care	$24.20

STENT KITS 10FR 5CM PIGTAIL

Facility

$756.00

Hospital Charge Code	270330641
Hospital Revenue Code	272
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$378.00
Rate for Payer: Aetna Commercial	$287.28
Rate for Payer: Aetna Medicare Advantage	$226.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$192.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$192.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$192.78
Rate for Payer: Cigna Commercial	$378.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.56
Rate for Payer: Oxford Commercial	$151.20
Rate for Payer: Qualcare PPO/HMO/WC	$113.40
Rate for Payer: UnitedHealthcare Commercial	$151.20
Rate for Payer: UnitedHealthcare Community & State	$23.89
Rate for Payer: Wellpoint Medicaid Managed Care	$21.47

STENT KITS 10FR 5CM PIGTAIL

Facility

$756.00

Hospital Charge Code	270330641
Hospital Revenue Code	272
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$113.40
Rate for Payer: Qualcare PPO/HMO/WC	$113.40

STENT LIBERTE MONO 12X27

Facility

$4,200.00

Service Code	HCPCS C1876
Hospital Charge Code	270662857
Hospital Revenue Code	278
Min. Negotiated Rate	$630.00
Max. Negotiated Rate	$1,016.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00

STENT LIBERTE MONO 12X27

Facility

$4,200.00

Service Code	HCPCS C1876
Hospital Charge Code	270662857
Hospital Revenue Code	278
Min. Negotiated Rate	$119.28
Max. Negotiated Rate	$2,100.00
Rate for Payer: Aetna Commercial	$1,596.00
Rate for Payer: Aetna Medicare Advantage	$1,260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$840.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,071.00
Rate for Payer: Cigna Commercial	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,016.40
Rate for Payer: Qualcare PPO/HMO/WC	$630.00
Rate for Payer: UnitedHealthcare Community & State	$132.72
Rate for Payer: Wellpoint Medicaid Managed Care	$119.28

STENT LIFE 6MMx60MMx130CM

Facility

$9,375.00

Hospital Charge Code	270671188
Hospital Revenue Code	278
Min. Negotiated Rate	$1,406.25
Max. Negotiated Rate	$2,268.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25

STENT LIFE 6MMx60MMx130CM

Facility

$9,375.00

Hospital Charge Code	270671188
Hospital Revenue Code	278
Min. Negotiated Rate	$266.25
Max. Negotiated Rate	$4,687.50
Rate for Payer: Aetna Commercial	$3,562.50
Rate for Payer: Aetna Medicare Advantage	$2,812.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,390.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,390.62
Rate for Payer: Cigna Commercial	$4,687.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,268.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,406.25
Rate for Payer: UnitedHealthcare Community & State	$296.25
Rate for Payer: Wellpoint Medicaid Managed Care	$266.25

STENT LIFESTAR 10 X 40 X 80

Facility

$4,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270688130
Hospital Revenue Code	278
Min. Negotiated Rate	$113.60
Max. Negotiated Rate	$2,000.00
Rate for Payer: Aetna Commercial	$1,520.00
Rate for Payer: Aetna Medicare Advantage	$1,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.00
Rate for Payer: Cigna Commercial	$2,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00
Rate for Payer: UnitedHealthcare Community & State	$126.40
Rate for Payer: Wellpoint Medicaid Managed Care	$113.60

STENT LIFESTAR 10 X 40 X 80

Facility

$4,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270688130
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$968.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$968.00
Rate for Payer: Qualcare PPO/HMO/WC	$600.00

STENT MCV BILI 10.0F 10CM 3932

Facility

$760.00

Service Code	HCPCS C2625
Hospital Charge Code	270617759
Hospital Revenue Code	278
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$24.02
Rate for Payer: Wellpoint Medicaid Managed Care	$21.58

STENT MCV BILI 10.0F 10CM 3932

Facility

$760.00

Service Code	HCPCS C2625
Hospital Charge Code	270617759
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV BILI 7.0F 7CM 3921

Facility

$760.00

Service Code	HCPCS C2625
Hospital Charge Code	270617754
Hospital Revenue Code	278
Min. Negotiated Rate	$21.58
Max. Negotiated Rate	$380.00
Rate for Payer: Aetna Commercial	$288.80
Rate for Payer: Aetna Medicare Advantage	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$193.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$193.80
Rate for Payer: Cigna Commercial	$380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: Qualcare PPO/HMO/WC	$114.00
Rate for Payer: UnitedHealthcare Community & State	$24.02
Rate for Payer: Wellpoint Medicaid Managed Care	$21.58

STENT MCV BILI 7.0F 7CM 3921

Facility

$760.00

Service Code	HCPCS C2625
Hospital Charge Code	270617754
Hospital Revenue Code	278
Min. Negotiated Rate	$114.00
Max. Negotiated Rate	$183.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$152.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.92
Rate for Payer: Qualcare PPO/HMO/WC	$114.00

STENT MCV CONTOR 6X24 18022201

Facility

$1,149.65

Service Code	HCPCS C1876
Hospital Charge Code	270615913
Hospital Revenue Code	278
Min. Negotiated Rate	$32.65
Max. Negotiated Rate	$574.83
Rate for Payer: Aetna Commercial	$436.87
Rate for Payer: Aetna Medicare Advantage	$344.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.16
Rate for Payer: Cigna Commercial	$574.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: Qualcare PPO/HMO/WC	$172.45
Rate for Payer: UnitedHealthcare Community & State	$36.33
Rate for Payer: Wellpoint Medicaid Managed Care	$32.65

STENT MCV CONTOR 6X24 18022201

Facility

$1,149.65

Service Code	HCPCS C1876
Hospital Charge Code	270615913
Hospital Revenue Code	278
Min. Negotiated Rate	$172.45
Max. Negotiated Rate	$278.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$229.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.22
Rate for Payer: Qualcare PPO/HMO/WC	$172.45

STENT METALLIC URETERAL 20CM

Facility

$4,770.00

Hospital Charge Code	270674320
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 20CM

Facility

$4,770.00

Hospital Charge Code	270674320
Hospital Revenue Code	278
Min. Negotiated Rate	$135.47
Max. Negotiated Rate	$2,385.00
Rate for Payer: Aetna Commercial	$1,812.60
Rate for Payer: Aetna Medicare Advantage	$1,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,216.35
Rate for Payer: Cigna Commercial	$2,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50
Rate for Payer: UnitedHealthcare Community & State	$150.73
Rate for Payer: Wellpoint Medicaid Managed Care	$135.47

STENT METALLIC URETERAL 22CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674321
Hospital Revenue Code	278
Min. Negotiated Rate	$715.50
Max. Negotiated Rate	$1,154.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50

STENT METALLIC URETERAL 22CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674321
Hospital Revenue Code	278
Min. Negotiated Rate	$135.47
Max. Negotiated Rate	$2,385.00
Rate for Payer: Aetna Commercial	$1,812.60
Rate for Payer: Aetna Medicare Advantage	$1,431.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,216.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$954.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,216.35
Rate for Payer: Cigna Commercial	$2,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,154.34
Rate for Payer: Qualcare PPO/HMO/WC	$715.50
Rate for Payer: UnitedHealthcare Community & State	$150.73
Rate for Payer: Wellpoint Medicaid Managed Care	$135.47

Know your out-of-pocket cost for care.

All Charges