Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT METALLIC URETERAL 24CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674322
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 24CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674322
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 26CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674323
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 26CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674323
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 28CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674324
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 28CM

Facility

$4,770.00

Service Code	HCPCS C2617
Hospital Charge Code	270674324
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 30CM

Facility

$4,770.00

Hospital Charge Code	270674325
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 30CM

Facility

$4,770.00

Hospital Charge Code	270674325
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 MINI MONOKA

Facility

$291.67

Hospital Charge Code	270673867
Hospital Revenue Code	278
Min. Negotiated Rate	$8.28
Max. Negotiated Rate	$145.84
Rate for Payer: Aetna Commercial	$110.83
Rate for Payer: Aetna Medicare Advantage	$87.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$74.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$74.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$74.38
Rate for Payer: Cigna Commercial	$145.84
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.58
Rate for Payer: Qualcare PPO/HMO/WC	$43.75
Rate for Payer: UnitedHealthcare Community & State	$9.22
Rate for Payer: Wellpoint Medicaid Managed Care	$8.28

STENT MINI MONOKA

Facility

$291.67

Hospital Charge Code	270673867
Hospital Revenue Code	278
Min. Negotiated Rate	$43.75
Max. Negotiated Rate	$70.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.58
Rate for Payer: Qualcare PPO/HMO/WC	$43.75

STENT MINI VISION RX 2.5 X 15

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643608
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

STENT MINI VISION RX 2.5 X 15

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643608
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MINI VISION RX 2.5 X 18

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643367
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

STENT MINI VISION RX 2.5 X 18

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643367
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MINI VISION RX 2.5 X 23

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643419
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

STENT MINI VISION RX 2.5 X 23

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643419
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MUL RX 2.75X12 100782123

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643292
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

STENT MUL RX 2.75X12 100782123

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643292
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MUL RX 2.75X18 100787418

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643416C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MUL RX 2.75X18 100787418

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643416C
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

STENT MUL RX 2.75X23 100784723

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643611C
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

STENT MUL RX 2.75X23 100784723

Facility

$3,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270643611C
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$726.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00

STENT MULTILENGH 3.7Fx21-32

Facility

$618.05

Hospital Charge Code	270673817
Hospital Revenue Code	278
Min. Negotiated Rate	$92.71
Max. Negotiated Rate	$149.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.57
Rate for Payer: Qualcare PPO/HMO/WC	$92.71

STENT MULTILENGH 3.7Fx21-32

Facility

$618.05

Hospital Charge Code	270673817
Hospital Revenue Code	278
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$309.02
Rate for Payer: Aetna Commercial	$234.86
Rate for Payer: Aetna Medicare Advantage	$185.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.60
Rate for Payer: Cigna Commercial	$309.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.57
Rate for Payer: Qualcare PPO/HMO/WC	$92.71
Rate for Payer: UnitedHealthcare Community & State	$19.53
Rate for Payer: Wellpoint Medicaid Managed Care	$17.55

STENT MULTI-LINE RX 4.0x8MM

Facility

$3,000.00

Hospital Charge Code	270644805
Hospital Revenue Code	278
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$1,500.00
Rate for Payer: Aetna Commercial	$1,140.00
Rate for Payer: Aetna Medicare Advantage	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$765.00
Rate for Payer: Cigna Commercial	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$726.00
Rate for Payer: Qualcare PPO/HMO/WC	$450.00
Rate for Payer: UnitedHealthcare Community & State	$94.80
Rate for Payer: Wellpoint Medicaid Managed Care	$85.20

Know your out-of-pocket cost for care.

All Charges