Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951N
Hospital Revenue Code	278
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$258.12
Rate for Payer: Aetna Commercial	$196.18
Rate for Payer: Aetna Medicare Advantage	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.64
Rate for Payer: Cigna Commercial	$258.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44
Rate for Payer: UnitedHealthcare Community & State	$16.31
Rate for Payer: Wellpoint Medicaid Managed Care	$14.66

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951
Hospital Revenue Code	278
Min. Negotiated Rate	$14.66
Max. Negotiated Rate	$258.12
Rate for Payer: Aetna Commercial	$196.18
Rate for Payer: Aetna Medicare Advantage	$154.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$131.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$131.64
Rate for Payer: Cigna Commercial	$258.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44
Rate for Payer: UnitedHealthcare Community & State	$16.31
Rate for Payer: Wellpoint Medicaid Managed Care	$14.66

STENT NEPHROSTOMY 8FR 24CM

Facility

$516.25

Service Code	HCPCS C2617
Hospital Charge Code	270665951
Hospital Revenue Code	278
Min. Negotiated Rate	$77.44
Max. Negotiated Rate	$124.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$103.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$124.93
Rate for Payer: Qualcare PPO/HMO/WC	$77.44

STENT NEPHROURETERAL 24CM 8FR

Facility

$820.00

Service Code	HCPCS C2617
Hospital Charge Code	270691572
Hospital Revenue Code	278
Min. Negotiated Rate	$123.00
Max. Negotiated Rate	$198.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: Qualcare PPO/HMO/WC	$123.00

STENT NEPHROURETERAL 24CM 8FR

Facility

$820.00

Service Code	HCPCS C2617
Hospital Charge Code	270691572
Hospital Revenue Code	278
Min. Negotiated Rate	$23.29
Max. Negotiated Rate	$410.00
Rate for Payer: Aetna Commercial	$311.60
Rate for Payer: Aetna Medicare Advantage	$246.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$209.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$164.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$209.10
Rate for Payer: Cigna Commercial	$410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.44
Rate for Payer: Qualcare PPO/HMO/WC	$123.00
Rate for Payer: UnitedHealthcare Community & State	$25.91
Rate for Payer: Wellpoint Medicaid Managed Care	$23.29

STENT NEUROFORM ATLAS 3X21MM

Facility

$39,226.75

Service Code	HCPCS C1876
Hospital Charge Code	270697798S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.04
Max. Negotiated Rate	$19,613.38
Rate for Payer: Aetna Commercial	$14,906.17
Rate for Payer: Aetna Medicare Advantage	$11,768.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,002.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,002.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,845.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,002.82
Rate for Payer: Cigna Commercial	$19,613.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,492.87
Rate for Payer: Qualcare PPO/HMO/WC	$5,884.01
Rate for Payer: UnitedHealthcare Community & State	$1,239.57
Rate for Payer: Wellpoint Medicaid Managed Care	$1,114.04

STENT NEUROFORM ATLAS 3X21MM

Facility

$39,226.75

Service Code	HCPCS C1876
Hospital Charge Code	270697798S
Hospital Revenue Code	278
Min. Negotiated Rate	$5,884.01
Max. Negotiated Rate	$9,492.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,845.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,492.87
Rate for Payer: Qualcare PPO/HMO/WC	$5,884.01

STENT NEUROFORM ATLAS 4X24MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697804S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$9,919.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT NEUROFORM ATLAS 4X24MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697804S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.11
Max. Negotiated Rate	$20,494.88
Rate for Payer: Aetna Commercial	$15,576.10
Rate for Payer: Aetna Medicare Advantage	$12,296.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.39
Rate for Payer: Cigna Commercial	$20,494.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46
Rate for Payer: UnitedHealthcare Community & State	$1,295.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1,164.11

STENT NEUROFORM ATLASZ4.5X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697805S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$9,919.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT NEUROFORM ATLASZ4.5X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697805S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.11
Max. Negotiated Rate	$20,494.88
Rate for Payer: Aetna Commercial	$15,576.10
Rate for Payer: Aetna Medicare Advantage	$12,296.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.39
Rate for Payer: Cigna Commercial	$20,494.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46
Rate for Payer: UnitedHealthcare Community & State	$1,295.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1,164.11

STENT NEUROFORM ATLAS Z 4X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697802S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.11
Max. Negotiated Rate	$20,494.88
Rate for Payer: Aetna Commercial	$15,576.10
Rate for Payer: Aetna Medicare Advantage	$12,296.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,452.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,452.39
Rate for Payer: Cigna Commercial	$20,494.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46
Rate for Payer: UnitedHealthcare Community & State	$1,295.28
Rate for Payer: Wellpoint Medicaid Managed Care	$1,164.11

STENT NEUROFORM ATLAS Z 4X21MM

Facility

$40,989.75

Service Code	HCPCS C1876
Hospital Charge Code	270697802S
Hospital Revenue Code	278
Min. Negotiated Rate	$6,148.46
Max. Negotiated Rate	$9,919.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,197.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,919.52
Rate for Payer: Qualcare PPO/HMO/WC	$6,148.46

STENT OMNILINK 10.0x29MMx135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648338
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 10.0x29MMx135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648338
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

STENT OMNILINK 10.0X39MMX135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648340C
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 10.0X39MMX135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648340C
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

STENT OMNILINK 10.0x59MMx135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648343
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

STENT OMNILINK 10.0x59MMx135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648343
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 10.0X59MMX135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648343C
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

STENT OMNILINK 10.0X59MMX135CM

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270648343C
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 6.0x29MMX135cm

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270673131
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

STENT OMNILINK 6.0x29MMX135cm

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270673131
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 6.0x39MMx135cm

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270673132
Hospital Revenue Code	278
Min. Negotiated Rate	$581.25
Max. Negotiated Rate	$937.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25

STENT OMNILINK 6.0x39MMx135cm

Facility

$3,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270673132
Hospital Revenue Code	278
Min. Negotiated Rate	$110.05
Max. Negotiated Rate	$1,937.50
Rate for Payer: Aetna Commercial	$1,472.50
Rate for Payer: Aetna Medicare Advantage	$1,162.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$988.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$775.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$988.12
Rate for Payer: Cigna Commercial	$1,937.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$937.75
Rate for Payer: Qualcare PPO/HMO/WC	$581.25
Rate for Payer: UnitedHealthcare Community & State	$122.45
Rate for Payer: Wellpoint Medicaid Managed Care	$110.05

Know your out-of-pocket cost for care.

All Charges