Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT PACIFIC PLUS 6X40X180

Facility

$1,047.40

Service Code	HCPCS C1876
Hospital Charge Code	270683562
Hospital Revenue Code	278
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$523.70
Rate for Payer: Aetna Commercial	$398.01
Rate for Payer: Aetna Medicare Advantage	$314.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.09
Rate for Payer: Cigna Commercial	$523.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11
Rate for Payer: UnitedHealthcare Community & State	$33.10
Rate for Payer: Wellpoint Medicaid Managed Care	$29.75

STENT PACIFIC PLUS 6X40X180

Facility

$1,047.40

Service Code	HCPCS C1876
Hospital Charge Code	270683562
Hospital Revenue Code	278
Min. Negotiated Rate	$157.11
Max. Negotiated Rate	$253.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$209.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$253.47
Rate for Payer: Qualcare PPO/HMO/WC	$157.11

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561N
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561
Hospital Revenue Code	278
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$570.00
Rate for Payer: Aetna Commercial	$433.20
Rate for Payer: Aetna Medicare Advantage	$342.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$290.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$290.70
Rate for Payer: Cigna Commercial	$570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00
Rate for Payer: UnitedHealthcare Community & State	$36.02
Rate for Payer: Wellpoint Medicaid Managed Care	$32.38

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561N
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PACIFIC PLUS 6X60X180

Facility

$1,140.00

Service Code	HCPCS C1876
Hospital Charge Code	270683561
Hospital Revenue Code	278
Min. Negotiated Rate	$171.00
Max. Negotiated Rate	$275.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$228.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$275.88
Rate for Payer: Qualcare PPO/HMO/WC	$171.00

STENT PALMAZ XL 40MM

Facility

$6,925.00

Hospital Charge Code	270634569
Hospital Revenue Code	278
Min. Negotiated Rate	$196.67
Max. Negotiated Rate	$3,462.50
Rate for Payer: Aetna Commercial	$2,631.50
Rate for Payer: Aetna Medicare Advantage	$2,077.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,765.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,765.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,765.88
Rate for Payer: Cigna Commercial	$3,462.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.75
Rate for Payer: UnitedHealthcare Community & State	$218.83
Rate for Payer: Wellpoint Medicaid Managed Care	$196.67

STENT PALMAZ XL 40MM

Facility

$6,925.00

Hospital Charge Code	270634569
Hospital Revenue Code	278
Min. Negotiated Rate	$1,038.75
Max. Negotiated Rate	$1,675.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,675.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,038.75

STENT PALMAZ XL 50MM

Facility

$7,475.00

Hospital Charge Code	270634568
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.25
Max. Negotiated Rate	$1,808.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25

STENT PALMAZ XL 50MM

Facility

$7,475.00

Hospital Charge Code	270634568
Hospital Revenue Code	278
Min. Negotiated Rate	$212.29
Max. Negotiated Rate	$3,737.50
Rate for Payer: Aetna Commercial	$2,840.50
Rate for Payer: Aetna Medicare Advantage	$2,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,906.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,906.12
Rate for Payer: Cigna Commercial	$3,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,808.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,121.25
Rate for Payer: UnitedHealthcare Community & State	$236.21
Rate for Payer: Wellpoint Medicaid Managed Care	$212.29

STENT PANCREATIC 4 FR X 4 CM

Facility

$385.95

Service Code	HCPCS C2617
Hospital Charge Code	270679146
Hospital Revenue Code	278
Min. Negotiated Rate	$57.89
Max. Negotiated Rate	$93.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.40
Rate for Payer: Qualcare PPO/HMO/WC	$57.89

STENT PANCREATIC 4 FR X 4 CM

Facility

$385.95

Service Code	HCPCS C2617
Hospital Charge Code	270679146
Hospital Revenue Code	278
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$192.97
Rate for Payer: Aetna Commercial	$146.66
Rate for Payer: Aetna Medicare Advantage	$115.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.42
Rate for Payer: Cigna Commercial	$192.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.40
Rate for Payer: Qualcare PPO/HMO/WC	$57.89
Rate for Payer: UnitedHealthcare Community & State	$12.20
Rate for Payer: Wellpoint Medicaid Managed Care	$10.96

STENT PANCREATIC 4FRX7CM

Facility

$1,150.00

Hospital Charge Code	270670583
Hospital Revenue Code	278
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

STENT PANCREATIC 4FRX7CM

Facility

$1,150.00

Hospital Charge Code	270670583
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

STENT PAPYRUS 2.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691980
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

STENT PAPYRUS 2.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691980
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 2.5X20MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691981
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

STENT PAPYRUS 2.5X20MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691981
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691984
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3.5X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691984
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

STENT PAPYRUS 3X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691982
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3X15MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691982
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

STENT PAPYRUS 3X20MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691983
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$3,630.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00

STENT PAPYRUS 3X20MM

Facility

$15,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270691983
Hospital Revenue Code	278
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$7,500.00
Rate for Payer: Aetna Commercial	$5,700.00
Rate for Payer: Aetna Medicare Advantage	$4,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,825.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,825.00
Rate for Payer: Cigna Commercial	$7,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,630.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,250.00
Rate for Payer: UnitedHealthcare Community & State	$474.00
Rate for Payer: Wellpoint Medicaid Managed Care	$426.00

STENT PERC PLUS 4.8X 22 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696154
Hospital Revenue Code	278
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$441.88
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$33.02

Know your out-of-pocket cost for care.

All Charges