Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT PERCUFLEX

Facility

$630.00

Service Code	HCPCS C2617
Hospital Charge Code	270650848
Hospital Revenue Code	278
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial	$239.40
Rate for Payer: Aetna Medicare Advantage	$189.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.65
Rate for Payer: Cigna Commercial	$315.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50
Rate for Payer: UnitedHealthcare Community & State	$19.91
Rate for Payer: Wellpoint Medicaid Managed Care	$17.89

STENT PERCUFLEX

Facility

$630.00

Service Code	HCPCS C2617
Hospital Charge Code	270650848
Hospital Revenue Code	278
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$152.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$126.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$152.46
Rate for Payer: Qualcare PPO/HMO/WC	$94.50

STENT PERCUFLEX 8FR 22cm

Facility

$618.00

Service Code	HCPCS C2617
Hospital Charge Code	270623953
Hospital Revenue Code	278
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$309.00
Rate for Payer: Aetna Commercial	$234.84
Rate for Payer: Aetna Medicare Advantage	$185.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$157.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$157.59
Rate for Payer: Cigna Commercial	$309.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: Qualcare PPO/HMO/WC	$92.70
Rate for Payer: UnitedHealthcare Community & State	$19.53
Rate for Payer: Wellpoint Medicaid Managed Care	$17.55

STENT PERCUFLEX 8FR 22cm

Facility

$618.00

Service Code	HCPCS C2617
Hospital Charge Code	270623953
Hospital Revenue Code	278
Min. Negotiated Rate	$92.70
Max. Negotiated Rate	$149.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$123.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$149.56
Rate for Payer: Qualcare PPO/HMO/WC	$92.70

STENT PERCUFLEX PLUS URTERAL

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658587
Hospital Revenue Code	278
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$98.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: Qualcare PPO/HMO/WC	$60.94

STENT PERCUFLEX PLUS URTERAL

Facility

$406.25

Service Code	HCPCS C2617
Hospital Charge Code	270658587
Hospital Revenue Code	278
Min. Negotiated Rate	$11.54
Max. Negotiated Rate	$203.12
Rate for Payer: Aetna Commercial	$154.38
Rate for Payer: Aetna Medicare Advantage	$121.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$103.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$81.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$103.59
Rate for Payer: Cigna Commercial	$203.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$98.31
Rate for Payer: Qualcare PPO/HMO/WC	$60.94
Rate for Payer: UnitedHealthcare Community & State	$12.84
Rate for Payer: Wellpoint Medicaid Managed Care	$11.54

STENT PERIP 4 5X80 S45080120P6

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668911
Hospital Revenue Code	278
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$2,130.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,761.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT PERIP 4 5X80 S45080120P6

Facility

$8,805.00

Service Code	HCPCS C1876
Hospital Charge Code	270668911
Hospital Revenue Code	278
Min. Negotiated Rate	$250.06
Max. Negotiated Rate	$4,402.50
Rate for Payer: Aetna Commercial	$3,345.90
Rate for Payer: Aetna Medicare Advantage	$2,641.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,245.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,761.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,130.81
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Community & State	$278.24
Rate for Payer: Wellpoint Medicaid Managed Care	$250.06

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	321036903
Hospital Revenue Code	361
Min. Negotiated Rate	$1,608.03
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,721.45
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,789.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,608.03

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	321036903
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	7412058
Hospital Revenue Code	361
Min. Negotiated Rate	$1,384.26
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,672.80
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,540.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,384.26

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	366836903
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	366836903
Hospital Revenue Code	361
Min. Negotiated Rate	$1,384.26
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,672.80
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,540.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,384.26

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	2709024
Hospital Revenue Code	361
Min. Negotiated Rate	$1,384.26
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,672.80
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,540.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,384.26

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	2692129
Hospital Revenue Code	361
Min. Negotiated Rate	$1,608.03
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14,721.45
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,789.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,608.03

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	2709024
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	5100837
Hospital Revenue Code	361
Min. Negotiated Rate	$1,384.26
Max. Negotiated Rate	$49,750.44
Rate for Payer: Aetna Commercial	$37,304.26
Rate for Payer: Aetna Medicare Advantage	$44,435.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49,750.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13,714.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49,750.44
Rate for Payer: Cigna Commercial	$27,491.26
Rate for Payer: Cigna Medicare Advantage	$13,714.80
Rate for Payer: Clover Medicare Advantage	$13,029.06
Rate for Payer: EmblemHealth Commercial	$41,144.40
Rate for Payer: Humana Medicare Advantage	$14,126.24
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13,714.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12,672.80
Rate for Payer: Oxford Commercial	$14,968.00
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23
Rate for Payer: UnitedHealthcare Commercial	$16,639.00
Rate for Payer: UnitedHealthcare Community & State	$1,540.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$13,714.80
Rate for Payer: Wellcare Medicare Advantage	$13,714.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,384.26

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	5100837
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPH DIALYSIS SEGMENT

Facility

$56,620.95

Service Code	HCPCS 36903
Hospital Charge Code	2692129
Hospital Revenue Code	361
Min. Negotiated Rate	$8,493.14
Max. Negotiated Rate	$8,493.14
Rate for Payer: Qualcare PPO/HMO/WC	$8,493.14

STENT PERIPH DIALYSIS SEGMENT

Facility

$48,741.55

Service Code	HCPCS 36903
Hospital Charge Code	7412058
Hospital Revenue Code	361
Min. Negotiated Rate	$7,311.23
Max. Negotiated Rate	$7,311.23
Rate for Payer: Qualcare PPO/HMO/WC	$7,311.23

STENT PERIPHERAL 5.5X120MM 6FR

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064
Hospital Revenue Code	272
Min. Negotiated Rate	$1,491.75
Max. Negotiated Rate	$1,491.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75

STENT PERIPHERAL 5.5X120MM 6FR

Facility

$8,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

STENT PERIPHERAL 5.5X120MM 6FR

Facility

$8,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064A
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$276.50
Rate for Payer: Wellpoint Medicaid Managed Care	$248.50

STENT PERIPHERAL 5.5X120MM 6FR

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270669064
Hospital Revenue Code	272
Min. Negotiated Rate	$282.44
Max. Negotiated Rate	$4,972.50
Rate for Payer: Aetna Commercial	$3,779.10
Rate for Payer: Aetna Medicare Advantage	$2,983.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,535.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,535.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,535.97
Rate for Payer: Cigna Commercial	$4,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,585.70
Rate for Payer: Oxford Commercial	$1,989.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75
Rate for Payer: UnitedHealthcare Commercial	$1,989.00
Rate for Payer: UnitedHealthcare Community & State	$314.26
Rate for Payer: Wellpoint Medicaid Managed Care	$282.44

Know your out-of-pocket cost for care.

All Charges