Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT PLACEMT RETRO CAROTID

Facility

$20,000.00

Service Code	HCPCS 37217
Hospital Charge Code	321037217
Hospital Revenue Code	361
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$7,600.00
Rate for Payer: Aetna Medicare Advantage	$6,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,100.00
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	$5,100.00
Rate for Payer: Cigna Commercial	$10,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,200.00
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$632.00
Rate for Payer: Wellpoint Medicaid Managed Care	$568.00

STENT PLACEMT RETRO CAROTID

Facility

$20,000.00

Service Code	HCPCS 37217
Hospital Charge Code	321037217
Hospital Revenue Code	361
Min. Negotiated Rate	$3,000.00
Max. Negotiated Rate	$3,000.00
Rate for Payer: Qualcare PPO/HMO/WC	$3,000.00

STENT PLASTIC 7 X12

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663632
Hospital Revenue Code	278
Min. Negotiated Rate	$19.03
Max. Negotiated Rate	$335.00
Rate for Payer: Aetna Commercial	$254.60
Rate for Payer: Aetna Medicare Advantage	$201.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.85
Rate for Payer: Cigna Commercial	$335.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50
Rate for Payer: UnitedHealthcare Community & State	$21.17
Rate for Payer: Wellpoint Medicaid Managed Care	$19.03

STENT PLASTIC 7 X12

Facility

$670.00

Service Code	HCPCS C2625
Hospital Charge Code	270663632
Hospital Revenue Code	278
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$162.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$134.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$162.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.50

STENT PRECISE PRO RX 7X40 MM 1

Facility

$10,590.00

Service Code	HCPCS C1876
Hospital Charge Code	270689712
Hospital Revenue Code	278
Min. Negotiated Rate	$1,588.50
Max. Negotiated Rate	$2,562.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,562.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,588.50

STENT PRECISE PRO RX 7X40 MM 1

Facility

$10,590.00

Service Code	HCPCS C1876
Hospital Charge Code	270689712
Hospital Revenue Code	278
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$5,295.00
Rate for Payer: Aetna Commercial	$4,024.20
Rate for Payer: Aetna Medicare Advantage	$3,177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,700.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,700.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,118.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,700.45
Rate for Payer: Cigna Commercial	$5,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,562.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,588.50
Rate for Payer: UnitedHealthcare Community & State	$334.64
Rate for Payer: Wellpoint Medicaid Managed Care	$300.76

STENT PRECISE PRO RX 8X40 MM 1

Facility

$10,590.00

Service Code	HCPCS C1876
Hospital Charge Code	270689711
Hospital Revenue Code	278
Min. Negotiated Rate	$1,588.50
Max. Negotiated Rate	$2,562.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,562.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,588.50

STENT PRECISE PRO RX 8X40 MM 1

Facility

$10,590.00

Service Code	HCPCS C1876
Hospital Charge Code	270689711
Hospital Revenue Code	278
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$5,295.00
Rate for Payer: Aetna Commercial	$4,024.20
Rate for Payer: Aetna Medicare Advantage	$3,177.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,700.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,700.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,118.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,700.45
Rate for Payer: Cigna Commercial	$5,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,562.78
Rate for Payer: Qualcare PPO/HMO/WC	$1,588.50
Rate for Payer: UnitedHealthcare Community & State	$334.64
Rate for Payer: Wellpoint Medicaid Managed Care	$300.76

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811N
Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.75
Max. Negotiated Rate	$1,323.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811N
Hospital Revenue Code	272
Min. Negotiated Rate	$250.63
Max. Negotiated Rate	$4,412.50
Rate for Payer: Aetna Commercial	$3,353.50
Rate for Payer: Aetna Medicare Advantage	$2,647.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,250.38
Rate for Payer: Cigna Commercial	$4,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,294.50
Rate for Payer: Oxford Commercial	$1,765.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75
Rate for Payer: UnitedHealthcare Commercial	$1,765.00
Rate for Payer: UnitedHealthcare Community & State	$278.87
Rate for Payer: Wellpoint Medicaid Managed Care	$250.63

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811
Hospital Revenue Code	272
Min. Negotiated Rate	$250.63
Max. Negotiated Rate	$4,412.50
Rate for Payer: Aetna Commercial	$3,353.50
Rate for Payer: Aetna Medicare Advantage	$2,647.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,250.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,250.38
Rate for Payer: Cigna Commercial	$4,412.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,294.50
Rate for Payer: Oxford Commercial	$1,765.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75
Rate for Payer: UnitedHealthcare Commercial	$1,765.00
Rate for Payer: UnitedHealthcare Community & State	$278.87
Rate for Payer: Wellpoint Medicaid Managed Care	$250.63

STENT PRECISE RX 6 MM x 40 MM

Facility

$8,825.00

Service Code	HCPCS C1876
Hospital Charge Code	270683811
Hospital Revenue Code	272
Min. Negotiated Rate	$1,323.75
Max. Negotiated Rate	$1,323.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,323.75

STENT PRECSE RX 6x30 P06030RXB

Facility

$10,639.25

Service Code	HCPCS C1876
Hospital Charge Code	270631755
Hospital Revenue Code	278
Min. Negotiated Rate	$302.15
Max. Negotiated Rate	$5,319.62
Rate for Payer: Aetna Commercial	$4,042.91
Rate for Payer: Aetna Medicare Advantage	$3,191.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,713.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,713.01
Rate for Payer: Cigna Commercial	$5,319.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89
Rate for Payer: UnitedHealthcare Community & State	$336.20
Rate for Payer: Wellpoint Medicaid Managed Care	$302.15

STENT PRECSE RX 6x30 P06030RXB

Facility

$10,639.25

Service Code	HCPCS C1876
Hospital Charge Code	270631755
Hospital Revenue Code	278
Min. Negotiated Rate	$1,595.89
Max. Negotiated Rate	$2,574.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,127.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,574.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,595.89

STENT PRO 8X80 PRB35-08-80-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637010C
Hospital Revenue Code	278
Min. Negotiated Rate	$675.00
Max. Negotiated Rate	$1,089.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00

STENT PRO 8X80 PRB35-08-80-120

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637010C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,710.00
Rate for Payer: Aetna Medicare Advantage	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,147.50
Rate for Payer: Cigna Commercial	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,089.00
Rate for Payer: Qualcare PPO/HMO/WC	$675.00
Rate for Payer: UnitedHealthcare Community & State	$142.20
Rate for Payer: Wellpoint Medicaid Managed Care	$127.80

STENT PRO 8X80 PRB35-08-80-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270637010N
Hospital Revenue Code	278
Min. Negotiated Rate	$731.25
Max. Negotiated Rate	$1,179.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25

STENT PRO 8X80 PRB35-08-80-120

Facility

$4,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270637010N
Hospital Revenue Code	278
Min. Negotiated Rate	$138.45
Max. Negotiated Rate	$2,437.50
Rate for Payer: Aetna Commercial	$1,852.50
Rate for Payer: Aetna Medicare Advantage	$1,462.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,243.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,243.12
Rate for Payer: Cigna Commercial	$2,437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,179.75
Rate for Payer: Qualcare PPO/HMO/WC	$731.25
Rate for Payer: UnitedHealthcare Community & State	$154.05
Rate for Payer: Wellpoint Medicaid Managed Care	$138.45

STENT PROMUS 3.5 X 20MM

Facility

$7,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270665444
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 PROMUS 3.5 X 20MM

Facility

$7,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270665444
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 PROMUS 3 5 X 24MM

Facility

$5,257.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.30
Max. Negotiated Rate	$2,628.50
Rate for Payer: Aetna Commercial	$1,997.66
Rate for Payer: Aetna Medicare Advantage	$1,577.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,340.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,340.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,051.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,340.54
Rate for Payer: Cigna Commercial	$2,628.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.19
Rate for Payer: Qualcare PPO/HMO/WC	$788.55
Rate for Payer: UnitedHealthcare Community & State	$166.12
Rate for Payer: Wellpoint Medicaid Managed Care	$149.30

STENT PROMUS 3 5 X 24MM

Facility

$6,350.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471
Hospital Revenue Code	278
Min. Negotiated Rate	$180.34
Max. Negotiated Rate	$3,175.00
Rate for Payer: Aetna Commercial	$2,413.00
Rate for Payer: Aetna Medicare Advantage	$1,905.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,619.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,619.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,619.25
Rate for Payer: Cigna Commercial	$3,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$952.50
Rate for Payer: UnitedHealthcare Community & State	$200.66
Rate for Payer: Wellpoint Medicaid Managed Care	$180.34

STENT PROMUS 3 5 X 24MM

Facility

$6,350.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471
Hospital Revenue Code	278
Min. Negotiated Rate	$952.50
Max. Negotiated Rate	$1,536.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$952.50

STENT PROMUS 3 5 X 24MM

Facility

$5,257.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471N
Hospital Revenue Code	278
Min. Negotiated Rate	$788.55
Max. Negotiated Rate	$1,272.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,051.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,272.19
Rate for Payer: Qualcare PPO/HMO/WC	$788.55

STENT PROMUS 3 5 X 24MM

Facility

$6,350.00

Service Code	HCPCS C1874
Hospital Charge Code	270660471S
Hospital Revenue Code	278
Min. Negotiated Rate	$952.50
Max. Negotiated Rate	$1,536.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,536.70
Rate for Payer: Qualcare PPO/HMO/WC	$952.50

Know your out-of-pocket cost for care.

All Charges