Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT PROTEGE EVERFLEX 8X100

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008N
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STENT PROTEGE EVERFLEX 8X100

Facility

$5,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008C
Hospital Revenue Code	278
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Aetna Commercial	$1,900.00
Rate for Payer: Aetna Medicare Advantage	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,275.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,275.00
Rate for Payer: Cigna Commercial	$2,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00
Rate for Payer: UnitedHealthcare Community & State	$158.00
Rate for Payer: Wellpoint Medicaid Managed Care	$142.00

STENT PROTEGE EVERFLEX 8X100

Facility

$5,000.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008C
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$1,210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,210.00
Rate for Payer: Qualcare PPO/HMO/WC	$750.00

STENT PROTEGE EVERFLEX 8X100

Facility

$5,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270637008N
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009S
Hospital Revenue Code	278
Min. Negotiated Rate	$272.25
Max. Negotiated Rate	$439.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: Qualcare PPO/HMO/WC	$272.25

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009N
Hospital Revenue Code	278
Min. Negotiated Rate	$272.25
Max. Negotiated Rate	$439.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: Qualcare PPO/HMO/WC	$272.25

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009N
Hospital Revenue Code	278
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$907.50
Rate for Payer: Aetna Commercial	$689.70
Rate for Payer: Aetna Medicare Advantage	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$462.82
Rate for Payer: Cigna Commercial	$907.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: Qualcare PPO/HMO/WC	$272.25
Rate for Payer: UnitedHealthcare Community & State	$57.35
Rate for Payer: Wellpoint Medicaid Managed Care	$51.55

STENT PROTEGE EVERFLEX 8x150

Facility

$1,815.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009S
Hospital Revenue Code	278
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$907.50
Rate for Payer: Aetna Commercial	$689.70
Rate for Payer: Aetna Medicare Advantage	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$462.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$462.82
Rate for Payer: Cigna Commercial	$907.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$439.23
Rate for Payer: Qualcare PPO/HMO/WC	$272.25
Rate for Payer: UnitedHealthcare Community & State	$57.35
Rate for Payer: Wellpoint Medicaid Managed Care	$51.55

STENT PROTEGE EVERFLEX 8x150

Facility

$5,500.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009
Hospital Revenue Code	278
Min. Negotiated Rate	$825.00
Max. Negotiated Rate	$1,331.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00

STENT PROTEGE EVERFLEX 8x150

Facility

$5,500.00

Service Code	HCPCS C2617
Hospital Charge Code	270637009
Hospital Revenue Code	278
Min. Negotiated Rate	$156.20
Max. Negotiated Rate	$2,750.00
Rate for Payer: Aetna Commercial	$2,090.00
Rate for Payer: Aetna Medicare Advantage	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,402.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,402.50
Rate for Payer: Cigna Commercial	$2,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,331.00
Rate for Payer: Qualcare PPO/HMO/WC	$825.00
Rate for Payer: UnitedHealthcare Community & State	$173.80
Rate for Payer: Wellpoint Medicaid Managed Care	$156.20

STENT PROTEGE EVERFLEX 8X30

Facility

$1,395.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087S
Hospital Revenue Code	278
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: Qualcare PPO/HMO/WC	$209.25
Rate for Payer: UnitedHealthcare Community & State	$44.08
Rate for Payer: Wellpoint Medicaid Managed Care	$39.62

STENT PROTEGE EVERFLEX 8X30

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087
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 PROTEGE EVERFLEX 8X30

Facility

$1,395.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087S
Hospital Revenue Code	278
Min. Negotiated Rate	$209.25
Max. Negotiated Rate	$337.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$279.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$337.59
Rate for Payer: Qualcare PPO/HMO/WC	$209.25

STENT PROTEGE EVERFLEX 8X30

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270644087
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 PROTEGE EVERFLEX 8X40

Facility

$1,470.00

Service Code	HCPCS C2617
Hospital Charge Code	270642225
Hospital Revenue Code	278
Min. Negotiated Rate	$41.75
Max. Negotiated Rate	$735.00
Rate for Payer: Aetna Commercial	$558.60
Rate for Payer: Aetna Medicare Advantage	$441.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$374.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$374.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$374.85
Rate for Payer: Cigna Commercial	$735.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.74
Rate for Payer: Qualcare PPO/HMO/WC	$220.50
Rate for Payer: UnitedHealthcare Community & State	$46.45
Rate for Payer: Wellpoint Medicaid Managed Care	$41.75

STENT PROTEGE EVERFLEX 8X40

Facility

$1,470.00

Service Code	HCPCS C2617
Hospital Charge Code	270642225
Hospital Revenue Code	278
Min. Negotiated Rate	$220.50
Max. Negotiated Rate	$355.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$294.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$355.74
Rate for Payer: Qualcare PPO/HMO/WC	$220.50

STENT PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798N
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 PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798S
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 PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798S
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 PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798
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 PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798N
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 PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Hospital Charge Code	270636799
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 PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Hospital Charge Code	270636799
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 PROTEGE EVERFLEX 8x60x12

Facility

$4,500.00

Service Code	HCPCS C1876
Hospital Charge Code	270636798
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 PROTEGE EVRFLX6FRBIL 5X

Facility

$8,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270657481N
Hospital Revenue Code	278
Min. Negotiated Rate	$240.69
Max. Negotiated Rate	$4,237.50
Rate for Payer: Aetna Commercial	$3,220.50
Rate for Payer: Aetna Medicare Advantage	$2,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,161.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,161.12
Rate for Payer: Cigna Commercial	$4,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,050.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,271.25
Rate for Payer: UnitedHealthcare Community & State	$267.81
Rate for Payer: Wellpoint Medicaid Managed Care	$240.69

Know your out-of-pocket cost for care.

All Charges