Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT RESOLUTE ONYX 2.00 x 26

Facility

$4,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270682643
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 RESOLUTE ONYX 2.00 x 30

Facility

$4,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270682644
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 RESOLUTE ONYX 2.00 x 30

Facility

$4,875.00

Service Code	HCPCS C1874
Hospital Charge Code	270682644
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 RESOLUTE ONYX 2.00 x 8

Facility

$5,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270682645
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 RESOLUTE ONYX 2.00 x 8

Facility

$5,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270682645
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 RESOLUTE ONYX 2.25 x 08

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682646
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 08

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682646
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 12

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682647
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 12

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682647
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 15

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682648
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 15

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682648
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 18

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682649
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 18

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682649
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682650
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682650
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682650S
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682650S
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 26

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682651
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 26

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682651
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 30

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682652
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 30

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682652
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 34

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682653
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

STENT RESOLUTE ONYX 2.25 x 34

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682653
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 38

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682654
Hospital Revenue Code	278
Min. Negotiated Rate	$768.75
Max. Negotiated Rate	$1,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75

STENT RESOLUTE ONYX 2.25 x 38

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682654
Hospital Revenue Code	278
Min. Negotiated Rate	$145.55
Max. Negotiated Rate	$2,562.50
Rate for Payer: Aetna Commercial	$1,947.50
Rate for Payer: Aetna Medicare Advantage	$1,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,306.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,306.88
Rate for Payer: Cigna Commercial	$2,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,240.25
Rate for Payer: Qualcare PPO/HMO/WC	$768.75
Rate for Payer: UnitedHealthcare Community & State	$161.95
Rate for Payer: Wellpoint Medicaid Managed Care	$145.55

Know your out-of-pocket cost for care.

All Charges