Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT RESOLUTE ONYX 3.00 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682592
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 3.00 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682592
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 3.00 x 26

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682593
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 3.00 x 26

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682593
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 3.00 x 30

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682671
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 3.00 x 30

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682671
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 3.00 x 30

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682671S
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 3.00 x 30

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682671S
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 3.00 x 34

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682672
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 3.00 x 34

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682672
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 3.00 x 38

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682673
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 3.00 x 38

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682673
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 3.50 x 08

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682674
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 3.50 x 08

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682674
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 3.50 x 12

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682587
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 3.50 x 12

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682587
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 3.50 x 15

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682589S
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 3.50 x 15

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682589
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 3.50 x 15

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682589S
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 3.50 x 15

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682589
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 3.50 x 18

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682675
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 3.50 x 18

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682675
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 3.50 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682676
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 3.50 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682676S
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 3.50 x 22

Facility

$5,125.00

Service Code	HCPCS C1874
Hospital Charge Code	270682676S
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