Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT RX XPENDITION 3.0X12

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658774S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658775
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

STENT RX XPENDITION 3.0X15

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658775
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

STENT SINGLE PIGTAIL 5FR 5 CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679127
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT SINGLE PIGTAIL 5FR 5 CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679127
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

STENT SINGLE PIGTAIL 5FR 7CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679124
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

STENT SINGLE PIGTAIL 5FR 7CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679124
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT - SMART STENT #N840BBR

Facility

$5,059.00

Hospital Charge Code	5100515
Hospital Revenue Code	278
Min. Negotiated Rate	$758.85
Max. Negotiated Rate	$1,224.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,011.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.28
Rate for Payer: Qualcare PPO/HMO/WC	$758.85

STENT - SMART STENT #N840BBR

Facility

$5,059.00

Hospital Charge Code	5100515
Hospital Revenue Code	278
Min. Negotiated Rate	$143.68
Max. Negotiated Rate	$2,529.50
Rate for Payer: Aetna Commercial	$1,922.42
Rate for Payer: Aetna Medicare Advantage	$1,517.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,290.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,290.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,011.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,290.05
Rate for Payer: Cigna Commercial	$2,529.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,224.28
Rate for Payer: Qualcare PPO/HMO/WC	$758.85
Rate for Payer: UnitedHealthcare Community & State	$159.86
Rate for Payer: Wellpoint Medicaid Managed Care	$143.68

STENTS ORSIRO 2.75/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700911
Hospital Revenue Code	278
Min. Negotiated Rate	$337.50
Max. Negotiated Rate	$544.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50

STENTS ORSIRO 2.75/9

Facility

$2,250.00

Service Code	HCPCS C1874
Hospital Charge Code	270700911
Hospital Revenue Code	278
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$544.50
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

STENT STRAIGHT LEADING 5FRx5CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679133
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

STENT STRAIGHT LEADING 5FRx5CM

Facility

$850.00

Service Code	HCPCS C2625
Hospital Charge Code	270679133
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

STENT SUPERA 4.5x100MM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270671334
Hospital Revenue Code	272
Min. Negotiated Rate	$1,220.62
Max. Negotiated Rate	$1,220.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62

STENT SUPERA 4.5x100MM

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270671334
Hospital Revenue Code	272
Min. Negotiated Rate	$231.10
Max. Negotiated Rate	$4,068.75
Rate for Payer: Aetna Commercial	$3,092.25
Rate for Payer: Aetna Medicare Advantage	$2,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,075.06
Rate for Payer: Cigna Commercial	$4,068.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.75
Rate for Payer: Oxford Commercial	$1,627.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62
Rate for Payer: UnitedHealthcare Commercial	$1,627.50
Rate for Payer: UnitedHealthcare Community & State	$257.14
Rate for Payer: Wellpoint Medicaid Managed Care	$231.10

STENT SUPERA 4.5x120mm 6F

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270672069
Hospital Revenue Code	278
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) NJ Health	$1,989.00
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	$2,406.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75
Rate for Payer: UnitedHealthcare Community & State	$314.26
Rate for Payer: Wellpoint Medicaid Managed Care	$282.44

STENT SUPERA 4.5x120mm 6F

Facility

$9,945.00

Service Code	HCPCS C1876
Hospital Charge Code	270672069
Hospital Revenue Code	278
Min. Negotiated Rate	$1,491.75
Max. Negotiated Rate	$2,406.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,989.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,406.69
Rate for Payer: Qualcare PPO/HMO/WC	$1,491.75

STENT SUPERA 4.5x120mm 6F

Facility

$8,805.00

Hospital Charge Code	270705282
Hospital Revenue Code	272
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) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,289.30
Rate for Payer: Oxford Commercial	$1,761.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Commercial	$1,761.00
Rate for Payer: UnitedHealthcare Community & State	$278.24
Rate for Payer: Wellpoint Medicaid Managed Care	$250.06

STENT SUPERA 4.5x120mm 6F

Facility

$8,805.00

Hospital Charge Code	270705282
Hospital Revenue Code	272
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$1,320.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

STENT SUPERA 4.5x60mm 120cm 6F

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270670960
Hospital Revenue Code	272
Min. Negotiated Rate	$1,220.62
Max. Negotiated Rate	$1,220.62
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62

STENT SUPERA 4.5x60mm 120cm 6F

Facility

$8,137.50

Service Code	HCPCS C1876
Hospital Charge Code	270670960
Hospital Revenue Code	272
Min. Negotiated Rate	$231.10
Max. Negotiated Rate	$4,068.75
Rate for Payer: Aetna Commercial	$3,092.25
Rate for Payer: Aetna Medicare Advantage	$2,441.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,075.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,075.06
Rate for Payer: Cigna Commercial	$4,068.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,115.75
Rate for Payer: Oxford Commercial	$1,627.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,220.62
Rate for Payer: UnitedHealthcare Commercial	$1,627.50
Rate for Payer: UnitedHealthcare Community & State	$257.14
Rate for Payer: Wellpoint Medicaid Managed Care	$231.10

STENT SUPERA 4.5x60mm 120cm 6F

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270670960A
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

STENT SUPERA 4.5x60mm 120cm 6F

Facility

$7,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270670960A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

STENT SUPERA 4x60mm 120cm

Facility

$8,805.00

Hospital Charge Code	270644884
Hospital Revenue Code	272
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) PPO	$2,245.28
Rate for Payer: Cigna Commercial	$4,402.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,289.30
Rate for Payer: Oxford Commercial	$1,761.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75
Rate for Payer: UnitedHealthcare Commercial	$1,761.00
Rate for Payer: UnitedHealthcare Community & State	$278.24
Rate for Payer: Wellpoint Medicaid Managed Care	$250.06

STENT SUPERA 4x60mm 120cm

Facility

$8,805.00

Hospital Charge Code	270644884
Hospital Revenue Code	272
Min. Negotiated Rate	$1,320.75
Max. Negotiated Rate	$1,320.75
Rate for Payer: Qualcare PPO/HMO/WC	$1,320.75

Know your out-of-pocket cost for care.

All Charges