Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT TRACH P/COVRD 12x40x25MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270676648
Hospital Revenue Code	278
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$521.40
Rate for Payer: Wellpoint Medicaid Managed Care	$468.60

STENT TRACH P/COVRD 12x40x25MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270676648
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT TRACH P/COVRD 14x40x40MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270677586
Hospital Revenue Code	278
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$521.40
Rate for Payer: Wellpoint Medicaid Managed Care	$468.60

STENT TRACH P/COVRD 14x40x40MM

Facility

$16,500.00

Service Code	HCPCS C1874
Hospital Charge Code	270677586
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT TRACH P/COVRD 16x40x40MM

Facility

$16,500.00

Hospital Charge Code	270677587
Hospital Revenue Code	278
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$521.40
Rate for Payer: Wellpoint Medicaid Managed Care	$468.60

STENT TRACH P/COVRD 16x40x40MM

Facility

$16,500.00

Hospital Charge Code	270677587
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT TREVO 3 X 20 CM

Facility

$39,975.00

Hospital Charge Code	270685068
Hospital Revenue Code	278
Min. Negotiated Rate	$1,135.29
Max. Negotiated Rate	$19,987.50
Rate for Payer: Aetna Commercial	$15,190.50
Rate for Payer: Aetna Medicare Advantage	$11,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,193.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,193.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,193.62
Rate for Payer: Cigna Commercial	$19,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,673.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,996.25
Rate for Payer: UnitedHealthcare Community & State	$1,263.21
Rate for Payer: Wellpoint Medicaid Managed Care	$1,135.29

STENT TREVO 3 X 20 CM

Facility

$39,975.00

Hospital Charge Code	270685068
Hospital Revenue Code	278
Min. Negotiated Rate	$5,996.25
Max. Negotiated Rate	$9,673.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,673.95
Rate for Payer: Qualcare PPO/HMO/WC	$5,996.25

STENT TX XPEDITION 2.75X18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658768
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 TX XPEDITION 2.75X18

Facility

$7,000.00

Service Code	HCPCS C1874
Hospital Charge Code	270658768
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 ULTRAFLEX TRACH 18X80MM

Facility

$16,500.00

Hospital Charge Code	270671168
Hospital Revenue Code	278
Min. Negotiated Rate	$2,475.00
Max. Negotiated Rate	$3,993.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00

STENT ULTRAFLEX TRACH 18X80MM

Facility

$16,500.00

Hospital Charge Code	270671168
Hospital Revenue Code	278
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$8,250.00
Rate for Payer: Aetna Commercial	$6,270.00
Rate for Payer: Aetna Medicare Advantage	$4,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,207.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,207.50
Rate for Payer: Cigna Commercial	$8,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,993.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,475.00
Rate for Payer: UnitedHealthcare Community & State	$521.40
Rate for Payer: Wellpoint Medicaid Managed Care	$468.60

STENT UNCOVERED BILIARY 8x10

Facility

$8,504.25

Service Code	HCPCS C1876
Hospital Charge Code	270677074
Hospital Revenue Code	278
Min. Negotiated Rate	$241.52
Max. Negotiated Rate	$4,252.12
Rate for Payer: Aetna Commercial	$3,231.61
Rate for Payer: Aetna Medicare Advantage	$2,551.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,168.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,168.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,168.58
Rate for Payer: Cigna Commercial	$4,252.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.64
Rate for Payer: UnitedHealthcare Community & State	$268.73
Rate for Payer: Wellpoint Medicaid Managed Care	$241.52

STENT UNCOVERED BILIARY 8x10

Facility

$8,504.25

Service Code	HCPCS C1876
Hospital Charge Code	270677074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.64
Max. Negotiated Rate	$2,058.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,700.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,058.03
Rate for Payer: Qualcare PPO/HMO/WC	$1,275.64

STENT UNIVERSA FIRM 6x22

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647871
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x22

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647871
Hospital Revenue Code	278
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

STENT UNIVERSA FIRM 6x26

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647873
Hospital Revenue Code	278
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

STENT UNIVERSA FIRM 6x26

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647873
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA FIRM 6x28

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647874
Hospital Revenue Code	278
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

STENT UNIVERSA FIRM 6x28

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647874
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 5FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647869
Hospital Revenue Code	278
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

STENT UNIVERSA SOFT 5FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647869
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6 24

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647872
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

STENT UNIVERSA SOFT 6 24

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647872
Hospital Revenue Code	278
Min. Negotiated Rate	$12.85
Max. Negotiated Rate	$226.20
Rate for Payer: Aetna Commercial	$171.91
Rate for Payer: Aetna Medicare Advantage	$135.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$115.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$115.36
Rate for Payer: Cigna Commercial	$226.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86
Rate for Payer: UnitedHealthcare Community & State	$14.30
Rate for Payer: Wellpoint Medicaid Managed Care	$12.85

STENT UNIVERSA SOFT 6FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647870
Hospital Revenue Code	278
Min. Negotiated Rate	$67.86
Max. Negotiated Rate	$109.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$90.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$109.48
Rate for Payer: Qualcare PPO/HMO/WC	$67.86

Know your out-of-pocket cost for care.

All Charges