Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT UNIVERSA SOFT 6FR22-32CM

Facility

$452.40

Service Code	HCPCS C2625
Hospital Charge Code	270647870
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 SOFT7 FR22-32cm

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658545
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 SOFT7 FR22-32cm

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658545
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,URE.BARD INLAY DBL PIGTA

Facility

$7,187.00

Hospital Charge Code	270335395
Hospital Revenue Code	278
Min. Negotiated Rate	$204.11
Max. Negotiated Rate	$3,593.50
Rate for Payer: Aetna Commercial	$2,731.06
Rate for Payer: Aetna Medicare Advantage	$2,156.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,832.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,832.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,437.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,832.68
Rate for Payer: Cigna Commercial	$3,593.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,739.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.05
Rate for Payer: UnitedHealthcare Community & State	$227.11
Rate for Payer: Wellpoint Medicaid Managed Care	$204.11

STENT,URE.BARD INLAY DBL PIGTA

Facility

$7,187.00

Hospital Charge Code	270335395
Hospital Revenue Code	278
Min. Negotiated Rate	$1,078.05
Max. Negotiated Rate	$1,739.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,437.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,739.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,078.05

STENT, URETERAL

Facility

$924.00

Hospital Charge Code	2008165
Hospital Revenue Code	278
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$223.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.61
Rate for Payer: Qualcare PPO/HMO/WC	$138.60

STENT, URETERAL

Facility

$924.00

Hospital Charge Code	2008165
Hospital Revenue Code	278
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$462.00
Rate for Payer: Aetna Commercial	$351.12
Rate for Payer: Aetna Medicare Advantage	$277.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$235.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$184.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$235.62
Rate for Payer: Cigna Commercial	$462.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$223.61
Rate for Payer: Qualcare PPO/HMO/WC	$138.60
Rate for Payer: UnitedHealthcare Community & State	$29.20
Rate for Payer: Wellpoint Medicaid Managed Care	$26.24

STENT URETERAL 4.7 Fr./22cm-32

Facility

$295.00

Service Code	HCPCS C2617
Hospital Charge Code	270636831
Hospital Revenue Code	278
Min. Negotiated Rate	$44.25
Max. Negotiated Rate	$71.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25

STENT URETERAL 4.7 Fr./22cm-32

Facility

$295.00

Service Code	HCPCS C2617
Hospital Charge Code	270636831
Hospital Revenue Code	278
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$147.50
Rate for Payer: Aetna Commercial	$112.10
Rate for Payer: Aetna Medicare Advantage	$88.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$75.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$59.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$75.22
Rate for Payer: Cigna Commercial	$147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$71.39
Rate for Payer: Qualcare PPO/HMO/WC	$44.25
Rate for Payer: UnitedHealthcare Community & State	$9.32
Rate for Payer: Wellpoint Medicaid Managed Care	$8.38

STENT URETERAL 4.7FR X 22CM

Facility

$846.35

Service Code	HCPCS C2617
Hospital Charge Code	270661333
Hospital Revenue Code	278
Min. Negotiated Rate	$24.04
Max. Negotiated Rate	$423.18
Rate for Payer: Aetna Commercial	$321.61
Rate for Payer: Aetna Medicare Advantage	$253.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.82
Rate for Payer: Cigna Commercial	$423.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.82
Rate for Payer: Qualcare PPO/HMO/WC	$126.95
Rate for Payer: UnitedHealthcare Community & State	$26.74
Rate for Payer: Wellpoint Medicaid Managed Care	$24.04

STENT URETERAL 4.7FR X 22CM

Facility

$846.35

Service Code	HCPCS C2617
Hospital Charge Code	270661333
Hospital Revenue Code	278
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$204.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.82
Rate for Payer: Qualcare PPO/HMO/WC	$126.95

STENT URETERAL 6FR 30CM SET

Facility

$1,223.00

Hospital Charge Code	270331429
Hospital Revenue Code	278
Min. Negotiated Rate	$34.73
Max. Negotiated Rate	$611.50
Rate for Payer: Aetna Commercial	$464.74
Rate for Payer: Aetna Medicare Advantage	$366.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$311.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$311.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$311.87
Rate for Payer: Cigna Commercial	$611.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.97
Rate for Payer: Qualcare PPO/HMO/WC	$183.45
Rate for Payer: UnitedHealthcare Community & State	$38.65
Rate for Payer: Wellpoint Medicaid Managed Care	$34.73

STENT URETERAL 6FR 30CM SET

Facility

$1,223.00

Hospital Charge Code	270331429
Hospital Revenue Code	278
Min. Negotiated Rate	$183.45
Max. Negotiated Rate	$295.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$244.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$295.97
Rate for Payer: Qualcare PPO/HMO/WC	$183.45

STENT URETERAL 6FRX22

Facility

$425.00

Service Code	HCPCS C2617
Hospital Charge Code	270660561
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

STENT URETERAL 6FRX22

Facility

$425.00

Service Code	HCPCS C2617
Hospital Charge Code	270660561
Hospital Revenue Code	278
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

STENT URETERAL 7FR 30CM SET

Facility

$816.00

Hospital Charge Code	270331430
Hospital Revenue Code	278
Min. Negotiated Rate	$23.17
Max. Negotiated Rate	$408.00
Rate for Payer: Aetna Commercial	$310.08
Rate for Payer: Aetna Medicare Advantage	$244.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.08
Rate for Payer: Cigna Commercial	$408.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40
Rate for Payer: UnitedHealthcare Community & State	$25.79
Rate for Payer: Wellpoint Medicaid Managed Care	$23.17

STENT URETERAL 7FR 30CM SET

Facility

$816.00

Hospital Charge Code	270331430
Hospital Revenue Code	278
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$197.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$197.47
Rate for Payer: Qualcare PPO/HMO/WC	$122.40

STENT URETERAL 8FR 30CM SET

Facility

$971.00

Hospital Charge Code	270331431
Hospital Revenue Code	278
Min. Negotiated Rate	$145.65
Max. Negotiated Rate	$234.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.98
Rate for Payer: Qualcare PPO/HMO/WC	$145.65

STENT URETERAL 8FR 30CM SET

Facility

$971.00

Hospital Charge Code	270331431
Hospital Revenue Code	278
Min. Negotiated Rate	$27.58
Max. Negotiated Rate	$485.50
Rate for Payer: Aetna Commercial	$368.98
Rate for Payer: Aetna Medicare Advantage	$291.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$247.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$247.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$194.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$247.60
Rate for Payer: Cigna Commercial	$485.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$234.98
Rate for Payer: Qualcare PPO/HMO/WC	$145.65
Rate for Payer: UnitedHealthcare Community & State	$30.68
Rate for Payer: Wellpoint Medicaid Managed Care	$27.58

STENT URETERAL CONTOUR 6Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684752
Hospital Revenue Code	278
Min. Negotiated Rate	$30.84
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$34.32
Rate for Payer: Wellpoint Medicaid Managed Care	$30.84

STENT URETERAL CONTOUR 6Fx20cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684752
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684753
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

STENT URETERAL CONTOUR 6Fx22cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684753
Hospital Revenue Code	278
Min. Negotiated Rate	$30.84
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$34.32
Rate for Payer: Wellpoint Medicaid Managed Care	$30.84

STENT URETERAL CONTOUR 6Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684754
Hospital Revenue Code	278
Min. Negotiated Rate	$30.84
Max. Negotiated Rate	$543.00
Rate for Payer: Aetna Commercial	$412.68
Rate for Payer: Aetna Medicare Advantage	$325.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$276.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$276.93
Rate for Payer: Cigna Commercial	$543.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90
Rate for Payer: UnitedHealthcare Community & State	$34.32
Rate for Payer: Wellpoint Medicaid Managed Care	$30.84

STENT URETERAL CONTOUR 6Fx24cm

Facility

$1,086.00

Service Code	HCPCS C2617
Hospital Charge Code	270684754
Hospital Revenue Code	278
Min. Negotiated Rate	$162.90
Max. Negotiated Rate	$262.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$217.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$262.81
Rate for Payer: Qualcare PPO/HMO/WC	$162.90

Know your out-of-pocket cost for care.

All Charges