Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658590
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 URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658590
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 URETERAL SOFT 7.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658589
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 URETERAL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658594
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 URETERAL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658594
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 URETERAL VL 6F 22-30 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270689651
Hospital Revenue Code	278
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$441.88
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$33.02

STENT URETERAL VL 6F 22-30 CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270689651
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URETERAL WIRE 4.7F 22-32

Facility

$319.15

Service Code	HCPCS C2617
Hospital Charge Code	270696691
Hospital Revenue Code	278
Min. Negotiated Rate	$9.06
Max. Negotiated Rate	$159.57
Rate for Payer: Aetna Commercial	$121.28
Rate for Payer: Aetna Medicare Advantage	$95.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$81.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$81.38
Rate for Payer: Cigna Commercial	$159.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.87
Rate for Payer: UnitedHealthcare Community & State	$10.09
Rate for Payer: Wellpoint Medicaid Managed Care	$9.06

STENT URETERAL WIRE 4.7F 22-32

Facility

$319.15

Service Code	HCPCS C2617
Hospital Charge Code	270696691
Hospital Revenue Code	278
Min. Negotiated Rate	$47.87
Max. Negotiated Rate	$77.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$63.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$77.23
Rate for Payer: Qualcare PPO/HMO/WC	$47.87

STENT URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595N
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595S
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595N
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595
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 URETERL SOFT 8.0 FR

Facility

$452.40

Service Code	HCPCS C2617
Hospital Charge Code	270658595S
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 URETER PERCUFLEX 6FX24CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696158
Hospital Revenue Code	278
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$441.88
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$33.02

STENT URETER PERCUFLEX 6FX24CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696158
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URETHERAL 4.7FR 24CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660098
Hospital Revenue Code	278
Min. Negotiated Rate	$24.03
Max. Negotiated Rate	$423.15
Rate for Payer: Aetna Commercial	$321.59
Rate for Payer: Aetna Medicare Advantage	$253.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.81
Rate for Payer: Cigna Commercial	$423.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94
Rate for Payer: UnitedHealthcare Community & State	$26.74
Rate for Payer: Wellpoint Medicaid Managed Care	$24.03

STENT URETHERAL 4.7FR 24CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660098
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$204.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENT URETHERAL 4.7FR 26CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660099
Hospital Revenue Code	278
Min. Negotiated Rate	$24.03
Max. Negotiated Rate	$423.15
Rate for Payer: Aetna Commercial	$321.59
Rate for Payer: Aetna Medicare Advantage	$253.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$215.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$215.81
Rate for Payer: Cigna Commercial	$423.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94
Rate for Payer: UnitedHealthcare Community & State	$26.74
Rate for Payer: Wellpoint Medicaid Managed Care	$24.03

STENT URETHERAL 4.7FR 26CM

Facility

$846.30

Service Code	HCPCS C2625
Hospital Charge Code	270660099
Hospital Revenue Code	278
Min. Negotiated Rate	$126.94
Max. Negotiated Rate	$204.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$169.26
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.80
Rate for Payer: Qualcare PPO/HMO/WC	$126.94

STENTURETPERCUFL6F2.0MMX26CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696159
Hospital Revenue Code	278
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$581.42
Rate for Payer: Aetna Commercial	$441.88
Rate for Payer: Aetna Medicare Advantage	$348.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.53
Rate for Payer: Cigna Commercial	$581.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43
Rate for Payer: UnitedHealthcare Community & State	$36.75
Rate for Payer: Wellpoint Medicaid Managed Care	$33.02

STENTURETPERCUFL6F2.0MMX26CM

Facility

$1,162.85

Service Code	HCPCS C2617
Hospital Charge Code	270696159
Hospital Revenue Code	278
Min. Negotiated Rate	$174.43
Max. Negotiated Rate	$281.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$232.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$281.41
Rate for Payer: Qualcare PPO/HMO/WC	$174.43

STENT URET PGTL 5 24CM 031524

Facility

$436.50

Service Code	HCPCS C2617
Hospital Charge Code	270601228
Hospital Revenue Code	278
Min. Negotiated Rate	$65.47
Max. Negotiated Rate	$105.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.63
Rate for Payer: Qualcare PPO/HMO/WC	$65.47

STENT URET PGTL 5 24CM 031524

Facility

$436.50

Service Code	HCPCS C2617
Hospital Charge Code	270601228
Hospital Revenue Code	278
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$218.25
Rate for Payer: Aetna Commercial	$165.87
Rate for Payer: Aetna Medicare Advantage	$130.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$111.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$111.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$87.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$111.31
Rate for Payer: Cigna Commercial	$218.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$105.63
Rate for Payer: Qualcare PPO/HMO/WC	$65.47
Rate for Payer: UnitedHealthcare Community & State	$13.79
Rate for Payer: Wellpoint Medicaid Managed Care	$12.40

Know your out-of-pocket cost for care.

All Charges