Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT URET PRCFLX 6X24 175-262

Facility

$1,073.65

Service Code	HCPCS C2617
Hospital Charge Code	270616190
Hospital Revenue Code	278
Min. Negotiated Rate	$30.49
Max. Negotiated Rate	$536.83
Rate for Payer: Aetna Commercial	$407.99
Rate for Payer: Aetna Medicare Advantage	$322.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$273.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$273.78
Rate for Payer: Cigna Commercial	$536.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: Qualcare PPO/HMO/WC	$161.05
Rate for Payer: UnitedHealthcare Community & State	$33.93
Rate for Payer: Wellpoint Medicaid Managed Care	$30.49

STENT URET PRCFLX 6X24 175-262

Facility

$1,073.65

Service Code	HCPCS C2617
Hospital Charge Code	270616190
Hospital Revenue Code	278
Min. Negotiated Rate	$161.05
Max. Negotiated Rate	$259.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$259.82
Rate for Payer: Qualcare PPO/HMO/WC	$161.05

STENT VAIBAHN 8MMX5CMX120CM

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642C
Hospital Revenue Code	278
Min. Negotiated Rate	$500.27
Max. Negotiated Rate	$8,807.50
Rate for Payer: Aetna Commercial	$6,693.70
Rate for Payer: Aetna Medicare Advantage	$5,284.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,491.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,491.82
Rate for Payer: Cigna Commercial	$8,807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25
Rate for Payer: UnitedHealthcare Community & State	$556.63
Rate for Payer: Wellpoint Medicaid Managed Care	$500.27

STENT VAIBAHN 8MMX5CMX120CM

Facility

$17,615.00

Service Code	HCPCS C1876
Hospital Charge Code	270648642C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,642.25
Max. Negotiated Rate	$4,262.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,523.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,262.83
Rate for Payer: Qualcare PPO/HMO/WC	$2,642.25

STENT VASCULAR FREDX21 3X13MM

Facility

$86,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270700648S
Hospital Revenue Code	278
Min. Negotiated Rate	$12,990.00
Max. Negotiated Rate	$20,957.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,320.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,957.20
Rate for Payer: Qualcare PPO/HMO/WC	$12,990.00

STENT VASCULAR FREDX21 3X13MM

Facility

$86,600.00

Service Code	HCPCS C1889
Hospital Charge Code	270700648S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,459.44
Max. Negotiated Rate	$43,300.00
Rate for Payer: Aetna Commercial	$32,908.00
Rate for Payer: Aetna Medicare Advantage	$25,980.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22,083.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22,083.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$17,320.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22,083.00
Rate for Payer: Cigna Commercial	$43,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20,957.20
Rate for Payer: Qualcare PPO/HMO/WC	$12,990.00
Rate for Payer: UnitedHealthcare Community & State	$2,736.56
Rate for Payer: Wellpoint Medicaid Managed Care	$2,459.44

STENT VASCULAR ZILVER 518

Facility

$8,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270662856
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

STENT VASCULAR ZILVER 518

Facility

$8,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270662856
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$1,996.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50

STENT VBX ENDOPROS 11 X 79 CM

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406
Hospital Revenue Code	278
Min. Negotiated Rate	$485.50
Max. Negotiated Rate	$8,547.50
Rate for Payer: Aetna Commercial	$6,496.10
Rate for Payer: Aetna Medicare Advantage	$5,128.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,359.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,359.23
Rate for Payer: Cigna Commercial	$8,547.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25
Rate for Payer: UnitedHealthcare Community & State	$540.20
Rate for Payer: Wellpoint Medicaid Managed Care	$485.50

STENT VBX ENDOPROS 11 X 79 CM

Facility

$17,095.00

Service Code	HCPCS C1874
Hospital Charge Code	270683406
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.25
Max. Negotiated Rate	$4,136.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,419.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,136.99
Rate for Payer: Qualcare PPO/HMO/WC	$2,564.25

STENT VIABAHAN 8X10X120MM

Facility

$20,550.00

Service Code	HCPCS C1876
Hospital Charge Code	270695023S
Hospital Revenue Code	278
Min. Negotiated Rate	$3,082.50
Max. Negotiated Rate	$4,973.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,110.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,973.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,082.50

STENT VIABAHAN 8X10X120MM

Facility

$20,550.00

Service Code	HCPCS C1876
Hospital Charge Code	270695023S
Hospital Revenue Code	278
Min. Negotiated Rate	$583.62
Max. Negotiated Rate	$10,275.00
Rate for Payer: Aetna Commercial	$7,809.00
Rate for Payer: Aetna Medicare Advantage	$6,165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,240.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,110.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,240.25
Rate for Payer: Cigna Commercial	$10,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,973.10
Rate for Payer: Qualcare PPO/HMO/WC	$3,082.50
Rate for Payer: UnitedHealthcare Community & State	$649.38
Rate for Payer: Wellpoint Medicaid Managed Care	$583.62

STENT VIABAHN .014 6MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690860
Hospital Revenue Code	278
Min. Negotiated Rate	$5,426.25
Max. Negotiated Rate	$8,754.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25

STENT VIABAHN .014 6MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690860
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.37
Max. Negotiated Rate	$18,087.50
Rate for Payer: Aetna Commercial	$13,746.50
Rate for Payer: Aetna Medicare Advantage	$10,852.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,224.62
Rate for Payer: Cigna Commercial	$18,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25
Rate for Payer: UnitedHealthcare Community & State	$1,143.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1,027.37

STENT VIABAHN .014 7MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690861
Hospital Revenue Code	278
Min. Negotiated Rate	$1,027.37
Max. Negotiated Rate	$18,087.50
Rate for Payer: Aetna Commercial	$13,746.50
Rate for Payer: Aetna Medicare Advantage	$10,852.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,224.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,224.62
Rate for Payer: Cigna Commercial	$18,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25
Rate for Payer: UnitedHealthcare Community & State	$1,143.13
Rate for Payer: Wellpoint Medicaid Managed Care	$1,027.37

STENT VIABAHN .014 7MM X25 MM

Facility

$36,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270690861
Hospital Revenue Code	278
Min. Negotiated Rate	$5,426.25
Max. Negotiated Rate	$8,754.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,754.35
Rate for Payer: Qualcare PPO/HMO/WC	$5,426.25

STENT VIABAHN 35 RO 8MM X 7.6

Facility

$19,230.00

Hospital Charge Code	270689581
Hospital Revenue Code	272
Min. Negotiated Rate	$2,884.50
Max. Negotiated Rate	$2,884.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50

STENT VIABAHN 35 RO 8MM X 7.6

Facility

$19,230.00

Hospital Charge Code	270689581
Hospital Revenue Code	272
Min. Negotiated Rate	$546.13
Max. Negotiated Rate	$9,615.00
Rate for Payer: Aetna Commercial	$7,307.40
Rate for Payer: Aetna Medicare Advantage	$5,769.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,903.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,903.65
Rate for Payer: Cigna Commercial	$9,615.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,999.80
Rate for Payer: Oxford Commercial	$3,846.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,884.50
Rate for Payer: UnitedHealthcare Commercial	$3,846.00
Rate for Payer: UnitedHealthcare Community & State	$607.67
Rate for Payer: Wellpoint Medicaid Managed Care	$546.13

STENT VIABAHN 35 X 13 MM 10 CM

Facility

$18,760.00

Service Code	HCPCS C1876
Hospital Charge Code	270688211
Hospital Revenue Code	278
Min. Negotiated Rate	$2,814.00
Max. Negotiated Rate	$4,539.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,752.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,539.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,814.00

STENT VIABAHN 35 X 13 MM 10 CM

Facility

$18,760.00

Service Code	HCPCS C1876
Hospital Charge Code	270688211
Hospital Revenue Code	278
Min. Negotiated Rate	$532.78
Max. Negotiated Rate	$9,380.00
Rate for Payer: Aetna Commercial	$7,128.80
Rate for Payer: Aetna Medicare Advantage	$5,628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,783.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,783.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,752.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,783.80
Rate for Payer: Cigna Commercial	$9,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,539.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,814.00
Rate for Payer: UnitedHealthcare Community & State	$592.82
Rate for Payer: Wellpoint Medicaid Managed Care	$532.78

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635
Hospital Revenue Code	278
Min. Negotiated Rate	$2,514.00
Max. Negotiated Rate	$4,055.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$8,380.00
Rate for Payer: Aetna Commercial	$6,368.80
Rate for Payer: Aetna Medicare Advantage	$5,028.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,273.80
Rate for Payer: Cigna Commercial	$8,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00
Rate for Payer: UnitedHealthcare Community & State	$529.62
Rate for Payer: Wellpoint Medicaid Managed Care	$475.98

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,514.00
Max. Negotiated Rate	$4,055.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00

STENT VIABAHN 5MMx10CM 120CM

Facility

$16,760.00

Service Code	HCPCS C1874
Hospital Charge Code	270648635N
Hospital Revenue Code	278
Min. Negotiated Rate	$475.98
Max. Negotiated Rate	$8,380.00
Rate for Payer: Aetna Commercial	$6,368.80
Rate for Payer: Aetna Medicare Advantage	$5,028.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,273.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,352.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,273.80
Rate for Payer: Cigna Commercial	$8,380.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,055.92
Rate for Payer: Qualcare PPO/HMO/WC	$2,514.00
Rate for Payer: UnitedHealthcare Community & State	$529.62
Rate for Payer: Wellpoint Medicaid Managed Care	$475.98

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636O
Hospital Revenue Code	278
Min. Negotiated Rate	$548.69
Max. Negotiated Rate	$9,660.00
Rate for Payer: Aetna Commercial	$7,341.60
Rate for Payer: Aetna Medicare Advantage	$5,796.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,926.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,926.60
Rate for Payer: Cigna Commercial	$9,660.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00
Rate for Payer: UnitedHealthcare Community & State	$610.51
Rate for Payer: Wellpoint Medicaid Managed Care	$548.69

Know your out-of-pocket cost for care.

All Charges