Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.00
Max. Negotiated Rate	$4,675.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636C
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

STENT VIABAHN 5MMX15CMX120CM

Facility

$19,320.00

Service Code	HCPCS C1876
Hospital Charge Code	270648636C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,898.00
Max. Negotiated Rate	$4,675.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,864.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,675.44
Rate for Payer: Qualcare PPO/HMO/WC	$2,898.00

STENT VIABAHN 6MM 10x120CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638
Hospital Revenue Code	278
Min. Negotiated Rate	$547.27
Max. Negotiated Rate	$9,635.00
Rate for Payer: Aetna Commercial	$7,322.60
Rate for Payer: Aetna Medicare Advantage	$5,781.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,913.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,913.85
Rate for Payer: Cigna Commercial	$9,635.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50
Rate for Payer: UnitedHealthcare Community & State	$608.93
Rate for Payer: Wellpoint Medicaid Managed Care	$547.27

STENT VIABAHN 6MM 10x120CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.50
Max. Negotiated Rate	$4,663.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,854.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,663.34
Rate for Payer: Qualcare PPO/HMO/WC	$2,890.50

STENT VIABAHN 6MM 10x120CM

Facility

$17,900.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638N
Hospital Revenue Code	278
Min. Negotiated Rate	$508.36
Max. Negotiated Rate	$8,950.00
Rate for Payer: Aetna Commercial	$6,802.00
Rate for Payer: Aetna Medicare Advantage	$5,370.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,564.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,564.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,580.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,564.50
Rate for Payer: Cigna Commercial	$8,950.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,331.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,685.00
Rate for Payer: UnitedHealthcare Community & State	$565.64
Rate for Payer: Wellpoint Medicaid Managed Care	$508.36

STENT VIABAHN 6MM 10x120CM

Facility

$17,900.00

Service Code	HCPCS C1876
Hospital Charge Code	270648638N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,685.00
Max. Negotiated Rate	$4,331.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,331.80
Rate for Payer: Qualcare PPO/HMO/WC	$2,685.00

STENT VIABAHN 6MM 15x120CM

Facility

$19,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639N
Hospital Revenue Code	278
Min. Negotiated Rate	$566.58
Max. Negotiated Rate	$9,975.00
Rate for Payer: Aetna Commercial	$7,581.00
Rate for Payer: Aetna Medicare Advantage	$5,985.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,087.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,990.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,087.25
Rate for Payer: Cigna Commercial	$9,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,827.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,992.50
Rate for Payer: UnitedHealthcare Community & State	$630.42
Rate for Payer: Wellpoint Medicaid Managed Care	$566.58

STENT VIABAHN 6MM 15x120CM

Facility

$20,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639
Hospital Revenue Code	278
Min. Negotiated Rate	$3,142.50
Max. Negotiated Rate	$5,069.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,069.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,142.50

STENT VIABAHN 6MM 15x120CM

Facility

$19,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,992.50
Max. Negotiated Rate	$4,827.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,990.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,827.90
Rate for Payer: Qualcare PPO/HMO/WC	$2,992.50

STENT VIABAHN 6MM 15x120CM

Facility

$20,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639
Hospital Revenue Code	278
Min. Negotiated Rate	$594.98
Max. Negotiated Rate	$10,475.00
Rate for Payer: Aetna Commercial	$7,961.00
Rate for Payer: Aetna Medicare Advantage	$6,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,342.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,342.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,342.25
Rate for Payer: Cigna Commercial	$10,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,069.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,142.50
Rate for Payer: UnitedHealthcare Community & State	$662.02
Rate for Payer: Wellpoint Medicaid Managed Care	$594.98

STENT VIABAHN 6MMX5CMX120CM

Facility

$20,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639C
Hospital Revenue Code	278
Min. Negotiated Rate	$594.98
Max. Negotiated Rate	$10,475.00
Rate for Payer: Aetna Commercial	$7,961.00
Rate for Payer: Aetna Medicare Advantage	$6,285.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,342.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,342.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,190.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,342.25
Rate for Payer: Cigna Commercial	$10,475.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,069.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,142.50
Rate for Payer: UnitedHealthcare Community & State	$662.02
Rate for Payer: Wellpoint Medicaid Managed Care	$594.98

STENT VIABAHN 6MMX5CMX120CM

Facility

$20,950.00

Service Code	HCPCS C1876
Hospital Charge Code	270648639C
Hospital Revenue Code	278
Min. Negotiated Rate	$3,142.50
Max. Negotiated Rate	$5,069.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,190.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,069.90
Rate for Payer: Qualcare PPO/HMO/WC	$3,142.50

STENT VIABAHN 7FR VBJ071002

Facility

$18,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270647585C
Hospital Revenue Code	278
Min. Negotiated Rate	$521.14
Max. Negotiated Rate	$9,175.00
Rate for Payer: Aetna Commercial	$6,973.00
Rate for Payer: Aetna Medicare Advantage	$5,505.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,679.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,679.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,670.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,679.25
Rate for Payer: Cigna Commercial	$9,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,440.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.50
Rate for Payer: UnitedHealthcare Community & State	$579.86
Rate for Payer: Wellpoint Medicaid Managed Care	$521.14

STENT VIABAHN 7FR VBJ071002

Facility

$18,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270647585C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,752.50
Max. Negotiated Rate	$4,440.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,670.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,440.70
Rate for Payer: Qualcare PPO/HMO/WC	$2,752.50

STENT VIABAHN 7MM X 29 MM

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270682404
Hospital Revenue Code	278
Min. Negotiated Rate	$473.71
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$527.09
Rate for Payer: Wellpoint Medicaid Managed Care	$473.71

STENT VIABAHN 7MM X 29 MM

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270682404
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

STENT VIABAHN 7MM X 29 MM

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270682404S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,502.00
Max. Negotiated Rate	$4,036.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00

STENT VIABAHN 7MM X 29 MM

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270682404S
Hospital Revenue Code	278
Min. Negotiated Rate	$473.71
Max. Negotiated Rate	$8,340.00
Rate for Payer: Aetna Commercial	$6,338.40
Rate for Payer: Aetna Medicare Advantage	$5,004.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,253.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,336.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,253.40
Rate for Payer: Cigna Commercial	$8,340.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,036.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,502.00
Rate for Payer: UnitedHealthcare Community & State	$527.09
Rate for Payer: Wellpoint Medicaid Managed Care	$473.71

STENT VIABAHN 7MMx5CMx120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640
Hospital Revenue Code	278
Min. Negotiated Rate	$417.76
Max. Negotiated Rate	$7,355.00
Rate for Payer: Aetna Commercial	$5,589.80
Rate for Payer: Aetna Medicare Advantage	$4,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,751.05
Rate for Payer: Cigna Commercial	$7,355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50
Rate for Payer: UnitedHealthcare Community & State	$464.84
Rate for Payer: Wellpoint Medicaid Managed Care	$417.76

STENT VIABAHN 7MMx5CMx120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640
Hospital Revenue Code	278
Min. Negotiated Rate	$2,206.50
Max. Negotiated Rate	$3,559.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50

STENT VIABAHN 7MMX5CMX120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640S
Hospital Revenue Code	278
Min. Negotiated Rate	$417.76
Max. Negotiated Rate	$7,355.00
Rate for Payer: Aetna Commercial	$5,589.80
Rate for Payer: Aetna Medicare Advantage	$4,413.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,751.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,751.05
Rate for Payer: Cigna Commercial	$7,355.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50
Rate for Payer: UnitedHealthcare Community & State	$464.84
Rate for Payer: Wellpoint Medicaid Managed Care	$417.76

STENT VIABAHN 7MMX5CMX120CM

Facility

$14,710.00

Service Code	HCPCS C1876
Hospital Charge Code	270648640S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,206.50
Max. Negotiated Rate	$3,559.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,942.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,559.82
Rate for Payer: Qualcare PPO/HMO/WC	$2,206.50

STENT VIABAHN 8FR 8x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669521
Hospital Revenue Code	278
Min. Negotiated Rate	$538.89
Max. Negotiated Rate	$9,487.50
Rate for Payer: Aetna Commercial	$7,210.50
Rate for Payer: Aetna Medicare Advantage	$5,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,838.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,838.62
Rate for Payer: Cigna Commercial	$9,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25
Rate for Payer: UnitedHealthcare Community & State	$599.61
Rate for Payer: Wellpoint Medicaid Managed Care	$538.89

STENT VIABAHN 8FR 8x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669521
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

Know your out-of-pocket cost for care.

All Charges