Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404
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 VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404O
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 VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404
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 VIABAHN 8 MMx135MM

Facility

$17,095.00

Service Code	HCPCS C1876
Hospital Charge Code	270686404O
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 VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405O
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$592.50
Rate for Payer: Wellpoint Medicaid Managed Care	$532.50

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405O
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$4,537.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50

STENT VIABAHN 8 MMx59MM

Facility

$18,750.00

Service Code	HCPCS C1876
Hospital Charge Code	270686405
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$9,375.00
Rate for Payer: Aetna Commercial	$7,125.00
Rate for Payer: Aetna Medicare Advantage	$5,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,781.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,781.25
Rate for Payer: Cigna Commercial	$9,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,537.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,812.50
Rate for Payer: UnitedHealthcare Community & State	$592.50
Rate for Payer: Wellpoint Medicaid Managed Care	$532.50

STENT VIABAHN 8mmX59mmx135mm

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678
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 8mmX59mmx135mm

Facility

$16,680.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678
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 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$3,938.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678S
Hospital Revenue Code	278
Min. Negotiated Rate	$462.21
Max. Negotiated Rate	$8,137.50
Rate for Payer: Aetna Commercial	$6,184.50
Rate for Payer: Aetna Medicare Advantage	$4,882.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,150.12
Rate for Payer: Cigna Commercial	$8,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25
Rate for Payer: UnitedHealthcare Community & State	$514.29
Rate for Payer: Wellpoint Medicaid Managed Care	$462.21

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,441.25
Max. Negotiated Rate	$3,938.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25

STENT VIABAHN 8MMX59MMx135MM

Facility

$16,275.00

Service Code	HCPCS C1876
Hospital Charge Code	270679678N
Hospital Revenue Code	278
Min. Negotiated Rate	$462.21
Max. Negotiated Rate	$8,137.50
Rate for Payer: Aetna Commercial	$6,184.50
Rate for Payer: Aetna Medicare Advantage	$4,882.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,150.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,150.12
Rate for Payer: Cigna Commercial	$8,137.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,938.55
Rate for Payer: Qualcare PPO/HMO/WC	$2,441.25
Rate for Payer: UnitedHealthcare Community & State	$514.29
Rate for Payer: Wellpoint Medicaid Managed Care	$462.21

STENT VIABAHN 8x15cm

Facility

$18,975.00

Hospital Charge Code	270671133
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

STENT VIABAHN 8x15cm

Facility

$18,975.00

Hospital Charge Code	270671133
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 8x39MM 135CM

Facility

$19,235.00

Service Code	HCPCS C1874
Hospital Charge Code	270699839S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,885.25
Max. Negotiated Rate	$4,654.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,847.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,654.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,885.25

STENT VIABAHN 8x39MM 135CM

Facility

$19,235.00

Service Code	HCPCS C1874
Hospital Charge Code	270699839S
Hospital Revenue Code	278
Min. Negotiated Rate	$546.27
Max. Negotiated Rate	$9,617.50
Rate for Payer: Aetna Commercial	$7,309.30
Rate for Payer: Aetna Medicare Advantage	$5,770.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,904.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,904.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,904.93
Rate for Payer: Cigna Commercial	$9,617.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,654.87
Rate for Payer: Qualcare PPO/HMO/WC	$2,885.25
Rate for Payer: UnitedHealthcare Community & State	$607.83
Rate for Payer: Wellpoint Medicaid Managed Care	$546.27

STENT VIABAHN 9FR 9x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669522
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 9FR 9x15 120cm

Facility

$18,975.00

Hospital Charge Code	270669522
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

STENT VIABAHN 9x15cm

Facility

$18,975.00

Hospital Charge Code	270671134
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

STENT VIABAHN 9x15cm

Facility

$18,975.00

Hospital Charge Code	270671134
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 ENDOPRO 7MMx10CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270676102
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 ENDOPRO 7MMx10CM

Facility

$19,270.00

Service Code	HCPCS C1876
Hospital Charge Code	270676102
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 VBX

Facility

$18,295.00

Service Code	HCPCS C1876
Hospital Charge Code	270679851
Hospital Revenue Code	278
Min. Negotiated Rate	$519.58
Max. Negotiated Rate	$9,147.50
Rate for Payer: Aetna Commercial	$6,952.10
Rate for Payer: Aetna Medicare Advantage	$5,488.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,665.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,659.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,665.23
Rate for Payer: Cigna Commercial	$9,147.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,427.39
Rate for Payer: Qualcare PPO/HMO/WC	$2,744.25
Rate for Payer: UnitedHealthcare Community & State	$578.12
Rate for Payer: Wellpoint Medicaid Managed Care	$519.58

Know your out-of-pocket cost for care.

All Charges