Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT WALL 10FR 18x90mm 75cm

Facility

$9,000.00

Service Code	HCPCS C1784
Hospital Charge Code	270678423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$2,178.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,800.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,178.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,350.00

STENT WALL 4X40

Facility

$5,250.00

Hospital Charge Code	270627758
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

STENT WALL 4X40

Facility

$5,250.00

Hospital Charge Code	270627758
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

STENT WALLFELX BILI 10x40 7052

Facility

$12,995.00

Service Code	HCPCS C1876
Hospital Charge Code	270643124
Hospital Revenue Code	278
Min. Negotiated Rate	$369.06
Max. Negotiated Rate	$6,497.50
Rate for Payer: Aetna Commercial	$4,938.10
Rate for Payer: Aetna Medicare Advantage	$3,898.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,313.72
Rate for Payer: Cigna Commercial	$6,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25
Rate for Payer: UnitedHealthcare Community & State	$410.64
Rate for Payer: Wellpoint Medicaid Managed Care	$369.06

STENT WALLFELX BILI 10x40 7052

Facility

$12,995.00

Service Code	HCPCS C1876
Hospital Charge Code	270643124
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$3,144.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFLEX 10MM X 40MM

Facility

$12,995.00

Service Code	HCPCS C1784
Hospital Charge Code	270680142
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.25
Max. Negotiated Rate	$3,144.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25

STENT WALLFLEX 10MM X 40MM

Facility

$12,995.00

Service Code	HCPCS C1784
Hospital Charge Code	270680142
Hospital Revenue Code	278
Min. Negotiated Rate	$369.06
Max. Negotiated Rate	$6,497.50
Rate for Payer: Aetna Commercial	$4,938.10
Rate for Payer: Aetna Medicare Advantage	$3,898.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,313.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,313.72
Rate for Payer: Cigna Commercial	$6,497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,144.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.25
Rate for Payer: UnitedHealthcare Community & State	$410.64
Rate for Payer: Wellpoint Medicaid Managed Care	$369.06

STENT WALLFLEX 23X10.5

Facility

$12,047.05

Service Code	HCPCS C1876
Hospital Charge Code	270643744
Hospital Revenue Code	278
Min. Negotiated Rate	$342.14
Max. Negotiated Rate	$6,023.52
Rate for Payer: Aetna Commercial	$4,577.88
Rate for Payer: Aetna Medicare Advantage	$3,614.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,072.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,072.00
Rate for Payer: Cigna Commercial	$6,023.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.06
Rate for Payer: UnitedHealthcare Community & State	$380.69
Rate for Payer: Wellpoint Medicaid Managed Care	$342.14

STENT WALLFLEX 23X10.5

Facility

$12,047.05

Service Code	HCPCS C1876
Hospital Charge Code	270643744
Hospital Revenue Code	278
Min. Negotiated Rate	$1,807.06
Max. Negotiated Rate	$2,915.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,409.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,915.39
Rate for Payer: Qualcare PPO/HMO/WC	$1,807.06

STENT WALLFLEX 27/22X 10 60 CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270663057
Hospital Revenue Code	278
Min. Negotiated Rate	$1,946.25
Max. Negotiated Rate	$3,139.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25

STENT WALLFLEX 27/22X 10 60 CM

Facility

$12,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270663057
Hospital Revenue Code	278
Min. Negotiated Rate	$368.49
Max. Negotiated Rate	$6,487.50
Rate for Payer: Aetna Commercial	$4,930.50
Rate for Payer: Aetna Medicare Advantage	$3,892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,308.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,595.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,308.62
Rate for Payer: Cigna Commercial	$6,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,139.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,946.25
Rate for Payer: UnitedHealthcare Community & State	$410.01
Rate for Payer: Wellpoint Medicaid Managed Care	$368.49

STENT WALLFLEX 8MM X 8FR

Facility

$8,470.00

Service Code	HCPCS C1876
Hospital Charge Code	270688376
Hospital Revenue Code	278
Min. Negotiated Rate	$240.55
Max. Negotiated Rate	$4,235.00
Rate for Payer: Aetna Commercial	$3,218.60
Rate for Payer: Aetna Medicare Advantage	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,159.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,159.85
Rate for Payer: Cigna Commercial	$4,235.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,049.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,270.50
Rate for Payer: UnitedHealthcare Community & State	$267.65
Rate for Payer: Wellpoint Medicaid Managed Care	$240.55

STENT WALLFLEX 8MM X 8FR

Facility

$8,470.00

Service Code	HCPCS C1876
Hospital Charge Code	270688376
Hospital Revenue Code	278
Min. Negotiated Rate	$1,270.50
Max. Negotiated Rate	$2,049.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,694.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,049.74
Rate for Payer: Qualcare PPO/HMO/WC	$1,270.50

STENT WALLFLEX BILI 10x60 7053

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270642716
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILI 10x60 7053

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270642716
Hospital Revenue Code	278
Min. Negotiated Rate	$369.19
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$4,939.81
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92
Rate for Payer: UnitedHealthcare Community & State	$410.78
Rate for Payer: Wellpoint Medicaid Managed Care	$369.19

STENT,WALL FLEX BILIARY

Facility

$4,225.00

Hospital Charge Code	270322297
Hospital Revenue Code	278
Min. Negotiated Rate	$119.99
Max. Negotiated Rate	$2,112.50
Rate for Payer: Aetna Commercial	$1,605.50
Rate for Payer: Aetna Medicare Advantage	$1,267.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,077.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$845.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,077.38
Rate for Payer: Cigna Commercial	$2,112.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.45
Rate for Payer: Qualcare PPO/HMO/WC	$633.75
Rate for Payer: UnitedHealthcare Community & State	$133.51
Rate for Payer: Wellpoint Medicaid Managed Care	$119.99

STENT,WALL FLEX BILIARY

Facility

$4,225.00

Hospital Charge Code	270322297
Hospital Revenue Code	278
Min. Negotiated Rate	$633.75
Max. Negotiated Rate	$1,022.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$845.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,022.45
Rate for Payer: Qualcare PPO/HMO/WC	$633.75

STENT WALLFLEX BILIARY 10X60MM

Facility

$19,985.00

Service Code	HCPCS C1874
Hospital Charge Code	270648050
Hospital Revenue Code	278
Min. Negotiated Rate	$2,997.75
Max. Negotiated Rate	$4,836.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,997.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,836.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,997.75

STENT WALLFLEX BILIARY 10X60MM

Facility

$19,985.00

Service Code	HCPCS C1874
Hospital Charge Code	270648050
Hospital Revenue Code	278
Min. Negotiated Rate	$567.57
Max. Negotiated Rate	$9,992.50
Rate for Payer: Aetna Commercial	$7,594.30
Rate for Payer: Aetna Medicare Advantage	$5,995.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,096.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,096.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,997.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,096.18
Rate for Payer: Cigna Commercial	$9,992.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,836.37
Rate for Payer: Qualcare PPO/HMO/WC	$2,997.75
Rate for Payer: UnitedHealthcare Community & State	$631.53
Rate for Payer: Wellpoint Medicaid Managed Care	$567.57

STENT WALLFLEX BILIARY 10x80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270677877
Hospital Revenue Code	278
Min. Negotiated Rate	$369.19
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$4,939.81
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92
Rate for Payer: UnitedHealthcare Community & State	$410.78
Rate for Payer: Wellpoint Medicaid Managed Care	$369.19

STENT WALLFLEX BILIARY 10x80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270677877
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10X80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270646676C
Hospital Revenue Code	278
Min. Negotiated Rate	$369.19
Max. Negotiated Rate	$6,499.75
Rate for Payer: Aetna Commercial	$4,939.81
Rate for Payer: Aetna Medicare Advantage	$3,899.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,314.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,314.87
Rate for Payer: Cigna Commercial	$6,499.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92
Rate for Payer: UnitedHealthcare Community & State	$410.78
Rate for Payer: Wellpoint Medicaid Managed Care	$369.19

STENT WALLFLEX BILIARY 10X80

Facility

$12,999.50

Service Code	HCPCS C1876
Hospital Charge Code	270646676C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,949.92
Max. Negotiated Rate	$3,145.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,599.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,145.88
Rate for Payer: Qualcare PPO/HMO/WC	$1,949.92

STENT WALLFLEX BILIARY 10X80

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270646676N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,126.25
Max. Negotiated Rate	$3,430.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25

STENT WALLFLEX BILIARY 10X80

Facility

$14,175.00

Service Code	HCPCS C1876
Hospital Charge Code	270646676N
Hospital Revenue Code	278
Min. Negotiated Rate	$402.57
Max. Negotiated Rate	$7,087.50
Rate for Payer: Aetna Commercial	$5,386.50
Rate for Payer: Aetna Medicare Advantage	$4,252.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,614.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,835.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,614.62
Rate for Payer: Cigna Commercial	$7,087.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,430.35
Rate for Payer: Qualcare PPO/HMO/WC	$2,126.25
Rate for Payer: UnitedHealthcare Community & State	$447.93
Rate for Payer: Wellpoint Medicaid Managed Care	$402.57

Know your out-of-pocket cost for care.

All Charges