Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

STENT XIENCE SKY P 5.00 X 12

Facility

$3,500.00

Hospital Charge Code	270704416
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

STENT XIENCE SKY P 5.00 X 15

Facility

$3,500.00

Hospital Charge Code	270704417
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

STENT XIENCE SKY P 5.00 X 15

Facility

$3,500.00

Hospital Charge Code	270704417
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 5.00 X 18

Facility

$3,500.00

Hospital Charge Code	270704418
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

STENT XIENCE SKY P 5.00 X 18

Facility

$3,500.00

Hospital Charge Code	270704418
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 5.00 X 23

Facility

$3,500.00

Hospital Charge Code	270704420
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 5.00 X 23

Facility

$3,500.00

Hospital Charge Code	270704420
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

STENT XIENCE SKY P 5.00 X 23

Facility

$3,500.00

Hospital Charge Code	270704419
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

STENT XIENCE SKY P 5.00 X 23

Facility

$3,500.00

Hospital Charge Code	270704419
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT XIENCE SKY P 5.00 X 33

Facility

$3,500.00

Hospital Charge Code	270704421
Hospital Revenue Code	272
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$910.00
Rate for Payer: Oxford Commercial	$700.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Commercial	$700.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

STENT XIENCE SKY P 5.00 X 33

Facility

$3,500.00

Hospital Charge Code	270704421
Hospital Revenue Code	272
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$525.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

STENT ZILVER DES PTX 6MM X 140

Facility

$11,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270683859
Hospital Revenue Code	278
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$378.41
Rate for Payer: Wellpoint Medicaid Managed Care	$340.09

STENT ZILVER DES PTX 6MM X 140

Facility

$11,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270683859
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT ZILVER DES PTX 6MM X 140

Facility

$11,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270683859N
Hospital Revenue Code	278
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$378.41
Rate for Payer: Wellpoint Medicaid Managed Care	$340.09

STENT ZILVER DES PTX 6MM X 140

Facility

$11,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270683859N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

STENT ZILVER DES PTX 6x100x125

Facility

$8,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677114
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

STENT ZILVER DES PTX 6x100x125

Facility

$8,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677114N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,346.25
Max. Negotiated Rate	$2,171.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25

STENT ZILVER DES PTX 6x100x125

Facility

$8,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677114N
Hospital Revenue Code	278
Min. Negotiated Rate	$254.89
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$283.61
Rate for Payer: Wellpoint Medicaid Managed Care	$254.89

STENT ZILVER DES PTX 6x100x125

Facility

$8,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677114
Hospital Revenue Code	278
Min. Negotiated Rate	$254.89
Max. Negotiated Rate	$4,487.50
Rate for Payer: Aetna Commercial	$3,410.50
Rate for Payer: Aetna Medicare Advantage	$2,692.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,288.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,795.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,288.62
Rate for Payer: Cigna Commercial	$4,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,171.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,346.25
Rate for Payer: UnitedHealthcare Community & State	$283.61
Rate for Payer: Wellpoint Medicaid Managed Care	$254.89

STENT ZILVER DES PTX 6x120x125

Facility

$9,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677115N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

STENT ZILVER DES PTX 6x120x125

Facility

$9,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677115
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

STENT ZILVER DES PTX 6x120x125

Facility

$9,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677115N
Hospital Revenue Code	278
Min. Negotiated Rate	$283.29
Max. Negotiated Rate	$4,987.50
Rate for Payer: Aetna Commercial	$3,790.50
Rate for Payer: Aetna Medicare Advantage	$2,992.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,543.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,543.62
Rate for Payer: Cigna Commercial	$4,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25
Rate for Payer: UnitedHealthcare Community & State	$315.21
Rate for Payer: Wellpoint Medicaid Managed Care	$283.29

STENT ZILVER DES PTX 6x120x125

Facility

$9,975.00

Service Code	HCPCS C1876
Hospital Charge Code	270677115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,496.25
Max. Negotiated Rate	$2,413.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,995.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,413.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,496.25

STENT ZILVER DES PTX 6x40x125

Facility

$5,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270677111
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

STENT ZILVER DES PTX 6x40x125

Facility

$5,875.00

Service Code	HCPCS C1876
Hospital Charge Code	270677111N
Hospital Revenue Code	278
Min. Negotiated Rate	$881.25
Max. Negotiated Rate	$1,421.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,421.75
Rate for Payer: Qualcare PPO/HMO/WC	$881.25

Know your out-of-pocket cost for care.

All Charges