Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

IR-TRANS BALLN ANG ILI-LT

Facility

$27,397.00

Service Code	HCPCS 37220LT
Hospital Charge Code	411037220L
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-LT

Facility

$27,397.00

Service Code	HCPCS 37220LT
Hospital Charge Code	366837220L
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR-TRANS BALLN ANG ILI-LT

Facility

$27,397.00

Service Code	HCPCS 37220LT
Hospital Charge Code	321037220L
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-LT

Facility

$27,397.00

Service Code	HCPCS 37220LT
Hospital Charge Code	321037220L
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR-TRANS BALLN ANG ILI-LT

Facility

$27,397.00

Service Code	HCPCS 37220LT
Hospital Charge Code	411037220L
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	411037220R
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	366837220R
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	2691325
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	321037220R
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	2691325
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	321037220R
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	411037220R
Hospital Revenue Code	361
Min. Negotiated Rate	$778.07
Max. Negotiated Rate	$13,698.50
Rate for Payer: Aetna Commercial	$10,410.86
Rate for Payer: Aetna Medicare Advantage	$8,219.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,986.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,986.23
Rate for Payer: Cigna Commercial	$13,698.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,123.22
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55
Rate for Payer: UnitedHealthcare Community & State	$865.75
Rate for Payer: Wellpoint Medicaid Managed Care	$778.07

IR-TRANS BALLN ANG ILI-RT

Facility

$27,397.00

Service Code	HCPCS 37220RT
Hospital Charge Code	366837220R
Hospital Revenue Code	361
Min. Negotiated Rate	$4,109.55
Max. Negotiated Rate	$4,109.55
Rate for Payer: Qualcare PPO/HMO/WC	$4,109.55

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	2690540
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	321037228B
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	7411807
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	2690540
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	321037228B
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

IR-TRANS BALLN ANG TIB-BI

Facility

$61,616.39

Service Code	HCPCS 3722850
Hospital Charge Code	7411807
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	366837228L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	321037228L
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	366837228L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	321037228L
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	2691410
Hospital Revenue Code	361
Min. Negotiated Rate	$1,749.91
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16,020.26
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Community & State	$1,947.08
Rate for Payer: Wellpoint Medicaid Managed Care	$1,749.91

IR-TRANS BALLN ANG TIB-LT

Facility

$61,616.39

Service Code	HCPCS 37228LT
Hospital Charge Code	2691410
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

Know your out-of-pocket cost for care.

All Charges