Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLN EC 6x100 AB35W06100F135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644321A
Hospital Revenue Code	278
Min. Negotiated Rate	$24.35
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62
Rate for Payer: UnitedHealthcare Community & State	$27.10
Rate for Payer: Wellpoint Medicaid Managed Care	$24.35

BALLN EC 6x100 AB35W06100F135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644321C
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

BALLN EC 6x150mm AB35W06150135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.10

BALLN EC 6x150mm AB35W06150135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428C
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLN EC 6X30mm AB35W06030135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466A
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 6X30mm AB35W06030135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 6X30mm AB35W06030135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 6X30mm AB35W06030135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466A
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 6X40mm AB35W06040135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270641871C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 6X40mm AB35W06040135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270641871C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 6X40mm AB35W06040135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270641871A
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 6X40mm AB35W06040135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270641871A
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 7x100mm AB35W07100135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644471C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x100mm AB35W07100135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644471A
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 7x100mm AB35W07100135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644471A
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x100mm AB35W07100135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644471C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 7x120mm AB35W07120135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644017A
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 7x120mm AB35W07120135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644017C
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x120mm AB35W07120135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644017C
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLN EC 7x120mm AB35W07120135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644017A
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLN EC 7x200mm AB35W07200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472C
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLN EC 7x200mm AB35W07200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472A
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLN EC 7x200mm AB35W07200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472A
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.10

BALLN EC 7x200mm AB35W07200135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.10

BALLN EC 7x20mm AB35W07020135

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270644468A
Hospital Revenue Code	278
Min. Negotiated Rate	$128.62
Max. Negotiated Rate	$207.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62

Know your out-of-pocket cost for care.

All Charges