Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLON NCRS PTA AB18W060040150

Facility

$1,125.00

Service Code	HCPCS C1725
Hospital Charge Code	270644458C
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

BALLON NCRS PTA AB18W060040150

Facility

$1,125.00

Service Code	HCPCS C1725
Hospital Charge Code	270644458C
Hospital Revenue Code	278
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

BALLON OPTTILUME 90FR X40MM

Facility

$29,500.00

Hospital Charge Code	270702771
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$7,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

BALLON OPTTILUME 90FR X40MM

Facility

$29,500.00

Hospital Charge Code	270702771
Hospital Revenue Code	278
Min. Negotiated Rate	$837.80
Max. Negotiated Rate	$14,750.00
Rate for Payer: Aetna Commercial	$11,210.00
Rate for Payer: Aetna Medicare Advantage	$8,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,522.50
Rate for Payer: Cigna Commercial	$14,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00
Rate for Payer: UnitedHealthcare Community & State	$932.20
Rate for Payer: Wellpoint Medicaid Managed Care	$837.80

BALLON OPTTILUME 90FR X45MM

Facility

$29,500.00

Hospital Charge Code	270720772
Hospital Revenue Code	278
Min. Negotiated Rate	$4,425.00
Max. Negotiated Rate	$7,139.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00

BALLON OPTTILUME 90FR X45MM

Facility

$29,500.00

Hospital Charge Code	270720772
Hospital Revenue Code	278
Min. Negotiated Rate	$837.80
Max. Negotiated Rate	$14,750.00
Rate for Payer: Aetna Commercial	$11,210.00
Rate for Payer: Aetna Medicare Advantage	$8,850.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,522.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,900.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,522.50
Rate for Payer: Cigna Commercial	$14,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,139.00
Rate for Payer: Qualcare PPO/HMO/WC	$4,425.00
Rate for Payer: UnitedHealthcare Community & State	$932.20
Rate for Payer: Wellpoint Medicaid Managed Care	$837.80

BALLON TREK RX 22X12X12 101227

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645239S
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLON TREK RX 22X12X12 101227

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645239S
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

BALLON WALRUS GUIDE .087 95CM

Facility

$8,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270694053
Hospital Revenue Code	278
Min. Negotiated Rate	$248.50
Max. Negotiated Rate	$4,375.00
Rate for Payer: Aetna Commercial	$3,325.00
Rate for Payer: Aetna Medicare Advantage	$2,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,231.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,231.25
Rate for Payer: Cigna Commercial	$4,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50
Rate for Payer: UnitedHealthcare Community & State	$276.50
Rate for Payer: Wellpoint Medicaid Managed Care	$248.50

BALLON WALRUS GUIDE .087 95CM

Facility

$8,750.00

Service Code	HCPCS C1887
Hospital Charge Code	270694053
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$2,117.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,117.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,312.50

BALLOON 12-15MM 75CM

Facility

$1,538.70

Service Code	HCPCS C1726
Hospital Charge Code	270665632
Hospital Revenue Code	278
Min. Negotiated Rate	$230.81
Max. Negotiated Rate	$372.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81

BALLOON 12-15MM 75CM

Facility

$1,538.70

Service Code	HCPCS C1726
Hospital Charge Code	270665632
Hospital Revenue Code	278
Min. Negotiated Rate	$43.70
Max. Negotiated Rate	$769.35
Rate for Payer: Aetna Commercial	$584.71
Rate for Payer: Aetna Medicare Advantage	$461.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.37
Rate for Payer: Cigna Commercial	$769.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81
Rate for Payer: UnitedHealthcare Community & State	$48.62
Rate for Payer: Wellpoint Medicaid Managed Care	$43.70

BALLOON 12-18MM 75CM

Facility

$1,538.70

Hospital Charge Code	270665633
Hospital Revenue Code	278
Min. Negotiated Rate	$230.81
Max. Negotiated Rate	$372.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81

BALLOON 12-18MM 75CM

Facility

$1,538.70

Hospital Charge Code	270665633
Hospital Revenue Code	278
Min. Negotiated Rate	$43.70
Max. Negotiated Rate	$769.35
Rate for Payer: Aetna Commercial	$584.71
Rate for Payer: Aetna Medicare Advantage	$461.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.37
Rate for Payer: Cigna Commercial	$769.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.37
Rate for Payer: Qualcare PPO/HMO/WC	$230.81
Rate for Payer: UnitedHealthcare Community & State	$48.62
Rate for Payer: Wellpoint Medicaid Managed Care	$43.70

BALLOON 3.50MM X 08MM

Facility

$500.00

Hospital Charge Code	270645270
Hospital Revenue Code	279
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

BALLOON 3.50MM X 08MM

Facility

$500.00

Hospital Charge Code	270645270
Hospital Revenue Code	279
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BALLOON 3 APPLICATION RADIAL

Facility

$225.60

Hospital Charge Code	270680194
Hospital Revenue Code	272
Min. Negotiated Rate	$33.84
Max. Negotiated Rate	$33.84
Rate for Payer: Qualcare PPO/HMO/WC	$33.84

BALLOON 3 APPLICATION RADIAL

Facility

$225.60

Hospital Charge Code	270680194
Hospital Revenue Code	272
Min. Negotiated Rate	$6.41
Max. Negotiated Rate	$112.80
Rate for Payer: Aetna Commercial	$85.73
Rate for Payer: Aetna Medicare Advantage	$67.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.53
Rate for Payer: Cigna Commercial	$112.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$58.66
Rate for Payer: Oxford Commercial	$45.12
Rate for Payer: Qualcare PPO/HMO/WC	$33.84
Rate for Payer: UnitedHealthcare Commercial	$45.12
Rate for Payer: UnitedHealthcare Community & State	$7.13
Rate for Payer: Wellpoint Medicaid Managed Care	$6.41

BALLOON 3 APPLICATOR LINEAR

Facility

$323.00

Hospital Charge Code	270680193
Hospital Revenue Code	272
Min. Negotiated Rate	$9.17
Max. Negotiated Rate	$161.50
Rate for Payer: Aetna Commercial	$122.74
Rate for Payer: Aetna Medicare Advantage	$96.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.36
Rate for Payer: Cigna Commercial	$161.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.98
Rate for Payer: Oxford Commercial	$64.60
Rate for Payer: Qualcare PPO/HMO/WC	$48.45
Rate for Payer: UnitedHealthcare Commercial	$64.60
Rate for Payer: UnitedHealthcare Community & State	$10.21
Rate for Payer: Wellpoint Medicaid Managed Care	$9.17

BALLOON 3 APPLICATOR LINEAR

Facility

$323.00

Hospital Charge Code	270680193
Hospital Revenue Code	272
Min. Negotiated Rate	$48.45
Max. Negotiated Rate	$48.45
Rate for Payer: Qualcare PPO/HMO/WC	$48.45

BALLOON 40 12 X 40 CM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690306
Hospital Revenue Code	278
Min. Negotiated Rate	$37.63
Max. Negotiated Rate	$662.50
Rate for Payer: Aetna Commercial	$503.50
Rate for Payer: Aetna Medicare Advantage	$397.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$337.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$337.88
Rate for Payer: Cigna Commercial	$662.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75
Rate for Payer: UnitedHealthcare Community & State	$41.87
Rate for Payer: Wellpoint Medicaid Managed Care	$37.63

BALLOON 40 12 X 40 CM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690306
Hospital Revenue Code	278
Min. Negotiated Rate	$198.75
Max. Negotiated Rate	$320.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$265.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$320.65
Rate for Payer: Qualcare PPO/HMO/WC	$198.75

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662264
Hospital Revenue Code	278
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$1,570.00
Rate for Payer: Aetna Commercial	$1,193.20
Rate for Payer: Aetna Medicare Advantage	$942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.70
Rate for Payer: Cigna Commercial	$1,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: Qualcare PPO/HMO/WC	$471.00
Rate for Payer: UnitedHealthcare Community & State	$99.22
Rate for Payer: Wellpoint Medicaid Managed Care	$89.18

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662264
Hospital Revenue Code	278
Min. Negotiated Rate	$471.00
Max. Negotiated Rate	$759.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: Qualcare PPO/HMO/WC	$471.00

BALLOON ACHALASIA 30MM

Facility

$3,140.00

Hospital Charge Code	270662265
Hospital Revenue Code	278
Min. Negotiated Rate	$89.18
Max. Negotiated Rate	$1,570.00
Rate for Payer: Aetna Commercial	$1,193.20
Rate for Payer: Aetna Medicare Advantage	$942.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$800.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$628.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$800.70
Rate for Payer: Cigna Commercial	$1,570.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$759.88
Rate for Payer: Qualcare PPO/HMO/WC	$471.00
Rate for Payer: UnitedHealthcare Community & State	$99.22
Rate for Payer: Wellpoint Medicaid Managed Care	$89.18

Know your out-of-pocket cost for care.

All Charges