Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,887.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,887.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627A
Hospital Revenue Code	278
Min. Negotiated Rate	$221.52
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$246.48
Rate for Payer: Wellpoint Medicaid Managed Care	$221.52

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,887.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,887.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627
Hospital Revenue Code	278
Min. Negotiated Rate	$221.52
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$246.48
Rate for Payer: Wellpoint Medicaid Managed Care	$221.52

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627S
Hospital Revenue Code	278
Min. Negotiated Rate	$221.52
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$246.48
Rate for Payer: Wellpoint Medicaid Managed Care	$221.52

BALLOON ADMIRAL INP 5x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673627N
Hospital Revenue Code	278
Min. Negotiated Rate	$221.52
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$246.48
Rate for Payer: Wellpoint Medicaid Managed Care	$221.52

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706S
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706N
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706A
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x40x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673706A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878N
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878A
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878
Hospital Revenue Code	278
Min. Negotiated Rate	$1,057.50
Max. Negotiated Rate	$1,706.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878S
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 5x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673878
Hospital Revenue Code	278
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$3,525.00
Rate for Payer: Aetna Commercial	$2,679.00
Rate for Payer: Aetna Medicare Advantage	$2,115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,797.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,410.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,797.75
Rate for Payer: Cigna Commercial	$3,525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,706.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,057.50
Rate for Payer: UnitedHealthcare Community & State	$222.78
Rate for Payer: Wellpoint Medicaid Managed Care	$200.22

BALLOON ADMIRAL INP 6x120x130

Facility

$7,800.00

Service Code	HCPCS C1725
Hospital Charge Code	270673622N
Hospital Revenue Code	278
Min. Negotiated Rate	$221.52
Max. Negotiated Rate	$3,900.00
Rate for Payer: Aetna Commercial	$2,964.00
Rate for Payer: Aetna Medicare Advantage	$2,340.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,989.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,560.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,989.00
Rate for Payer: Cigna Commercial	$3,900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,887.60
Rate for Payer: Qualcare PPO/HMO/WC	$1,170.00
Rate for Payer: UnitedHealthcare Community & State	$246.48
Rate for Payer: Wellpoint Medicaid Managed Care	$221.52

Know your out-of-pocket cost for care.

All Charges