Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON ADMIRAL INP 6x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673623N
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 6x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673623
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 6x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673623
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 6x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673623S
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 7x60x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673877A
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 7x60x130

Facility

$7,050.00

Hospital Charge Code	270673877
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 7x60x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673877A
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 7x60x130

Facility

$7,050.00

Hospital Charge Code	270673877
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871N
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871A
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871S
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871N
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871S
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871
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 7x80x130

Facility

$7,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270673871A
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 INPC 4x150x130

Facility

$8,550.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121
Hospital Revenue Code	278
Min. Negotiated Rate	$242.82
Max. Negotiated Rate	$4,275.00
Rate for Payer: Aetna Commercial	$3,249.00
Rate for Payer: Aetna Medicare Advantage	$2,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,180.25
Rate for Payer: Cigna Commercial	$4,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50
Rate for Payer: UnitedHealthcare Community & State	$270.18
Rate for Payer: Wellpoint Medicaid Managed Care	$242.82

BALLOON ADMIRAL INPC 4x150x130

Facility

$8,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121N
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 ADMIRAL INPC 4x150x130

Facility

$8,550.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121A
Hospital Revenue Code	278
Min. Negotiated Rate	$242.82
Max. Negotiated Rate	$4,275.00
Rate for Payer: Aetna Commercial	$3,249.00
Rate for Payer: Aetna Medicare Advantage	$2,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,180.25
Rate for Payer: Cigna Commercial	$4,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50
Rate for Payer: UnitedHealthcare Community & State	$270.18
Rate for Payer: Wellpoint Medicaid Managed Care	$242.82

BALLOON ADMIRAL INPC 4x150x130

Facility

$8,550.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121A
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$2,069.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50

BALLOON ADMIRAL INPC 4x150x130

Facility

$8,550.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$2,069.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50

BALLOON ADMIRAL INPC 4x150x130

Facility

$8,550.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121S
Hospital Revenue Code	278
Min. Negotiated Rate	$242.82
Max. Negotiated Rate	$4,275.00
Rate for Payer: Aetna Commercial	$3,249.00
Rate for Payer: Aetna Medicare Advantage	$2,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,180.25
Rate for Payer: Cigna Commercial	$4,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50
Rate for Payer: UnitedHealthcare Community & State	$270.18
Rate for Payer: Wellpoint Medicaid Managed Care	$242.82

BALLOON ADMIRAL INPC 4x150x130

Facility

$8,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121N
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

BALLOON ADMIRAL INPC 4x150x130

Facility

$8,550.00

Service Code	HCPCS C1725
Hospital Charge Code	270678121
Hospital Revenue Code	278
Min. Negotiated Rate	$1,282.50
Max. Negotiated Rate	$2,069.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50

BALLOON ADMIRAL INPC 5x150x130

Facility

$8,550.00

Service Code	HCPCS C1725
Hospital Charge Code	270678122
Hospital Revenue Code	278
Min. Negotiated Rate	$242.82
Max. Negotiated Rate	$4,275.00
Rate for Payer: Aetna Commercial	$3,249.00
Rate for Payer: Aetna Medicare Advantage	$2,565.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,180.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,710.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,180.25
Rate for Payer: Cigna Commercial	$4,275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,069.10
Rate for Payer: Qualcare PPO/HMO/WC	$1,282.50
Rate for Payer: UnitedHealthcare Community & State	$270.18
Rate for Payer: Wellpoint Medicaid Managed Care	$242.82

Know your out-of-pocket cost for care.

All Charges