Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CATH MONORAIL 4x20cm

Facility

$1,493.50

Hospital Charge Code	270651414
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MONORAIL 4x2cm

Facility

$1,493.50

Hospital Charge Code	270651415
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MONORAIL 4x2cm

Facility

$1,493.50

Hospital Charge Code	270651415
Hospital Revenue Code	272
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$567.53
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.31
Rate for Payer: Oxford Commercial	$298.70
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Commercial	$298.70
Rate for Payer: UnitedHealthcare Community & State	$47.19
Rate for Payer: Wellpoint Medicaid Managed Care	$42.42

BALLOON CATH MONORAIL 4x4

Facility

$1,493.50

Hospital Charge Code	270651416
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MONORAIL 4x4

Facility

$1,493.50

Hospital Charge Code	270651416
Hospital Revenue Code	272
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$567.53
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.31
Rate for Payer: Oxford Commercial	$298.70
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Commercial	$298.70
Rate for Payer: UnitedHealthcare Community & State	$47.19
Rate for Payer: Wellpoint Medicaid Managed Care	$42.42

BALLOON CATH MONORAIL 5X2

Facility

$1,493.50

Hospital Charge Code	270651419
Hospital Revenue Code	272
Min. Negotiated Rate	$42.42
Max. Negotiated Rate	$746.75
Rate for Payer: Aetna Commercial	$567.53
Rate for Payer: Aetna Medicare Advantage	$448.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$380.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$380.84
Rate for Payer: Cigna Commercial	$746.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$388.31
Rate for Payer: Oxford Commercial	$298.70
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Commercial	$298.70
Rate for Payer: UnitedHealthcare Community & State	$47.19
Rate for Payer: Wellpoint Medicaid Managed Care	$42.42

BALLOON CATH MONORAIL 5X2

Facility

$1,493.50

Hospital Charge Code	270651419
Hospital Revenue Code	272
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$224.03
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON CATH MUSTANG 4x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270675782
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

BALLOON CATH MUSTANG 4x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270675782
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 5x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270670958
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

BALLOON CATH MUSTANG 5x200MM

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270670958
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 5x60MM 5F

Facility

$1,250.00

Hospital Charge Code	270675462
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

BALLOON CATH MUSTANG 5x60MM 5F

Facility

$1,250.00

Hospital Charge Code	270675462
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

BALLOONCATHOCCLSCEPTERC4X10MM

Facility

$8,125.00

Service Code	HCPCS C2628
Hospital Charge Code	270693917S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.75
Max. Negotiated Rate	$1,966.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75

BALLOONCATHOCCLSCEPTERC4X10MM

Facility

$8,125.00

Service Code	HCPCS C2628
Hospital Charge Code	270693917S
Hospital Revenue Code	278
Min. Negotiated Rate	$230.75
Max. Negotiated Rate	$4,062.50
Rate for Payer: Aetna Commercial	$3,087.50
Rate for Payer: Aetna Medicare Advantage	$2,437.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,071.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,625.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,071.88
Rate for Payer: Cigna Commercial	$4,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,966.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,218.75
Rate for Payer: UnitedHealthcare Community & State	$256.75
Rate for Payer: Wellpoint Medicaid Managed Care	$230.75

BALLOONCATHOCCLSCEPTERC4X15MM

Facility

$7,000.00

Service Code	HCPCS C2628
Hospital Charge Code	270693918S
Hospital Revenue Code	278
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$3,500.00
Rate for Payer: Aetna Commercial	$2,660.00
Rate for Payer: Aetna Medicare Advantage	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,785.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,785.00
Rate for Payer: Cigna Commercial	$3,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00
Rate for Payer: UnitedHealthcare Community & State	$221.20
Rate for Payer: Wellpoint Medicaid Managed Care	$198.80

BALLOONCATHOCCLSCEPTERC4X15MM

Facility

$7,000.00

Service Code	HCPCS C2628
Hospital Charge Code	270693918S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,694.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,400.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,694.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,050.00

BALLOONCATHOCCLSCEPTERXC4X11MM

Facility

$9,775.00

Service Code	HCPCS C2628
Hospital Charge Code	270693920S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.25
Max. Negotiated Rate	$2,365.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25

BALLOONCATHOCCLSCEPTERXC4X11MM

Facility

$9,775.00

Service Code	HCPCS C2628
Hospital Charge Code	270693920S
Hospital Revenue Code	278
Min. Negotiated Rate	$277.61
Max. Negotiated Rate	$4,887.50
Rate for Payer: Aetna Commercial	$3,714.50
Rate for Payer: Aetna Medicare Advantage	$2,932.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,492.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,955.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,492.62
Rate for Payer: Cigna Commercial	$4,887.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,365.55
Rate for Payer: Qualcare PPO/HMO/WC	$1,466.25
Rate for Payer: UnitedHealthcare Community & State	$308.89
Rate for Payer: Wellpoint Medicaid Managed Care	$277.61

BALLOON CATH OTW 4x120MM 150CM

Facility

$1,866.90

Hospital Charge Code	270674896
Hospital Revenue Code	278
Min. Negotiated Rate	$280.04
Max. Negotiated Rate	$451.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.79
Rate for Payer: Qualcare PPO/HMO/WC	$280.04

BALLOON CATH OTW 4x120MM 150CM

Facility

$1,866.90

Hospital Charge Code	270674896
Hospital Revenue Code	278
Min. Negotiated Rate	$53.02
Max. Negotiated Rate	$933.45
Rate for Payer: Aetna Commercial	$709.42
Rate for Payer: Aetna Medicare Advantage	$560.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$476.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$373.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$476.06
Rate for Payer: Cigna Commercial	$933.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$451.79
Rate for Payer: Qualcare PPO/HMO/WC	$280.04
Rate for Payer: UnitedHealthcare Community & State	$58.99
Rate for Payer: Wellpoint Medicaid Managed Care	$53.02

BALLOON CATH OTW 5x220MM

Facility

$1,770.00

Service Code	HCPCS C1725
Hospital Charge Code	270672789
Hospital Revenue Code	278
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$428.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: Qualcare PPO/HMO/WC	$265.50

BALLOON CATH OTW 5x220MM

Facility

$1,770.00

Service Code	HCPCS C1725
Hospital Charge Code	270672789
Hospital Revenue Code	278
Min. Negotiated Rate	$50.27
Max. Negotiated Rate	$885.00
Rate for Payer: Aetna Commercial	$672.60
Rate for Payer: Aetna Medicare Advantage	$531.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.35
Rate for Payer: Cigna Commercial	$885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: Qualcare PPO/HMO/WC	$265.50
Rate for Payer: UnitedHealthcare Community & State	$55.93
Rate for Payer: Wellpoint Medicaid Managed Care	$50.27

BALLOON CATH OTW 6x220MM 150CM

Facility

$1,770.00

Hospital Charge Code	270676073
Hospital Revenue Code	278
Min. Negotiated Rate	$50.27
Max. Negotiated Rate	$885.00
Rate for Payer: Aetna Commercial	$672.60
Rate for Payer: Aetna Medicare Advantage	$531.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$451.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$451.35
Rate for Payer: Cigna Commercial	$885.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: Qualcare PPO/HMO/WC	$265.50
Rate for Payer: UnitedHealthcare Community & State	$55.93
Rate for Payer: Wellpoint Medicaid Managed Care	$50.27

BALLOON CATH OTW 6x220MM 150CM

Facility

$1,770.00

Hospital Charge Code	270676073
Hospital Revenue Code	278
Min. Negotiated Rate	$265.50
Max. Negotiated Rate	$428.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$354.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$428.34
Rate for Payer: Qualcare PPO/HMO/WC	$265.50

Know your out-of-pocket cost for care.

All Charges