Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON CATH XXL 14-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270624069N
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CATH XXL 14-4/5.8/75cm

Facility

$1,300.00

Service Code	HCPCS C1725
Hospital Charge Code	270624069S
Hospital Revenue Code	278
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$41.08
Rate for Payer: Wellpoint Medicaid Managed Care	$36.92

BALLOON CATH XXL 14-4/5.8/75cm

Facility

$1,300.00

Service Code	HCPCS C1725
Hospital Charge Code	270624069S
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

BALLOON CATH XXL 14-6/5.8/75cm

Facility

$1,300.00

Service Code	HCPCS C1725
Hospital Charge Code	270626886
Hospital Revenue Code	278
Min. Negotiated Rate	$36.92
Max. Negotiated Rate	$650.00
Rate for Payer: Aetna Commercial	$494.00
Rate for Payer: Aetna Medicare Advantage	$390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$331.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$331.50
Rate for Payer: Cigna Commercial	$650.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00
Rate for Payer: UnitedHealthcare Community & State	$41.08
Rate for Payer: Wellpoint Medicaid Managed Care	$36.92

BALLOON CATH XXL 14-6/5.8/75cm

Facility

$1,300.00

Service Code	HCPCS C1725
Hospital Charge Code	270626886
Hospital Revenue Code	278
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$314.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$260.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$314.60
Rate for Payer: Qualcare PPO/HMO/WC	$195.00

BALLOON CATH XXL 16-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270624070
Hospital Revenue Code	278
Min. Negotiated Rate	$40.69
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$544.45
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Community & State	$45.27
Rate for Payer: Wellpoint Medicaid Managed Care	$40.69

BALLOON CATH XXL 16-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270624070
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CATH XXL 16-6/5.8/75cm

Facility

$1,564.00

Service Code	HCPCS C1725
Hospital Charge Code	270626887
Hospital Revenue Code	278
Min. Negotiated Rate	$234.60
Max. Negotiated Rate	$378.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.49
Rate for Payer: Qualcare PPO/HMO/WC	$234.60

BALLOON CATH XXL 16-6/5.8/75cm

Facility

$1,564.00

Service Code	HCPCS C1725
Hospital Charge Code	270626887
Hospital Revenue Code	278
Min. Negotiated Rate	$44.42
Max. Negotiated Rate	$782.00
Rate for Payer: Aetna Commercial	$594.32
Rate for Payer: Aetna Medicare Advantage	$469.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$398.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$312.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$398.82
Rate for Payer: Cigna Commercial	$782.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.49
Rate for Payer: Qualcare PPO/HMO/WC	$234.60
Rate for Payer: UnitedHealthcare Community & State	$49.42
Rate for Payer: Wellpoint Medicaid Managed Care	$44.42

BALLOON CATH XXL 18-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270627285
Hospital Revenue Code	278
Min. Negotiated Rate	$40.69
Max. Negotiated Rate	$716.38
Rate for Payer: Aetna Commercial	$544.45
Rate for Payer: Aetna Medicare Advantage	$429.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$365.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$365.35
Rate for Payer: Cigna Commercial	$716.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91
Rate for Payer: UnitedHealthcare Community & State	$45.27
Rate for Payer: Wellpoint Medicaid Managed Care	$40.69

BALLOON CATH XXL 18-4/5.8/75cm

Facility

$1,432.75

Service Code	HCPCS C1725
Hospital Charge Code	270627285
Hospital Revenue Code	278
Min. Negotiated Rate	$214.91
Max. Negotiated Rate	$346.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$286.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$346.73
Rate for Payer: Qualcare PPO/HMO/WC	$214.91

BALLOON CHOCOLATE 4 X 80 MM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270687486
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

BALLOON CHOCOLATE 4 X 80 MM

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270687486
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

BALLOON COATED 24FR 5CM 12CM

Facility

$17,125.00

Hospital Charge Code	270703746
Hospital Revenue Code	272
Min. Negotiated Rate	$2,568.75
Max. Negotiated Rate	$2,568.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75

BALLOON COATED 24FR 5CM 12CM

Facility

$17,125.00

Hospital Charge Code	270703746
Hospital Revenue Code	272
Min. Negotiated Rate	$486.35
Max. Negotiated Rate	$8,562.50
Rate for Payer: Aetna Commercial	$6,507.50
Rate for Payer: Aetna Medicare Advantage	$5,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,366.88
Rate for Payer: Cigna Commercial	$8,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,452.50
Rate for Payer: Oxford Commercial	$3,425.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75
Rate for Payer: UnitedHealthcare Commercial	$3,425.00
Rate for Payer: UnitedHealthcare Community & State	$541.15
Rate for Payer: Wellpoint Medicaid Managed Care	$486.35

BALLOON CONQUEST 6 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690213
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 CONQUEST 6 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690213
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 CONQUEST 7 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690214
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 CONQUEST 7 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690214
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 CONQUEST 8 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690215
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 CONQUEST 8 X 40 MM

Facility

$1,325.00

Service Code	HCPCS C1725
Hospital Charge Code	270690215
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 COYOTE 3.5x40MM 145CM

Facility

$1,493.50

Service Code	HCPCS C1725
Hospital Charge Code	270676781
Hospital Revenue Code	278
Min. Negotiated Rate	$224.03
Max. Negotiated Rate	$361.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$298.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03

BALLOON COYOTE 3.5x40MM 145CM

Facility

$1,493.50

Service Code	HCPCS C1725
Hospital Charge Code	270676781
Hospital Revenue Code	278
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) NJ Health	$298.70
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	$361.43
Rate for Payer: Qualcare PPO/HMO/WC	$224.03
Rate for Payer: UnitedHealthcare Community & State	$47.19
Rate for Payer: Wellpoint Medicaid Managed Care	$42.42

BALLOON COYOTE 4x220MM 150CM

Facility

$1,866.90

Service Code	HCPCS C1725
Hospital Charge Code	270674155
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 COYOTE 4x220MM 150CM

Facility

$1,866.90

Service Code	HCPCS C1725
Hospital Charge Code	270674155
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

Know your out-of-pocket cost for care.

All Charges