Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON C PANTERA LEO 3.5/30

Facility

$350.00

Hospital Charge Code	270700917
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 3.5/30

Facility

$350.00

Hospital Charge Code	270700917
Hospital Revenue Code	278
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

BALLOON C PANTERA LEO 3.75/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700916
Hospital Revenue Code	278
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

BALLOON C PANTERA LEO 3.75/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700916
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 4.0/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700915
Hospital Revenue Code	278
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

BALLOON C PANTERA LEO 4.0/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700915
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 4.5/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700914
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 4.5/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700914
Hospital Revenue Code	278
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

BALLOON C PANTERA LEO 5.0/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700913
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

BALLOON C PANTERA LEO 5.0/30

Facility

$350.00

Service Code	HCPCS C1874
Hospital Charge Code	270700913
Hospital Revenue Code	278
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$70.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$84.70
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

BALLOON CRE 6MM 7-8MM

Facility

$1,075.00

Hospital Charge Code	270672230
Hospital Revenue Code	278
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$33.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.53

BALLOON CRE 6MM 7-8MM

Facility

$1,075.00

Hospital Charge Code	270672230
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

BALLOON CRE FIXED WIRE 15-18mm

Facility

$942.00

Service Code	HCPCS C1726
Hospital Charge Code	270619881
Hospital Revenue Code	278
Min. Negotiated Rate	$26.75
Max. Negotiated Rate	$471.00
Rate for Payer: Aetna Commercial	$357.96
Rate for Payer: Aetna Medicare Advantage	$282.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$240.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$240.21
Rate for Payer: Cigna Commercial	$471.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.96
Rate for Payer: Qualcare PPO/HMO/WC	$141.30
Rate for Payer: UnitedHealthcare Community & State	$29.77
Rate for Payer: Wellpoint Medicaid Managed Care	$26.75

BALLOON CRE FIXED WIRE 15-18mm

Facility

$942.00

Service Code	HCPCS C1726
Hospital Charge Code	270619881
Hospital Revenue Code	278
Min. Negotiated Rate	$141.30
Max. Negotiated Rate	$227.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$188.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.96
Rate for Payer: Qualcare PPO/HMO/WC	$141.30

BALLOON CRE FIXED WIRE 6-8

Facility

$936.70

Hospital Charge Code	270654301
Hospital Revenue Code	272
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$468.35
Rate for Payer: Aetna Commercial	$355.95
Rate for Payer: Aetna Medicare Advantage	$281.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$238.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$238.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$238.86
Rate for Payer: Cigna Commercial	$468.35
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$243.54
Rate for Payer: Oxford Commercial	$187.34
Rate for Payer: Qualcare PPO/HMO/WC	$140.50
Rate for Payer: UnitedHealthcare Commercial	$187.34
Rate for Payer: UnitedHealthcare Community & State	$29.60
Rate for Payer: Wellpoint Medicaid Managed Care	$26.60

BALLOON CRE FIXED WIRE 6-8

Facility

$936.70

Hospital Charge Code	270654301
Hospital Revenue Code	272
Min. Negotiated Rate	$140.50
Max. Negotiated Rate	$140.50
Rate for Payer: Qualcare PPO/HMO/WC	$140.50

BALLOON CRE FIX WIRE 8-10

Facility

$939.05

Hospital Charge Code	270653652
Hospital Revenue Code	270
Min. Negotiated Rate	$140.86
Max. Negotiated Rate	$140.86
Rate for Payer: Qualcare PPO/HMO/WC	$140.86

BALLOON CRE FIX WIRE 8-10

Facility

$939.05

Hospital Charge Code	270653652
Hospital Revenue Code	270
Min. Negotiated Rate	$26.67
Max. Negotiated Rate	$469.52
Rate for Payer: Aetna Commercial	$356.84
Rate for Payer: Aetna Medicare Advantage	$281.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$239.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$239.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$239.46
Rate for Payer: Cigna Commercial	$469.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$244.15
Rate for Payer: Oxford Commercial	$187.81
Rate for Payer: Qualcare PPO/HMO/WC	$140.86
Rate for Payer: UnitedHealthcare Commercial	$187.81
Rate for Payer: UnitedHealthcare Community & State	$29.67
Rate for Payer: Wellpoint Medicaid Managed Care	$26.67

BALLOON CRE PULM 10-12MM

Facility

$1,538.20

Hospital Charge Code	270677585
Hospital Revenue Code	278
Min. Negotiated Rate	$230.73
Max. Negotiated Rate	$372.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: Qualcare PPO/HMO/WC	$230.73

BALLOON CRE PULM 10-12MM

Facility

$1,538.20

Hospital Charge Code	270677585
Hospital Revenue Code	278
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$769.10
Rate for Payer: Aetna Commercial	$584.52
Rate for Payer: Aetna Medicare Advantage	$461.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.24
Rate for Payer: Cigna Commercial	$769.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: Qualcare PPO/HMO/WC	$230.73
Rate for Payer: UnitedHealthcare Community & State	$48.61
Rate for Payer: Wellpoint Medicaid Managed Care	$43.68

BALLOON CRE PULM 8-10MM

Facility

$1,538.20

Hospital Charge Code	270677584
Hospital Revenue Code	278
Min. Negotiated Rate	$230.73
Max. Negotiated Rate	$372.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: Qualcare PPO/HMO/WC	$230.73

BALLOON CRE PULM 8-10MM

Facility

$1,538.20

Hospital Charge Code	270677584
Hospital Revenue Code	278
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$769.10
Rate for Payer: Aetna Commercial	$584.52
Rate for Payer: Aetna Medicare Advantage	$461.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.24
Rate for Payer: Cigna Commercial	$769.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.24
Rate for Payer: Qualcare PPO/HMO/WC	$230.73
Rate for Payer: UnitedHealthcare Community & State	$48.61
Rate for Payer: Wellpoint Medicaid Managed Care	$43.68

BALLOON CRE RX 3cm 10-11-12

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683531
Hospital Revenue Code	278
Min. Negotiated Rate	$41.89
Max. Negotiated Rate	$737.50
Rate for Payer: Aetna Commercial	$560.50
Rate for Payer: Aetna Medicare Advantage	$442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$376.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$376.12
Rate for Payer: Cigna Commercial	$737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25
Rate for Payer: UnitedHealthcare Community & State	$46.61
Rate for Payer: Wellpoint Medicaid Managed Care	$41.89

BALLOON CRE RX 3cm 10-11-12

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683531
Hospital Revenue Code	278
Min. Negotiated Rate	$221.25
Max. Negotiated Rate	$356.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$356.95
Rate for Payer: Qualcare PPO/HMO/WC	$221.25

BALLOON CRE RX 3cm 12-13.5-15

Facility

$1,395.00

Hospital Charge Code	270704195
Hospital Revenue Code	279
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$697.50
Rate for Payer: Aetna Commercial	$530.10
Rate for Payer: Aetna Medicare Advantage	$418.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$355.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$355.73
Rate for Payer: Cigna Commercial	$697.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$362.70
Rate for Payer: Oxford Commercial	$279.00
Rate for Payer: Qualcare PPO/HMO/WC	$209.25
Rate for Payer: UnitedHealthcare Commercial	$279.00
Rate for Payer: UnitedHealthcare Community & State	$44.08
Rate for Payer: Wellpoint Medicaid Managed Care	$39.62

Know your out-of-pocket cost for care.

All Charges