Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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

BALLOON CRE RX 3cm 8-9-10

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683530
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 8-9-10

Facility

$1,475.00

Service Code	HCPCS C1726
Hospital Charge Code	270683530
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

BALLOONCRE WG 10-12mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664035
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOONCRE WG 10-12mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664035
Hospital Revenue Code	272
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.20
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$33.81
Rate for Payer: Wellpoint Medicaid Managed Care	$30.39

BALLOONCRE WG 12-15mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664036
Hospital Revenue Code	272
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.20
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$33.81
Rate for Payer: Wellpoint Medicaid Managed Care	$30.39

BALLOONCRE WG 12-15mm 240cm

Facility

$1,070.00

Hospital Charge Code	270664036
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOONCRE WG 6-8mm240cm

Facility

$1,070.00

Hospital Charge Code	270654307
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOONCRE WG 6-8mm240cm

Facility

$1,070.00

Hospital Charge Code	270654307
Hospital Revenue Code	272
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.20
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$33.81
Rate for Payer: Wellpoint Medicaid Managed Care	$30.39

BALLOON CRE WG 8-10mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270627706
Hospital Revenue Code	278
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$258.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOON CRE WG 8-10mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270627706
Hospital Revenue Code	278
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Community & State	$33.81
Rate for Payer: Wellpoint Medicaid Managed Care	$30.39

BALLOONCRE WG 8-10Mm 240cm

Facility

$1,070.00

Hospital Charge Code	270658593
Hospital Revenue Code	272
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.20
Rate for Payer: Oxford Commercial	$214.00
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Commercial	$214.00
Rate for Payer: UnitedHealthcare Community & State	$33.81
Rate for Payer: Wellpoint Medicaid Managed Care	$30.39

BALLOONCRE WG 8-10Mm 240cm

Facility

$1,070.00

Hospital Charge Code	270658593
Hospital Revenue Code	272
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$160.50
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOON CRE WG PYLORIC 18-20mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270654304
Hospital Revenue Code	278
Min. Negotiated Rate	$30.39
Max. Negotiated Rate	$535.00
Rate for Payer: Aetna Commercial	$406.60
Rate for Payer: Aetna Medicare Advantage	$321.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.85
Rate for Payer: Cigna Commercial	$535.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: Qualcare PPO/HMO/WC	$160.50
Rate for Payer: UnitedHealthcare Community & State	$33.81
Rate for Payer: Wellpoint Medicaid Managed Care	$30.39

BALLOON CRE WG PYLORIC 18-20mm

Facility

$1,070.00

Service Code	HCPCS C1725
Hospital Charge Code	270654304
Hospital Revenue Code	278
Min. Negotiated Rate	$160.50
Max. Negotiated Rate	$258.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$214.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$258.94
Rate for Payer: Qualcare PPO/HMO/WC	$160.50

BALLOON CUTTING 4x1.5x140cm

Facility

$3,517.50

Hospital Charge Code	270642206
Hospital Revenue Code	278
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

BALLOON CUTTING 4x1.5x140cm

Facility

$3,517.50

Hospital Charge Code	270642206
Hospital Revenue Code	278
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$1,758.75
Rate for Payer: Aetna Commercial	$1,336.65
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: Cigna Commercial	$1,758.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$111.15
Rate for Payer: Wellpoint Medicaid Managed Care	$99.90

BALLOON CUTTING 5x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642207
Hospital Revenue Code	278
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

BALLOON CUTTING 5x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642207
Hospital Revenue Code	278
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$1,758.75
Rate for Payer: Aetna Commercial	$1,336.65
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: Cigna Commercial	$1,758.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$111.15
Rate for Payer: Wellpoint Medicaid Managed Care	$99.90

BALLOON CUTTING 6x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642209
Hospital Revenue Code	278
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$1,758.75
Rate for Payer: Aetna Commercial	$1,336.65
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: Cigna Commercial	$1,758.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$111.15
Rate for Payer: Wellpoint Medicaid Managed Care	$99.90

BALLOON CUTTING 6x2x135cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270642209
Hospital Revenue Code	278
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

BALLOON CUTTING 6x90cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270633879
Hospital Revenue Code	278
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

BALLOON CUTTING 6x90cm

Facility

$3,517.50

Service Code	HCPCS C1725
Hospital Charge Code	270633879
Hospital Revenue Code	278
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$1,758.75
Rate for Payer: Aetna Commercial	$1,336.65
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: Cigna Commercial	$1,758.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$111.15
Rate for Payer: Wellpoint Medicaid Managed Care	$99.90

BALLOON CUTTING 7x90cm

Facility

$3,517.50

Hospital Charge Code	270633880
Hospital Revenue Code	278
Min. Negotiated Rate	$527.62
Max. Negotiated Rate	$851.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62

BALLOON CUTTING 7x90cm

Facility

$3,517.50

Hospital Charge Code	270633880
Hospital Revenue Code	278
Min. Negotiated Rate	$99.90
Max. Negotiated Rate	$1,758.75
Rate for Payer: Aetna Commercial	$1,336.65
Rate for Payer: Aetna Medicare Advantage	$1,055.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$896.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$703.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$896.96
Rate for Payer: Cigna Commercial	$1,758.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$851.24
Rate for Payer: Qualcare PPO/HMO/WC	$527.62
Rate for Payer: UnitedHealthcare Community & State	$111.15
Rate for Payer: Wellpoint Medicaid Managed Care	$99.90

Know your out-of-pocket cost for care.

All Charges