Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON EVERCROSS 12x40x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671645N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

BALLOON EVERCROSS 12x40x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671645
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BALLOON EVERCROSS 12x60x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671646N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

BALLOON EVERCROSS 12x60x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671646N
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BALLOON EVERCROSS 12x60x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270671646
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLOON EVERCROSS 12x60x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270671646
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLOON EVERCROSS 4x100x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671609N
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BALLOON EVERCROSS 4x100x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270671609
Hospital Revenue Code	278
Min. Negotiated Rate	$19.34
Max. Negotiated Rate	$340.55
Rate for Payer: Aetna Commercial	$258.82
Rate for Payer: Aetna Medicare Advantage	$204.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$173.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$173.68
Rate for Payer: Cigna Commercial	$340.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17
Rate for Payer: UnitedHealthcare Community & State	$21.52
Rate for Payer: Wellpoint Medicaid Managed Care	$19.34

BALLOON EVERCROSS 4x100x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270671609
Hospital Revenue Code	278
Min. Negotiated Rate	$102.17
Max. Negotiated Rate	$164.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$136.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$164.83
Rate for Payer: Qualcare PPO/HMO/WC	$102.17

BALLOON EVERCROSS 4x100x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671609N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

BALLOON EVERCROSS 4x150x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671647
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BALLOON EVERCROSS 4x150x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671647
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

BALLOON EVERCROSS 4X150X135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671647S
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BALLOON EVERCROSS 4X150X135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671647S
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

BALLOON EVERCROSS 4x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270671648
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.10

BALLOON EVERCROSS 4x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671648N
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BALLOON EVERCROSS 4x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671648N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$287.50
Rate for Payer: Aetna Commercial	$218.50
Rate for Payer: Aetna Medicare Advantage	$172.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$146.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$146.62
Rate for Payer: Cigna Commercial	$287.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25
Rate for Payer: UnitedHealthcare Community & State	$18.17
Rate for Payer: Wellpoint Medicaid Managed Care	$16.33

BALLOON EVERCROSS 4x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270671648S
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.10

BALLOON EVERCROSS 4x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270671648
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLOON EVERCROSS 4x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270671648S
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLOON EVERCROSS 5x150x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270642506
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

BALLOON EVERCROSS 5x150x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270642506
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.10

BALLOON EVERCROSS 5x150x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270642506S
Hospital Revenue Code	278
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$406.70
Rate for Payer: Aetna Commercial	$309.09
Rate for Payer: Aetna Medicare Advantage	$244.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$207.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$207.42
Rate for Payer: Cigna Commercial	$406.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01
Rate for Payer: UnitedHealthcare Community & State	$25.70
Rate for Payer: Wellpoint Medicaid Managed Care	$23.10

BALLOON EVERCROSS 5x150x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270642506N
Hospital Revenue Code	278
Min. Negotiated Rate	$86.25
Max. Negotiated Rate	$139.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$115.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$139.15
Rate for Payer: Qualcare PPO/HMO/WC	$86.25

BALLOON EVERCROSS 5x150x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270642506S
Hospital Revenue Code	278
Min. Negotiated Rate	$122.01
Max. Negotiated Rate	$196.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$162.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$196.84
Rate for Payer: Qualcare PPO/HMO/WC	$122.01

Know your out-of-pocket cost for care.

All Charges