Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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 5x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644465
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 5x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644465
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 6x100x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644321
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 6x100x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644321
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 6x150x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428
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 6x150x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644428N
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 6x150x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428
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 6x150x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644428N
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 6X150X135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428S
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 6X150X135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644428S
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 6x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644148
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 6x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644148N
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 6x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644148N
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 6x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644148
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 7x150x135

Facility

$575.00

Hospital Charge Code	270644035
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 7x150x135

Facility

$575.00

Hospital Charge Code	270644035
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 7x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472
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 7x200x135

Facility

$813.40

Service Code	HCPCS C1725
Hospital Charge Code	270644472
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 7x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644472N
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 7x200x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644472N
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 PRA 6X15X135

Facility

$875.00

Service Code	HCPCS C1725
Hospital Charge Code	270683231
Hospital Revenue Code	278
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$211.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

BALLOON EVERCROSS PRA 6X15X135

Facility

$875.00

Service Code	HCPCS C1725
Hospital Charge Code	270683231
Hospital Revenue Code	278
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$175.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$211.75
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

BALLOON EVERCROSS PTA 10x20x80

Facility

$575.00

Hospital Charge Code	270644474
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 PTA 10x20x80

Facility

$575.00

Hospital Charge Code	270644474
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

Know your out-of-pocket cost for care.

All Charges