Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON EVERCROSS PTA 6x100x80

Facility

$857.50

Service Code	HCPCS C1725
Hospital Charge Code	270663762
Hospital Revenue Code	278
Min. Negotiated Rate	$24.35
Max. Negotiated Rate	$428.75
Rate for Payer: Aetna Commercial	$325.85
Rate for Payer: Aetna Medicare Advantage	$257.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$218.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$171.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$218.66
Rate for Payer: Cigna Commercial	$428.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$207.51
Rate for Payer: Qualcare PPO/HMO/WC	$128.62
Rate for Payer: UnitedHealthcare Community & State	$27.10
Rate for Payer: Wellpoint Medicaid Managed Care	$24.35

BALLOON EVERCROSS PTA 6x120mm

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639217C
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 PTA 6x120mm

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639217C
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 PTA 6x120x13

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639217
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 PTA 6x120x13

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270639217N
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 PTA 6x120x13

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639217
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 PTA 6x120x13

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270639217N
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 6X120X13

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639217S
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 PTA 6X120X13

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270639217S
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 PTA 6x120x80

Facility

$575.00

Hospital Charge Code	270671619
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 6x120x80

Facility

$575.00

Hospital Charge Code	270671619
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 PTA 6X20X130

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644274S
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 PTA 6X20X130

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644274S
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 PTA 6X20X130

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644274N
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 6X20X130

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644274N
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 PTA 6x20x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644274A
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 PTA 6x20x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644274A
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 PTA 6x20x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644274
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 PTA 6x20x135

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644274
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 PTA 6x20x80

Facility

$575.00

Hospital Charge Code	270671615
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 6x20x80

Facility

$575.00

Hospital Charge Code	270671615
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 PTA 6x30mm

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644466N
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 PTA 6x30mm

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466
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 PTA 6x30mm

Facility

$681.10

Service Code	HCPCS C1725
Hospital Charge Code	270644466
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 PTA 6x30mm

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270644466N
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

Know your out-of-pocket cost for care.

All Charges