Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON EVERCROSS PTA 9x80x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671638
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 9x80x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671638
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 9x80x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671638N
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 9x80x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671638N
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 9x80x135

Facility

$575.00

Service Code	HCPCS C1725
Hospital Charge Code	270671638S
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 9x80x80

Facility

$575.00

Hospital Charge Code	270671637
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 9x80x80

Facility

$575.00

Hospital Charge Code	270671637
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 EXTRACTOR 9mm-12mm

Facility

$740.00

Service Code	HCPCS C1726
Hospital Charge Code	270646919
Hospital Revenue Code	278
Min. Negotiated Rate	$21.02
Max. Negotiated Rate	$370.00
Rate for Payer: Aetna Commercial	$281.20
Rate for Payer: Aetna Medicare Advantage	$222.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.70
Rate for Payer: Cigna Commercial	$370.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.08
Rate for Payer: Qualcare PPO/HMO/WC	$111.00
Rate for Payer: UnitedHealthcare Community & State	$23.38
Rate for Payer: Wellpoint Medicaid Managed Care	$21.02

BALLOON EXTRACTOR 9mm-12mm

Facility

$740.00

Service Code	HCPCS C1726
Hospital Charge Code	270646919
Hospital Revenue Code	278
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$179.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$179.08
Rate for Payer: Qualcare PPO/HMO/WC	$111.00

BALLOON EXTRACTOR RX

Facility

$26.55

Hospital Charge Code	270654395
Hospital Revenue Code	272
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$13.28
Rate for Payer: Aetna Commercial	$10.09
Rate for Payer: Aetna Medicare Advantage	$7.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.77
Rate for Payer: Cigna Commercial	$13.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.90
Rate for Payer: Oxford Commercial	$5.31
Rate for Payer: Qualcare PPO/HMO/WC	$3.98
Rate for Payer: UnitedHealthcare Commercial	$5.31
Rate for Payer: UnitedHealthcare Community & State	$0.84
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

BALLOON EXTRACTOR RX

Facility

$26.55

Hospital Charge Code	270654395
Hospital Revenue Code	272
Min. Negotiated Rate	$3.98
Max. Negotiated Rate	$3.98
Rate for Payer: Qualcare PPO/HMO/WC	$3.98

BALLOON EXTRACTOR RX RETRIE

Facility

$752.50

Hospital Charge Code	270655029
Hospital Revenue Code	278
Min. Negotiated Rate	$21.37
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.10
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Community & State	$23.78
Rate for Payer: Wellpoint Medicaid Managed Care	$21.37

BALLOON EXTRACTOR RX RETRIE

Facility

$752.50

Hospital Charge Code	270655029
Hospital Revenue Code	278
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$182.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.10
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

BALLOON FORMULA 418 RENAL

Facility

$6,000.00

Hospital Charge Code	270660269
Hospital Revenue Code	272
Min. Negotiated Rate	$900.00
Max. Negotiated Rate	$900.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00

BALLOON FORMULA 418 RENAL

Facility

$6,000.00

Hospital Charge Code	270660269
Hospital Revenue Code	272
Min. Negotiated Rate	$170.40
Max. Negotiated Rate	$3,000.00
Rate for Payer: Aetna Commercial	$2,280.00
Rate for Payer: Aetna Medicare Advantage	$1,800.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,530.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,530.00
Rate for Payer: Cigna Commercial	$3,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,560.00
Rate for Payer: Oxford Commercial	$1,200.00
Rate for Payer: Qualcare PPO/HMO/WC	$900.00
Rate for Payer: UnitedHealthcare Commercial	$1,200.00
Rate for Payer: UnitedHealthcare Community & State	$189.60
Rate for Payer: Wellpoint Medicaid Managed Care	$170.40

BALLOON FOR RADIAL SCOPE OEA37

Facility

$72.32

Hospital Charge Code	270632769
Hospital Revenue Code	272
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$36.16
Rate for Payer: Aetna Commercial	$27.48
Rate for Payer: Aetna Medicare Advantage	$21.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.44
Rate for Payer: Cigna Commercial	$36.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.80
Rate for Payer: Oxford Commercial	$14.46
Rate for Payer: Qualcare PPO/HMO/WC	$10.85
Rate for Payer: UnitedHealthcare Commercial	$14.46
Rate for Payer: UnitedHealthcare Community & State	$2.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.05

BALLOON FOR RADIAL SCOPE OEA37

Facility

$72.32

Hospital Charge Code	270632769
Hospital Revenue Code	272
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$10.85
Rate for Payer: Qualcare PPO/HMO/WC	$10.85

BALLOON FORTREX OTW 10x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270677320
Hospital Revenue Code	278
Min. Negotiated Rate	$23.24
Max. Negotiated Rate	$409.15
Rate for Payer: Aetna Commercial	$310.95
Rate for Payer: Aetna Medicare Advantage	$245.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$208.67
Rate for Payer: Cigna Commercial	$409.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.03
Rate for Payer: Qualcare PPO/HMO/WC	$122.75
Rate for Payer: UnitedHealthcare Community & State	$25.86
Rate for Payer: Wellpoint Medicaid Managed Care	$23.24

BALLOON FORTREX OTW 10x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677320N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

BALLOON FORTREX OTW 10x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677320N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON FORTREX OTW 10x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270677320
Hospital Revenue Code	278
Min. Negotiated Rate	$122.75
Max. Negotiated Rate	$198.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$163.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$198.03
Rate for Payer: Qualcare PPO/HMO/WC	$122.75

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321N
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321
Hospital Revenue Code	278
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$254.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50

BALLOON FORTREX OTW 10x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677321N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.82
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial	$399.00
Rate for Payer: Aetna Medicare Advantage	$315.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.75
Rate for Payer: Cigna Commercial	$525.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$254.10
Rate for Payer: Qualcare PPO/HMO/WC	$157.50
Rate for Payer: UnitedHealthcare Community & State	$33.18
Rate for Payer: Wellpoint Medicaid Managed Care	$29.82

Know your out-of-pocket cost for care.

All Charges