Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON FORTREX OTW 7x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682548N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.22
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Community & State	$32.52
Rate for Payer: Wellpoint Medicaid Managed Care	$29.22

BALLOON FORTREX OTW 7x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682548N
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$249.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

BALLOON FORTREX OTW 7x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682548
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$249.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

BALLOON FORTREX OTW 8x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682551N
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$249.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

BALLOON FORTREX OTW 8x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682551
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 8x40x80CM

Facility

$818.30

Service Code	HCPCS C1725
Hospital Charge Code	270682551
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 8x40x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682551N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.22
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Community & State	$32.52
Rate for Payer: Wellpoint Medicaid Managed Care	$29.22

BALLOON FORTREX OTW 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552N
Hospital Revenue Code	278
Min. Negotiated Rate	$29.22
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Community & State	$32.52
Rate for Payer: Wellpoint Medicaid Managed Care	$29.22

BALLOON FORTREX OTW 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552N
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$249.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

BALLOON FORTREX OTW 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552
Hospital Revenue Code	278
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$249.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35

BALLOON FORTREX OTW 8x80x80CM

Facility

$1,029.00

Service Code	HCPCS C1725
Hospital Charge Code	270682552
Hospital Revenue Code	278
Min. Negotiated Rate	$29.22
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial	$391.02
Rate for Payer: Aetna Medicare Advantage	$308.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$262.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$205.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$262.39
Rate for Payer: Cigna Commercial	$514.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$249.02
Rate for Payer: Qualcare PPO/HMO/WC	$154.35
Rate for Payer: UnitedHealthcare Community & State	$32.52
Rate for Payer: Wellpoint Medicaid Managed Care	$29.22

BALLOON FORTREX OTW 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318
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 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318N
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 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318N
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 9x40x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677318
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319N
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319N
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 9x80x80CM

Facility

$1,050.00

Service Code	HCPCS C1725
Hospital Charge Code	270677319
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 HP ULTRA 15 FRX5 MM

Facility

$2,320.00

Service Code	HCPCS C1726
Hospital Charge Code	270684718
Hospital Revenue Code	278
Min. Negotiated Rate	$65.89
Max. Negotiated Rate	$1,160.00
Rate for Payer: Aetna Commercial	$881.60
Rate for Payer: Aetna Medicare Advantage	$696.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$591.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$591.60
Rate for Payer: Cigna Commercial	$1,160.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00
Rate for Payer: UnitedHealthcare Community & State	$73.31
Rate for Payer: Wellpoint Medicaid Managed Care	$65.89

BALLOON HP ULTRA 15 FRX5 MM

Facility

$2,320.00

Service Code	HCPCS C1726
Hospital Charge Code	270684718
Hospital Revenue Code	278
Min. Negotiated Rate	$348.00
Max. Negotiated Rate	$561.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$464.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$561.44
Rate for Payer: Qualcare PPO/HMO/WC	$348.00

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682S
Hospital Revenue Code	278
Min. Negotiated Rate	$124.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$138.25
Rate for Payer: Wellpoint Medicaid Managed Care	$124.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682S
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682N
Hospital Revenue Code	278
Min. Negotiated Rate	$656.25
Max. Negotiated Rate	$1,058.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25

BALLOON I/A LINEAR 7.5FR 34CC

Facility

$4,375.00

Service Code	HCPCS C1725
Hospital Charge Code	270657682
Hospital Revenue Code	278
Min. Negotiated Rate	$124.25
Max. Negotiated Rate	$2,187.50
Rate for Payer: Aetna Commercial	$1,662.50
Rate for Payer: Aetna Medicare Advantage	$1,312.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,115.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$875.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,115.62
Rate for Payer: Cigna Commercial	$2,187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,058.75
Rate for Payer: Qualcare PPO/HMO/WC	$656.25
Rate for Payer: UnitedHealthcare Community & State	$138.25
Rate for Payer: Wellpoint Medicaid Managed Care	$124.25

Know your out-of-pocket cost for care.

All Charges