Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON NC EUPHORA 2.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694519S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 2.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694519
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 3.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694520
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

BALLOON NC EUPHORA 3.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694520
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 3.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694520S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

BALLOON NC EUPHORA 3.5X15MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694520S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 3.5X20MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694521S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

BALLOON NC EUPHORA 3.5X20MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694521S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 3.5X20MMBAL

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694521
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 3.5X20MMBAL

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694521
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

BALLOON NC EUPHORA 5.0X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694522S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

BALLOON NC EUPHORA 5.0X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694522
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 5.0X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694522
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

BALLOON NC EUPHORA 5.0X12MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270694522S
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NC EUPHORA 8.0X4.5MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270696378
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

BALLOON NC EUPHORA 8.0X4.5MM

Facility

$475.00

Service Code	HCPCS C1725
Hospital Charge Code	270696378
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

BALLOON NCRS PTA AB14W02504015

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677S
Hospital Revenue Code	278
Min. Negotiated Rate	$43.70
Max. Negotiated Rate	$769.30
Rate for Payer: Aetna Commercial	$584.67
Rate for Payer: Aetna Medicare Advantage	$461.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$392.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$392.34
Rate for Payer: Cigna Commercial	$769.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: Qualcare PPO/HMO/WC	$230.79
Rate for Payer: UnitedHealthcare Community & State	$48.62
Rate for Payer: Wellpoint Medicaid Managed Care	$43.70

BALLOON NCRS PTA AB14W02504015

Facility

$1,538.60

Service Code	HCPCS C1725
Hospital Charge Code	270643677S
Hospital Revenue Code	278
Min. Negotiated Rate	$230.79
Max. Negotiated Rate	$372.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$307.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$372.34
Rate for Payer: Qualcare PPO/HMO/WC	$230.79

BALLOON NEPHROSTOMY

Facility

$1,348.50

Hospital Charge Code	270650767
Hospital Revenue Code	272
Min. Negotiated Rate	$38.30
Max. Negotiated Rate	$674.25
Rate for Payer: Aetna Commercial	$512.43
Rate for Payer: Aetna Medicare Advantage	$404.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$343.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$343.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$343.87
Rate for Payer: Cigna Commercial	$674.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$350.61
Rate for Payer: Oxford Commercial	$269.70
Rate for Payer: Qualcare PPO/HMO/WC	$202.28
Rate for Payer: UnitedHealthcare Commercial	$269.70
Rate for Payer: UnitedHealthcare Community & State	$42.61
Rate for Payer: Wellpoint Medicaid Managed Care	$38.30

BALLOON NEPHROSTOMY

Facility

$1,348.50

Hospital Charge Code	270650767
Hospital Revenue Code	272
Min. Negotiated Rate	$202.28
Max. Negotiated Rate	$202.28
Rate for Payer: Qualcare PPO/HMO/WC	$202.28

BALLOON OPTILUME 24/18F 3CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699438
Hospital Revenue Code	278
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$378.41
Rate for Payer: Wellpoint Medicaid Managed Care	$340.09

BALLOON OPTILUME 24/18F 3CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699438
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 24/18F 5CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699439
Hospital Revenue Code	278
Min. Negotiated Rate	$1,796.25
Max. Negotiated Rate	$2,897.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25

BALLOON OPTILUME 24/18F 5CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699439
Hospital Revenue Code	278
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$378.41
Rate for Payer: Wellpoint Medicaid Managed Care	$340.09

BALLOON OPTILUME 30/24F 3CM

Facility

$11,975.00

Service Code	HCPCS C1726
Hospital Charge Code	270699440
Hospital Revenue Code	278
Min. Negotiated Rate	$340.09
Max. Negotiated Rate	$5,987.50
Rate for Payer: Aetna Commercial	$4,550.50
Rate for Payer: Aetna Medicare Advantage	$3,592.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,053.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,053.62
Rate for Payer: Cigna Commercial	$5,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,897.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,796.25
Rate for Payer: UnitedHealthcare Community & State	$378.41
Rate for Payer: Wellpoint Medicaid Managed Care	$340.09

Know your out-of-pocket cost for care.

All Charges