Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON SPRINTER RX 2.5x09MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651193
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

BALLOON SPRINTER RX 2.5x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651194
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BALLOON SPRINTER RX 2.5x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651194
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON SPRINTER RX 2.5x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651195
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON SPRINTER RX 2.5x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651195
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BALLOON SPRINTER RX 2.5x21MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651196
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

BALLOON SPRINTER RX 2.5x21MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651196
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRINTER RX 2.5x27MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651197
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRINTER RX 2.5x27MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651197
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

BALLOON SPRINTER RX 2.75x06MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651198
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

BALLOON SPRINTER RX 2.75x06MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651198
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRINTER RX 2.75x06MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270650802
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

BALLOON SPRINTER RX 2.75x06MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270650802
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

BALLOON SPRINTER RX 2.75x09MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651199
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BALLOON SPRINTER RX 2.75x09MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651199
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON SPRINTER RX 2.75x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270650804
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON SPRINTER RX 2.75x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270650804
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BALLOON SPRINTER RX 2.75x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651201
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON SPRINTER RX 2.75x12MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651201
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BALLOON SPRINTER RX 2.75x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270650806
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON SPRINTER RX 2.75x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651202
Hospital Revenue Code	278
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$151.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75

BALLOON SPRINTER RX 2.75x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651202
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BALLOON SPRINTER RX 2.75x15MM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270650806
Hospital Revenue Code	278
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$312.50
Rate for Payer: Aetna Commercial	$237.50
Rate for Payer: Aetna Medicare Advantage	$187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$159.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$159.38
Rate for Payer: Cigna Commercial	$312.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$151.25
Rate for Payer: Qualcare PPO/HMO/WC	$93.75
Rate for Payer: UnitedHealthcare Community & State	$19.75
Rate for Payer: Wellpoint Medicaid Managed Care	$17.75

BALLOON SPRINTER RX 2.75x20MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270650807
Hospital Revenue Code	278
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Community & State	$23.70
Rate for Payer: Wellpoint Medicaid Managed Care	$21.30

BALLOON SPRINTER RX 2.75x20MM

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270650807
Hospital Revenue Code	278
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$181.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$150.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

Know your out-of-pocket cost for care.

All Charges