Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

SHEATH PINNACLE 6FR 45cm RXR01

Facility

$155.00

Service Code	HCPCS C1887
Hospital Charge Code	270642214A
Hospital Revenue Code	278
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$77.50
Rate for Payer: Aetna Commercial	$58.90
Rate for Payer: Aetna Medicare Advantage	$46.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$39.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$39.52
Rate for Payer: Cigna Commercial	$77.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25
Rate for Payer: UnitedHealthcare Community & State	$4.90
Rate for Payer: Wellpoint Medicaid Managed Care	$4.40

SHEATH PINNACLE 6FR 45cm RXR01

Facility

$155.00

Service Code	HCPCS C1887
Hospital Charge Code	270642214C
Hospital Revenue Code	278
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$37.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$37.51
Rate for Payer: Qualcare PPO/HMO/WC	$23.25

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$580.00

Service Code	HCPCS C1887
Hospital Charge Code	270642215C
Hospital Revenue Code	278
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$220.40
Rate for Payer: Aetna Medicare Advantage	$174.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$147.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$147.90
Rate for Payer: Cigna Commercial	$290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00
Rate for Payer: UnitedHealthcare Community & State	$18.33
Rate for Payer: Wellpoint Medicaid Managed Care	$16.47

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$585.65

Service Code	HCPCS C1887
Hospital Charge Code	270642215N
Hospital Revenue Code	278
Min. Negotiated Rate	$87.85
Max. Negotiated Rate	$141.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.73
Rate for Payer: Qualcare PPO/HMO/WC	$87.85

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$580.00

Service Code	HCPCS C1887
Hospital Charge Code	270642215C
Hospital Revenue Code	278
Min. Negotiated Rate	$87.00
Max. Negotiated Rate	$140.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$116.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.36
Rate for Payer: Qualcare PPO/HMO/WC	$87.00

SHEATH PINNACLE 6FR 65CM RSP01

Facility

$585.65

Service Code	HCPCS C1887
Hospital Charge Code	270642215N
Hospital Revenue Code	278
Min. Negotiated Rate	$16.63
Max. Negotiated Rate	$292.82
Rate for Payer: Aetna Commercial	$222.55
Rate for Payer: Aetna Medicare Advantage	$175.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$149.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$149.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$117.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$149.34
Rate for Payer: Cigna Commercial	$292.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.73
Rate for Payer: Qualcare PPO/HMO/WC	$87.85
Rate for Payer: UnitedHealthcare Community & State	$18.51
Rate for Payer: Wellpoint Medicaid Managed Care	$16.63

SHEATH PINNACLE 7FR

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270653587
Hospital Revenue Code	278
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna Commercial	$18.53
Rate for Payer: Aetna Medicare Advantage	$14.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.31
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

SHEATH PINNACLE 7FR

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270653587
Hospital Revenue Code	278
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$11.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.31

SHEATH PINNACLE 7FR 45CM

Facility

$427.50

Service Code	HCPCS C1894
Hospital Charge Code	270652537
Hospital Revenue Code	278
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$213.75
Rate for Payer: Aetna Commercial	$162.45
Rate for Payer: Aetna Medicare Advantage	$128.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$109.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$109.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$109.01
Rate for Payer: Cigna Commercial	$213.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.45
Rate for Payer: Qualcare PPO/HMO/WC	$64.12
Rate for Payer: UnitedHealthcare Community & State	$13.51
Rate for Payer: Wellpoint Medicaid Managed Care	$12.14

SHEATH PINNACLE 7FR 45CM

Facility

$427.50

Service Code	HCPCS C1894
Hospital Charge Code	270652537
Hospital Revenue Code	278
Min. Negotiated Rate	$64.12
Max. Negotiated Rate	$103.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$103.45
Rate for Payer: Qualcare PPO/HMO/WC	$64.12

SHEATH PINNACLE R/O 5FR X 6

Facility

$170.00

Hospital Charge Code	270666809
Hospital Revenue Code	270
Min. Negotiated Rate	$4.83
Max. Negotiated Rate	$85.00
Rate for Payer: Aetna Commercial	$64.60
Rate for Payer: Aetna Medicare Advantage	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.35
Rate for Payer: Cigna Commercial	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.20
Rate for Payer: Oxford Commercial	$34.00
Rate for Payer: Qualcare PPO/HMO/WC	$25.50
Rate for Payer: UnitedHealthcare Commercial	$34.00
Rate for Payer: UnitedHealthcare Community & State	$5.37
Rate for Payer: Wellpoint Medicaid Managed Care	$4.83

SHEATH PINNACLE R/O 5FR X 6

Facility

$170.00

Hospital Charge Code	270666809
Hospital Revenue Code	270
Min. Negotiated Rate	$25.50
Max. Negotiated Rate	$25.50
Rate for Payer: Qualcare PPO/HMO/WC	$25.50

SHEATH PINNACLE R/O HI/FLO

Facility

$173.25

Hospital Charge Code	270670033
Hospital Revenue Code	278
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$86.62
Rate for Payer: Aetna Commercial	$65.83
Rate for Payer: Aetna Medicare Advantage	$51.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$44.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$44.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$44.18
Rate for Payer: Cigna Commercial	$86.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.93
Rate for Payer: Qualcare PPO/HMO/WC	$25.99
Rate for Payer: UnitedHealthcare Community & State	$5.47
Rate for Payer: Wellpoint Medicaid Managed Care	$4.92

SHEATH PINNACLE R/O HI/FLO

Facility

$173.25

Hospital Charge Code	270670033
Hospital Revenue Code	278
Min. Negotiated Rate	$25.99
Max. Negotiated Rate	$41.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$34.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$41.93
Rate for Payer: Qualcare PPO/HMO/WC	$25.99

SHEATH PINNACLE R/O II 5FR X10

Facility

$150.00

Hospital Charge Code	270666810
Hospital Revenue Code	270
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

SHEATH PINNACLE R/O II 5FR X10

Facility

$150.00

Hospital Charge Code	270666810
Hospital Revenue Code	270
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

SHEATH PINNACLE R/O II INTRO

Facility

$121.50

Service Code	HCPCS C1894
Hospital Charge Code	270653781
Hospital Revenue Code	278
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$29.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.23

SHEATH PINNACLE R/O II INTRO

Facility

$121.50

Service Code	HCPCS C1894
Hospital Charge Code	270653781
Hospital Revenue Code	278
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna Commercial	$46.17
Rate for Payer: Aetna Medicare Advantage	$36.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.98
Rate for Payer: Cigna Commercial	$60.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.40
Rate for Payer: Qualcare PPO/HMO/WC	$18.23
Rate for Payer: UnitedHealthcare Community & State	$3.84
Rate for Payer: Wellpoint Medicaid Managed Care	$3.45

SHEATH PINNACLE R/O II INTROD

Facility

$166.00

Hospital Charge Code	270653921S
Hospital Revenue Code	271
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

SHEATH PINNACLE R/O II INTROD

Facility

$1,150.00

Hospital Charge Code	270653921N
Hospital Revenue Code	271
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$172.50
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

SHEATH PINNACLE R/O II INTROD

Facility

$1,150.00

Hospital Charge Code	270653921N
Hospital Revenue Code	271
Min. Negotiated Rate	$32.66
Max. Negotiated Rate	$575.00
Rate for Payer: Aetna Commercial	$437.00
Rate for Payer: Aetna Medicare Advantage	$345.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$293.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$293.25
Rate for Payer: Cigna Commercial	$575.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$299.00
Rate for Payer: Oxford Commercial	$230.00
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Commercial	$230.00
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

SHEATH PINNACLE R/O II INTROD

Facility

$166.00

Hospital Charge Code	270653921S
Hospital Revenue Code	271
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.20
Rate for Payer: UnitedHealthcare Community & State	$5.25
Rate for Payer: Wellpoint Medicaid Managed Care	$4.71

SHEATH PINNACLE R/O II INTROD

Facility

$166.00

Hospital Charge Code	270653921
Hospital Revenue Code	271
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$83.00
Rate for Payer: Aetna Commercial	$63.08
Rate for Payer: Aetna Medicare Advantage	$49.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.33
Rate for Payer: Cigna Commercial	$83.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.16
Rate for Payer: Oxford Commercial	$33.20
Rate for Payer: Qualcare PPO/HMO/WC	$24.90
Rate for Payer: UnitedHealthcare Commercial	$33.20
Rate for Payer: UnitedHealthcare Community & State	$5.25
Rate for Payer: Wellpoint Medicaid Managed Care	$4.71

SHEATH PINNACLE R/O II INTROD

Facility

$166.00

Hospital Charge Code	270653921
Hospital Revenue Code	271
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$24.90

SHEATH PINNACLE SUPR 10FR 11cm

Facility

$48.76

Service Code	HCPCS C1894
Hospital Charge Code	270628419
Hospital Revenue Code	278
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna Commercial	$18.53
Rate for Payer: Aetna Medicare Advantage	$14.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$9.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.43
Rate for Payer: Cigna Commercial	$24.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$7.31
Rate for Payer: UnitedHealthcare Community & State	$1.54
Rate for Payer: Wellpoint Medicaid Managed Care	$1.38

Know your out-of-pocket cost for care.

All Charges