Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALLOON TREK RX 3.5mm x 12mm

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645271
Hospital Revenue Code	279
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BALLOON TREK RX 3.5MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645271C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON TREK RX 3.5MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645271C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

BALLOON TREK RX 4.0mm x 12mm

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645286
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

BALLOON TREK RX 4.0mm x 12mm

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645286
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

BALLOON TREK RX 4.0MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645286C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

BALLOON TREK RX 4.0MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645286C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON TREK RX 4.5mm x 12mm

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645291
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BALLOON TREK RX 4.5mm x 12mm

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645291
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

BALLOON TREK RX 5.0MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645293C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

BALLOON TREK RX 5.0MM x 12MM

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645293C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

BALLOON TREX 3.75MM x 06MM

Facility

$400.00

Hospital Charge Code	270645277
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

BALLOON TREX 3.75MM x 06MM

Facility

$400.00

Hospital Charge Code	270645277
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

BALLOON TREX 3.75MM X 08MM

Facility

$400.00

Hospital Charge Code	270645278
Hospital Revenue Code	272
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$200.00
Rate for Payer: Aetna Commercial	$152.00
Rate for Payer: Aetna Medicare Advantage	$120.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$102.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$102.00
Rate for Payer: Cigna Commercial	$200.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.00
Rate for Payer: Oxford Commercial	$80.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00
Rate for Payer: UnitedHealthcare Commercial	$80.00
Rate for Payer: UnitedHealthcare Community & State	$12.64
Rate for Payer: Wellpoint Medicaid Managed Care	$11.36

BALLOON TREX 3.75MM X 08MM

Facility

$400.00

Hospital Charge Code	270645278
Hospital Revenue Code	272
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.00

BALLOON ULTRAVER .035 5X100MM

Facility

$1,150.00

Hospital Charge Code	270671199
Hospital Revenue Code	278
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) NJ Health	$230.00
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	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

BALLOON ULTRAVER .035 5X100MM

Facility

$1,150.00

Hospital Charge Code	270671199
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

BALLOON ULTRAVER .035 5X60MM

Facility

$1,150.00

Hospital Charge Code	270671200
Hospital Revenue Code	278
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) NJ Health	$230.00
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	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50
Rate for Payer: UnitedHealthcare Community & State	$36.34
Rate for Payer: Wellpoint Medicaid Managed Care	$32.66

BALLOON ULTRAVER .035 5X60MM

Facility

$1,150.00

Hospital Charge Code	270671200
Hospital Revenue Code	278
Min. Negotiated Rate	$172.50
Max. Negotiated Rate	$278.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$230.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$278.30
Rate for Payer: Qualcare PPO/HMO/WC	$172.50

BALLOON URO MAX KIT 5MM

Facility

$1,033.25

Hospital Charge Code	270650769
Hospital Revenue Code	272
Min. Negotiated Rate	$154.99
Max. Negotiated Rate	$154.99
Rate for Payer: Qualcare PPO/HMO/WC	$154.99

BALLOON URO MAX KIT 5MM

Facility

$1,033.25

Hospital Charge Code	270650769
Hospital Revenue Code	272
Min. Negotiated Rate	$29.34
Max. Negotiated Rate	$516.62
Rate for Payer: Aetna Commercial	$392.63
Rate for Payer: Aetna Medicare Advantage	$309.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$263.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$263.48
Rate for Payer: Cigna Commercial	$516.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$268.64
Rate for Payer: Oxford Commercial	$206.65
Rate for Payer: Qualcare PPO/HMO/WC	$154.99
Rate for Payer: UnitedHealthcare Commercial	$206.65
Rate for Payer: UnitedHealthcare Community & State	$32.65
Rate for Payer: Wellpoint Medicaid Managed Care	$29.34

BALLOON URO MAX ULTRA 15FR 6cm

Facility

$2,006.20

Hospital Charge Code	270651426
Hospital Revenue Code	272
Min. Negotiated Rate	$56.98
Max. Negotiated Rate	$1,003.10
Rate for Payer: Aetna Commercial	$762.36
Rate for Payer: Aetna Medicare Advantage	$601.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$511.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$511.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$511.58
Rate for Payer: Cigna Commercial	$1,003.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$521.61
Rate for Payer: Oxford Commercial	$401.24
Rate for Payer: Qualcare PPO/HMO/WC	$300.93
Rate for Payer: UnitedHealthcare Commercial	$401.24
Rate for Payer: UnitedHealthcare Community & State	$63.40
Rate for Payer: Wellpoint Medicaid Managed Care	$56.98

BALLOON URO MAX ULTRA 15FR 6cm

Facility

$2,006.20

Hospital Charge Code	270651426
Hospital Revenue Code	272
Min. Negotiated Rate	$300.93
Max. Negotiated Rate	$300.93
Rate for Payer: Qualcare PPO/HMO/WC	$300.93

BALLOON URO MAX ULTRA 24FR 8cm

Facility

$2,182.15

Hospital Charge Code	270651427
Hospital Revenue Code	272
Min. Negotiated Rate	$327.32
Max. Negotiated Rate	$327.32
Rate for Payer: Qualcare PPO/HMO/WC	$327.32

BALLOON URO MAX ULTRA 24FR 8cm

Facility

$2,182.15

Hospital Charge Code	270651427
Hospital Revenue Code	272
Min. Negotiated Rate	$61.97
Max. Negotiated Rate	$1,091.08
Rate for Payer: Aetna Commercial	$829.22
Rate for Payer: Aetna Medicare Advantage	$654.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.45
Rate for Payer: Cigna Commercial	$1,091.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$567.36
Rate for Payer: Oxford Commercial	$436.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.32
Rate for Payer: UnitedHealthcare Commercial	$436.43
Rate for Payer: UnitedHealthcare Community & State	$68.96
Rate for Payer: Wellpoint Medicaid Managed Care	$61.97

Know your out-of-pocket cost for care.

All Charges