Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BALN SPRT RX4.0x06 NCSP4006X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651227C
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

BALN SPRT RX4.0x09 NCSP4009X

Facility

$525.00

Service Code	HCPCS C1725
Hospital Charge Code	270651228C
Hospital Revenue Code	278
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$127.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75

BALN SPRT RX4.0x09 NCSP4009X

Facility

$525.00

Service Code	HCPCS C1725
Hospital Charge Code	270651228C
Hospital Revenue Code	278
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$262.50
Rate for Payer: Aetna Commercial	$199.50
Rate for Payer: Aetna Medicare Advantage	$157.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$133.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$133.88
Rate for Payer: Cigna Commercial	$262.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.05
Rate for Payer: Qualcare PPO/HMO/WC	$78.75
Rate for Payer: UnitedHealthcare Community & State	$16.59
Rate for Payer: Wellpoint Medicaid Managed Care	$14.91

BALN SPRT RX4.0x12 NCSP4012X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651229C
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

BALN SPRT RX4.0x12 NCSP4012X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651229C
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

BALN SPRT RX4.0x15 NCSP4015X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651230C
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

BALN SPRT RX4.0x15 NCSP4015X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651230C
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

BALN SPRT RX4.0x21 NCSP4021X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651231C
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

BALN SPRT RX4.0x21 NCSP4021X

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270651231C
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

BALN SPRT RX4.0x27 NCSP4027X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651232C
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

BALN SPRT RX4.0x27 NCSP4027X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651232C
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

BALN SPRT RX4.5x15 NCSP4515X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651233C
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

BALN SPRT RX4.5x15 NCSP4515X

Facility

$750.00

Service Code	HCPCS C1725
Hospital Charge Code	270651233C
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

BALN TREK RX 2 25x15 101227115

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645233
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

BALN TREK RX 2 25x15 101227115

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645233
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

BALN TREK RX 275x12 101227312

Facility

$500.00

Hospital Charge Code	270645246
Hospital Revenue Code	272
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) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.00
Rate for Payer: Oxford Commercial	$100.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Commercial	$100.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

BALN TREK RX 275x12 101227312

Facility

$500.00

Hospital Charge Code	270645246
Hospital Revenue Code	272
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

BALO ANGIOP CTR DIALYSIS SEG

Facility

$17,243.71

Service Code	HCPCS 36907
Hospital Charge Code	16000640
Hospital Revenue Code	360
Min. Negotiated Rate	$2,586.56
Max. Negotiated Rate	$2,586.56
Rate for Payer: Qualcare PPO/HMO/WC	$2,586.56

BALO ANGIOP CTR DIALYSIS SEG

Facility

$17,243.71

Service Code	HCPCS 36907
Hospital Charge Code	16000640
Hospital Revenue Code	360
Min. Negotiated Rate	$489.72
Max. Negotiated Rate	$8,621.85
Rate for Payer: Aetna Commercial	$6,552.61
Rate for Payer: Aetna Medicare Advantage	$5,173.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,397.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,397.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,397.15
Rate for Payer: Cigna Commercial	$8,621.85
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,483.36
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,586.56
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$544.90
Rate for Payer: Wellpoint Medicaid Managed Care	$489.72

BALOON DRUG COATED

Facility

$17,125.00

Hospital Charge Code	270703596
Hospital Revenue Code	278
Min. Negotiated Rate	$486.35
Max. Negotiated Rate	$8,562.50
Rate for Payer: Aetna Commercial	$6,507.50
Rate for Payer: Aetna Medicare Advantage	$5,137.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,366.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,425.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,366.88
Rate for Payer: Cigna Commercial	$8,562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,144.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75
Rate for Payer: UnitedHealthcare Community & State	$541.15
Rate for Payer: Wellpoint Medicaid Managed Care	$486.35

BALOON DRUG COATED

Facility

$17,125.00

Hospital Charge Code	270703596
Hospital Revenue Code	278
Min. Negotiated Rate	$2,568.75
Max. Negotiated Rate	$4,144.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,144.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,568.75

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3046M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$43.96
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$588.24
Rate for Payer: Aetna Medicare Advantage	$464.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$394.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$394.74
Rate for Payer: Cigna Commercial	$774.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$402.48
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$232.20
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$48.92
Rate for Payer: Wellpoint Medicaid Managed Care	$43.96

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3080M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

$2,250.00

Service Code	HCPCS M0245
Hospital Charge Code	3020M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$1,125.00
Rate for Payer: Aetna Commercial	$855.00
Rate for Payer: Aetna Medicare Advantage	$675.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$573.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$573.75
Rate for Payer: Cigna Commercial	$1,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$585.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$337.50
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$71.10
Rate for Payer: Wellpoint Medicaid Managed Care	$63.90

BAMLAN+ETESEVIMAB INFUS&MONITR

Facility

$1,548.00

Service Code	HCPCS M0245
Hospital Charge Code	3049M0245
Hospital Revenue Code	771
Min. Negotiated Rate	$232.20
Max. Negotiated Rate	$232.20
Rate for Payer: Qualcare PPO/HMO/WC	$232.20

Know your out-of-pocket cost for care.

All Charges