Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATH ARMADA 35 PTA 4.0x200x135

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270646618O
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

CATH ARMADA 35 PTA 4.0x200x135

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646618S
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

CATH ARMADA 35 PTA 4.0x200x135

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270646618C
Hospital Revenue Code	278
Min. Negotiated Rate	$187.50
Max. Negotiated Rate	$302.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50

CATH ARMADA 35 PTA 4.0x200x135

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646618
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

CATH ARMADA 35 PTA 4.0x200x135

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270646618C
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

CATH ARMADA 35 PTA 4.0x200x135

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646618S
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

CATH ARMADA 35 PTA 4.0x200x135

Facility

$1,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270646618O
Hospital Revenue Code	278
Min. Negotiated Rate	$35.50
Max. Negotiated Rate	$625.00
Rate for Payer: Aetna Commercial	$475.00
Rate for Payer: Aetna Medicare Advantage	$375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.75
Rate for Payer: Cigna Commercial	$625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.50
Rate for Payer: Qualcare PPO/HMO/WC	$187.50
Rate for Payer: UnitedHealthcare Community & State	$39.50
Rate for Payer: Wellpoint Medicaid Managed Care	$35.50

CATH ARMADA 35 PTA 4.0x250x135

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646619
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

CATH ARMADA 35 PTA 4.0x250x135

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270646619
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

CATH ARMADA 35 PTA 4.0x40x135

Facility

$775.00

Service Code	HCPCS C1725
Hospital Charge Code	270647085C
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CATH ARMADA 35 PTA 4.0x40x135

Facility

$775.00

Service Code	HCPCS C1725
Hospital Charge Code	270647085C
Hospital Revenue Code	278
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$22.01

CATH ARMADA 35 PTA 4.0x60x135

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270662394
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

CATH ARMADA 35 PTA 4.0x60x135

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270662394
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

CATH ARMADA 35 PTA 4.0x80x135

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647086
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

CATH ARMADA 35 PTA 4.0x80x135

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647086
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

CATH ARMADA 35 PTA 4x120x135

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647088
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

CATH ARMADA 35 PTA 4x120x135

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647088
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

CATH ARMADA 35PTA 4X20MM 80CM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647312
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

CATH ARMADA 35PTA 4X20MM 80CM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647312
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

CATH ARMADA 35 PTA 4X20MMX80CM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647321S
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

CATH ARMADA 35 PTA 4X20MMX80CM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647321S
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

CATH ARMADA 35 PTA 4X20MMX80CM

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270647321O
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$423.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50

CATH ARMADA 35 PTA 4X20MMX80CM

Facility

$1,750.00

Service Code	HCPCS C1725
Hospital Charge Code	270647321O
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$875.00
Rate for Payer: Aetna Commercial	$665.00
Rate for Payer: Aetna Medicare Advantage	$525.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$446.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$446.25
Rate for Payer: Cigna Commercial	$875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.50
Rate for Payer: Qualcare PPO/HMO/WC	$262.50
Rate for Payer: UnitedHealthcare Community & State	$55.30
Rate for Payer: Wellpoint Medicaid Managed Care	$49.70

CATH ARMADA 35 PTA 4X20MMX80CM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647321C
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

CATH ARMADA 35 PTA 4X20MMX80CM

Facility

$625.00

Service Code	HCPCS C1725
Hospital Charge Code	270647321C
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

Know your out-of-pocket cost for care.

All Charges