Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATH BALLN 5/40/80 050040080

Facility

$700.00

Hospital Charge Code	270661866
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATH BALLN 6/80/80 ADM60080080

Facility

$700.00

Hospital Charge Code	270661863
Hospital Revenue Code	272
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$182.00
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Commercial	$140.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CATH BALLN 6/80/80 ADM60080080

Facility

$700.00

Hospital Charge Code	270661863
Hospital Revenue Code	272
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$105.00
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATH BALLN ADM 050250130

Facility

$1,472.50

Hospital Charge Code	270658392
Hospital Revenue Code	272
Min. Negotiated Rate	$220.88
Max. Negotiated Rate	$220.88
Rate for Payer: Qualcare PPO/HMO/WC	$220.88

CATH BALLN ADM 050250130

Facility

$1,472.50

Hospital Charge Code	270658392
Hospital Revenue Code	272
Min. Negotiated Rate	$41.82
Max. Negotiated Rate	$736.25
Rate for Payer: Aetna Commercial	$559.55
Rate for Payer: Aetna Medicare Advantage	$441.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$375.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$375.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$375.49
Rate for Payer: Cigna Commercial	$736.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$382.85
Rate for Payer: Oxford Commercial	$294.50
Rate for Payer: Qualcare PPO/HMO/WC	$220.88
Rate for Payer: UnitedHealthcare Commercial	$294.50
Rate for Payer: UnitedHealthcare Community & State	$46.53
Rate for Payer: Wellpoint Medicaid Managed Care	$41.82

CATH BALLN ADM EXTRM 5/150/130

Facility

$1,092.50

Service Code	HCPCS C1725
Hospital Charge Code	270658390
Hospital Revenue Code	278
Min. Negotiated Rate	$163.88
Max. Negotiated Rate	$264.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.38
Rate for Payer: Qualcare PPO/HMO/WC	$163.88

CATH BALLN ADM EXTRM 5/150/130

Facility

$1,092.50

Service Code	HCPCS C1725
Hospital Charge Code	270658390
Hospital Revenue Code	278
Min. Negotiated Rate	$31.03
Max. Negotiated Rate	$546.25
Rate for Payer: Aetna Commercial	$415.15
Rate for Payer: Aetna Medicare Advantage	$327.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$278.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$278.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$218.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$278.59
Rate for Payer: Cigna Commercial	$546.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$264.38
Rate for Payer: Qualcare PPO/HMO/WC	$163.88
Rate for Payer: UnitedHealthcare Community & State	$34.52
Rate for Payer: Wellpoint Medicaid Managed Care	$31.03

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518C
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518C
Hospital Revenue Code	278
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Community & State	$120.87
Rate for Payer: Wellpoint Medicaid Managed Care	$108.63

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518S
Hospital Revenue Code	278
Min. Negotiated Rate	$573.75
Max. Negotiated Rate	$925.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518S
Hospital Revenue Code	278
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Community & State	$120.87
Rate for Payer: Wellpoint Medicaid Managed Care	$108.63

CATH BALLN CHOCOLATE 2.5X40CM

Facility

$3,825.00

Service Code	HCPCS C1725
Hospital Charge Code	270687518
Hospital Revenue Code	278
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$1,912.50
Rate for Payer: Aetna Commercial	$1,453.50
Rate for Payer: Aetna Medicare Advantage	$1,147.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$975.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$765.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$975.38
Rate for Payer: Cigna Commercial	$1,912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$925.65
Rate for Payer: Qualcare PPO/HMO/WC	$573.75
Rate for Payer: UnitedHealthcare Community & State	$120.87
Rate for Payer: Wellpoint Medicaid Managed Care	$108.63

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CATH BALLN CHOCOLATE 3.5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685242N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241N
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CATH BALLN CHOCOLATE 5X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685241N
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

CATH BALLN CHOCOLATE 6X120

Facility

$5,250.00

Service Code	HCPCS C1725
Hospital Charge Code	270685243
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

CATH BALLON AMPHN 1 5/20/150

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270657934
Hospital Revenue Code	278
Min. Negotiated Rate	$242.25
Max. Negotiated Rate	$390.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25

CATH BALLON AMPHN 1 5/20/150

Facility

$1,615.00

Service Code	HCPCS C1725
Hospital Charge Code	270657934
Hospital Revenue Code	278
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$807.50
Rate for Payer: Aetna Commercial	$613.70
Rate for Payer: Aetna Medicare Advantage	$484.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$411.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$323.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$411.82
Rate for Payer: Cigna Commercial	$807.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$390.83
Rate for Payer: Qualcare PPO/HMO/WC	$242.25
Rate for Payer: UnitedHealthcare Community & State	$51.03
Rate for Payer: Wellpoint Medicaid Managed Care	$45.87

Know your out-of-pocket cost for care.

All Charges