Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

CATH EMBOLECT 3FR 120803F

Facility

$250.00

Service Code	HCPCS C1757
Hospital Charge Code	270600372S
Hospital Revenue Code	278
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$60.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

CATH EMBOLECT 4FR 120804F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600371
Hospital Revenue Code	278
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$156.75
Rate for Payer: Aetna Commercial	$119.13
Rate for Payer: Aetna Medicare Advantage	$94.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.94
Rate for Payer: Cigna Commercial	$156.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.87
Rate for Payer: Qualcare PPO/HMO/WC	$47.02
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: Wellpoint Medicaid Managed Care	$8.90

CATH EMBOLECT 4FR 120804F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600371
Hospital Revenue Code	278
Min. Negotiated Rate	$47.02
Max. Negotiated Rate	$75.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.87
Rate for Payer: Qualcare PPO/HMO/WC	$47.02

CATH EMBOLECT 5FR 120805F

Facility

$343.85

Service Code	HCPCS C1757
Hospital Charge Code	270600383
Hospital Revenue Code	278
Min. Negotiated Rate	$51.58
Max. Negotiated Rate	$83.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.21
Rate for Payer: Qualcare PPO/HMO/WC	$51.58

CATH EMBOLECT 5FR 120805F

Facility

$343.85

Service Code	HCPCS C1757
Hospital Charge Code	270600383
Hospital Revenue Code	278
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$171.93
Rate for Payer: Aetna Commercial	$130.66
Rate for Payer: Aetna Medicare Advantage	$103.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$68.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.68
Rate for Payer: Cigna Commercial	$171.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.21
Rate for Payer: Qualcare PPO/HMO/WC	$51.58
Rate for Payer: UnitedHealthcare Community & State	$10.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.77

CATH EMBOLECT 6FR 120806F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600384
Hospital Revenue Code	278
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$156.75
Rate for Payer: Aetna Commercial	$119.13
Rate for Payer: Aetna Medicare Advantage	$94.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$79.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$79.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$79.94
Rate for Payer: Cigna Commercial	$156.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.87
Rate for Payer: Qualcare PPO/HMO/WC	$47.02
Rate for Payer: UnitedHealthcare Community & State	$9.91
Rate for Payer: Wellpoint Medicaid Managed Care	$8.90

CATH EMBOLECT 6FR 120806F

Facility

$313.50

Service Code	HCPCS C1757
Hospital Charge Code	270600384
Hospital Revenue Code	278
Min. Negotiated Rate	$47.02
Max. Negotiated Rate	$75.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$62.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$75.87
Rate for Payer: Qualcare PPO/HMO/WC	$47.02

CATH EMBOLECT D6 50CM 160246F

Facility

$2,493.65

Service Code	HCPCS C1757
Hospital Charge Code	270601078
Hospital Revenue Code	278
Min. Negotiated Rate	$70.82
Max. Negotiated Rate	$1,246.83
Rate for Payer: Aetna Commercial	$947.59
Rate for Payer: Aetna Medicare Advantage	$748.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$635.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$635.88
Rate for Payer: Cigna Commercial	$1,246.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.46
Rate for Payer: Qualcare PPO/HMO/WC	$374.05
Rate for Payer: UnitedHealthcare Community & State	$78.80
Rate for Payer: Wellpoint Medicaid Managed Care	$70.82

CATH EMBOLECT D6 50CM 160246F

Facility

$2,493.65

Service Code	HCPCS C1757
Hospital Charge Code	270601078
Hospital Revenue Code	278
Min. Negotiated Rate	$374.05
Max. Negotiated Rate	$603.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$498.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$603.46
Rate for Payer: Qualcare PPO/HMO/WC	$374.05

CATH EMBOLECT FOGARTY 4FR 40cm

Facility

$272.90

Hospital Charge Code	270651780
Hospital Revenue Code	272
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$136.45
Rate for Payer: Aetna Commercial	$103.70
Rate for Payer: Aetna Medicare Advantage	$81.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$69.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$69.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$69.59
Rate for Payer: Cigna Commercial	$136.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.95
Rate for Payer: Oxford Commercial	$54.58
Rate for Payer: Qualcare PPO/HMO/WC	$40.94
Rate for Payer: UnitedHealthcare Commercial	$54.58
Rate for Payer: UnitedHealthcare Community & State	$8.62
Rate for Payer: Wellpoint Medicaid Managed Care	$7.75

CATH EMBOLECT FOGARTY 4FR 40cm

Facility

$272.90

Hospital Charge Code	270651780
Hospital Revenue Code	272
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$40.94
Rate for Payer: Qualcare PPO/HMO/WC	$40.94

CATH EMBOLECTMY 3F 6x80 165138

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631115
Hospital Revenue Code	278
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$147.04
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04
Rate for Payer: UnitedHealthcare Community & State	$12.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.99

CATH EMBOLECTMY 3F 6x80 165138

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631115
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLECT PYTH 4F 5MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698568
Hospital Revenue Code	278
Min. Negotiated Rate	$28.26
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$378.10
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25
Rate for Payer: UnitedHealthcare Community & State	$31.44
Rate for Payer: Wellpoint Medicaid Managed Care	$28.26

CATH EMBOLECT PYTH 4F 5MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698568
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 5F11MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698570
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 5F11MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698570
Hospital Revenue Code	278
Min. Negotiated Rate	$28.26
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$378.10
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25
Rate for Payer: UnitedHealthcare Community & State	$31.44
Rate for Payer: Wellpoint Medicaid Managed Care	$28.26

CATH EMBOLECT PYTH 5F 9MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698569
Hospital Revenue Code	278
Min. Negotiated Rate	$149.25
Max. Negotiated Rate	$240.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25

CATH EMBOLECT PYTH 5F 9MMX40CM

Facility

$995.00

Service Code	HCPCS C1757
Hospital Charge Code	270698569
Hospital Revenue Code	278
Min. Negotiated Rate	$28.26
Max. Negotiated Rate	$497.50
Rate for Payer: Aetna Commercial	$378.10
Rate for Payer: Aetna Medicare Advantage	$298.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$253.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$199.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$253.72
Rate for Payer: Cigna Commercial	$497.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$240.79
Rate for Payer: Qualcare PPO/HMO/WC	$149.25
Rate for Payer: UnitedHealthcare Community & State	$31.44
Rate for Payer: Wellpoint Medicaid Managed Care	$28.26

CATH EMBOLTOMY 4F 10x80 165148

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631117
Hospital Revenue Code	278
Min. Negotiated Rate	$58.04
Max. Negotiated Rate	$93.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04

CATH EMBOLTOMY 4F 10x80 165148

Facility

$386.95

Service Code	HCPCS C1757
Hospital Charge Code	270631117
Hospital Revenue Code	278
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$193.47
Rate for Payer: Aetna Commercial	$147.04
Rate for Payer: Aetna Medicare Advantage	$116.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$98.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$77.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$98.67
Rate for Payer: Cigna Commercial	$193.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$93.64
Rate for Payer: Qualcare PPO/HMO/WC	$58.04
Rate for Payer: UnitedHealthcare Community & State	$12.23
Rate for Payer: Wellpoint Medicaid Managed Care	$10.99

CATH EPIDURAL 19G CLOSED TIP

Facility

$1,322.00

Hospital Charge Code	270676362
Hospital Revenue Code	272
Min. Negotiated Rate	$198.30
Max. Negotiated Rate	$198.30
Rate for Payer: Qualcare PPO/HMO/WC	$198.30

Know your out-of-pocket cost for care.

All Charges