Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER,INFUSION,O/THAN HEMO

Facility

$21.40

Service Code	HCPCS C1751
Hospital Charge Code	4800910
Hospital Revenue Code	278
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$10.70
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare Advantage	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.46
Rate for Payer: Cigna Commercial	$10.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.61

CATHETER,INFUSION,O/THAN HEMO

Facility

$21.40

Service Code	HCPCS C1751
Hospital Charge Code	4800910
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060S
Hospital Revenue Code	272
Min. Negotiated Rate	$396.89
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$5,310.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,633.50
Rate for Payer: Oxford Commercial	$2,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Commercial	$2,795.00
Rate for Payer: UnitedHealthcare Community & State	$441.61
Rate for Payer: Wellpoint Medicaid Managed Care	$396.89

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060
Hospital Revenue Code	272
Min. Negotiated Rate	$396.89
Max. Negotiated Rate	$6,987.50
Rate for Payer: Aetna Commercial	$5,310.50
Rate for Payer: Aetna Medicare Advantage	$4,192.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,563.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,563.62
Rate for Payer: Cigna Commercial	$6,987.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,633.50
Rate for Payer: Oxford Commercial	$2,795.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Commercial	$2,795.00
Rate for Payer: UnitedHealthcare Community & State	$441.61
Rate for Payer: Wellpoint Medicaid Managed Care	$396.89

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060
Hospital Revenue Code	272
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$2,096.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER JET 7 REPERFUTION TUB

Facility

$13,975.00

Hospital Charge Code	270685060S
Hospital Revenue Code	272
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$2,096.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977S
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JETSTREAM G3 SF 1.85

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270661977N
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857N
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857S
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC 2.1/3MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270643857N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,418.75
Max. Negotiated Rate	$3,902.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75

CATHETER JETSTREAM XC, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519S
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JETSTREAM XC, 2.4MM

Facility

$16,125.00

Service Code	HCPCS C1724
Hospital Charge Code	270647519N
Hospital Revenue Code	278
Min. Negotiated Rate	$457.95
Max. Negotiated Rate	$8,062.50
Rate for Payer: Aetna Commercial	$6,127.50
Rate for Payer: Aetna Medicare Advantage	$4,837.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,111.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,111.88
Rate for Payer: Cigna Commercial	$8,062.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,902.25
Rate for Payer: Qualcare PPO/HMO/WC	$2,418.75
Rate for Payer: UnitedHealthcare Community & State	$509.55
Rate for Payer: Wellpoint Medicaid Managed Care	$457.95

CATHETER JL6.0 6FR/100CM/.035

Facility

$37.35

Service Code	HCPCS C1887
Hospital Charge Code	270658052
Hospital Revenue Code	278
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$18.68
Rate for Payer: Aetna Commercial	$14.19
Rate for Payer: Aetna Medicare Advantage	$11.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.52
Rate for Payer: Cigna Commercial	$18.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$5.60
Rate for Payer: UnitedHealthcare Community & State	$1.18
Rate for Payer: Wellpoint Medicaid Managed Care	$1.06

CATHETER JL6.0 6FR/100CM/.035

Facility

$37.35

Service Code	HCPCS C1887
Hospital Charge Code	270658052
Hospital Revenue Code	278
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$5.60

CATHETER JL6.0 6FR/100CM/.035

Facility

$37.35

Service Code	HCPCS C1887
Hospital Charge Code	270658022
Hospital Revenue Code	278
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$9.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.47
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.04
Rate for Payer: Qualcare PPO/HMO/WC	$5.60

Know your out-of-pocket cost for care.

All Charges