Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER OTW SPLIT 5913230

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418N
Hospital Revenue Code	278
Min. Negotiated Rate	$54.67
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Community & State	$60.83
Rate for Payer: Wellpoint Medicaid Managed Care	$54.67

CATHETER OTW SPLIT 5913230

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418N
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418S
Hospital Revenue Code	278
Min. Negotiated Rate	$49.84
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$666.90
Rate for Payer: Aetna Medicare Advantage	$526.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$447.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$447.52
Rate for Payer: Cigna Commercial	$877.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25
Rate for Payer: UnitedHealthcare Community & State	$55.46
Rate for Payer: Wellpoint Medicaid Managed Care	$49.84

CATHETER OTW SPLIT 5913230

Facility

$1,755.00

Service Code	HCPCS C1750
Hospital Charge Code	270661418S
Hospital Revenue Code	278
Min. Negotiated Rate	$263.25
Max. Negotiated Rate	$424.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$351.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$424.71
Rate for Payer: Qualcare PPO/HMO/WC	$263.25

CATHETER OTW XK 27CM SPLIT

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404N
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$465.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATHETER OTW XK 27CM SPLIT

Facility

$1,925.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404N
Hospital Revenue Code	278
Min. Negotiated Rate	$54.67
Max. Negotiated Rate	$962.50
Rate for Payer: Aetna Commercial	$731.50
Rate for Payer: Aetna Medicare Advantage	$577.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$490.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$385.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$490.88
Rate for Payer: Cigna Commercial	$962.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$465.85
Rate for Payer: Qualcare PPO/HMO/WC	$288.75
Rate for Payer: UnitedHealthcare Community & State	$60.83
Rate for Payer: Wellpoint Medicaid Managed Care	$54.67

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404S
Hospital Revenue Code	278
Min. Negotiated Rate	$273.75
Max. Negotiated Rate	$441.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404
Hospital Revenue Code	278
Min. Negotiated Rate	$51.83
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Community & State	$57.67
Rate for Payer: Wellpoint Medicaid Managed Care	$51.83

CATHETER OTW XK 27CM SPLIT

Facility

$1,825.00

Service Code	HCPCS C1750
Hospital Charge Code	270661404S
Hospital Revenue Code	278
Min. Negotiated Rate	$51.83
Max. Negotiated Rate	$912.50
Rate for Payer: Aetna Commercial	$693.50
Rate for Payer: Aetna Medicare Advantage	$547.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$465.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$365.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$465.38
Rate for Payer: Cigna Commercial	$912.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$441.65
Rate for Payer: Qualcare PPO/HMO/WC	$273.75
Rate for Payer: UnitedHealthcare Community & State	$57.67
Rate for Payer: Wellpoint Medicaid Managed Care	$51.83

CATHETER PALINDRONE DIALY 19CM

Facility

$2,183.60

Hospital Charge Code	270669446
Hospital Revenue Code	278
Min. Negotiated Rate	$327.54
Max. Negotiated Rate	$528.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54

CATHETER PALINDRONE DIALY 19CM

Facility

$2,183.60

Hospital Charge Code	270669446
Hospital Revenue Code	278
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$1,091.80
Rate for Payer: Aetna Commercial	$829.77
Rate for Payer: Aetna Medicare Advantage	$655.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.82
Rate for Payer: Cigna Commercial	$1,091.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54
Rate for Payer: UnitedHealthcare Community & State	$69.00
Rate for Payer: Wellpoint Medicaid Managed Care	$62.01

CATHETER PALINDRONE DIALY 23CM

Facility

$2,183.60

Hospital Charge Code	270669447
Hospital Revenue Code	278
Min. Negotiated Rate	$327.54
Max. Negotiated Rate	$528.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54

CATHETER PALINDRONE DIALY 23CM

Facility

$2,183.60

Hospital Charge Code	270669447
Hospital Revenue Code	278
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$1,091.80
Rate for Payer: Aetna Commercial	$829.77
Rate for Payer: Aetna Medicare Advantage	$655.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.82
Rate for Payer: Cigna Commercial	$1,091.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54
Rate for Payer: UnitedHealthcare Community & State	$69.00
Rate for Payer: Wellpoint Medicaid Managed Care	$62.01

CATHETER PALINDRONE DIALY 28CM

Facility

$2,183.60

Hospital Charge Code	270669448
Hospital Revenue Code	278
Min. Negotiated Rate	$62.01
Max. Negotiated Rate	$1,091.80
Rate for Payer: Aetna Commercial	$829.77
Rate for Payer: Aetna Medicare Advantage	$655.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$556.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$556.82
Rate for Payer: Cigna Commercial	$1,091.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54
Rate for Payer: UnitedHealthcare Community & State	$69.00
Rate for Payer: Wellpoint Medicaid Managed Care	$62.01

CATHETER PALINDRONE DIALY 28CM

Facility

$2,183.60

Hospital Charge Code	270669448
Hospital Revenue Code	278
Min. Negotiated Rate	$327.54
Max. Negotiated Rate	$528.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$436.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$528.43
Rate for Payer: Qualcare PPO/HMO/WC	$327.54

CATHETER PASSER

Facility

$72.00

Hospital Charge Code	270335598
Hospital Revenue Code	272
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$27.36
Rate for Payer: Aetna Medicare Advantage	$21.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$18.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$18.36
Rate for Payer: Cigna Commercial	$36.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.72
Rate for Payer: Oxford Commercial	$14.40
Rate for Payer: Qualcare PPO/HMO/WC	$10.80
Rate for Payer: UnitedHealthcare Commercial	$14.40
Rate for Payer: UnitedHealthcare Community & State	$2.28
Rate for Payer: Wellpoint Medicaid Managed Care	$2.04

CATHETER PASSER

Facility

$72.00

Hospital Charge Code	270335598
Hospital Revenue Code	272
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$10.80

CATHETER PASSER 36CM

Facility

$119.00

Hospital Charge Code	270335606
Hospital Revenue Code	272
Min. Negotiated Rate	$3.38
Max. Negotiated Rate	$59.50
Rate for Payer: Aetna Commercial	$45.22
Rate for Payer: Aetna Medicare Advantage	$35.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.34
Rate for Payer: Cigna Commercial	$59.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$30.94
Rate for Payer: Oxford Commercial	$23.80
Rate for Payer: Qualcare PPO/HMO/WC	$17.85
Rate for Payer: UnitedHealthcare Commercial	$23.80
Rate for Payer: UnitedHealthcare Community & State	$3.76
Rate for Payer: Wellpoint Medicaid Managed Care	$3.38

CATHETER PASSER 36CM

Facility

$119.00

Hospital Charge Code	270335606
Hospital Revenue Code	272
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$17.85
Rate for Payer: Qualcare PPO/HMO/WC	$17.85

CATHETER PASSER 38CM

Facility

$490.00

Hospital Charge Code	270691735
Hospital Revenue Code	272
Min. Negotiated Rate	$73.50
Max. Negotiated Rate	$73.50
Rate for Payer: Qualcare PPO/HMO/WC	$73.50

CATHETER PASSER 38CM

Facility

$490.00

Hospital Charge Code	270691735
Hospital Revenue Code	272
Min. Negotiated Rate	$13.92
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial	$186.20
Rate for Payer: Aetna Medicare Advantage	$147.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.95
Rate for Payer: Cigna Commercial	$245.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.40
Rate for Payer: Oxford Commercial	$98.00
Rate for Payer: Qualcare PPO/HMO/WC	$73.50
Rate for Payer: UnitedHealthcare Commercial	$98.00
Rate for Payer: UnitedHealthcare Community & State	$15.48
Rate for Payer: Wellpoint Medicaid Managed Care	$13.92

CATHETER PASSER 55CM.

Facility

$142.00

Hospital Charge Code	270335605
Hospital Revenue Code	272
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$71.00
Rate for Payer: Aetna Commercial	$53.96
Rate for Payer: Aetna Medicare Advantage	$42.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$36.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$36.21
Rate for Payer: Cigna Commercial	$71.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$36.92
Rate for Payer: Oxford Commercial	$28.40
Rate for Payer: Qualcare PPO/HMO/WC	$21.30
Rate for Payer: UnitedHealthcare Commercial	$28.40
Rate for Payer: UnitedHealthcare Community & State	$4.49
Rate for Payer: Wellpoint Medicaid Managed Care	$4.03

CATHETER PASSER 55CM.

Facility

$142.00

Hospital Charge Code	270335605
Hospital Revenue Code	272
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$21.30
Rate for Payer: Qualcare PPO/HMO/WC	$21.30

CATHETER PEAR SHAPED

Facility

$8,250.00

Service Code	HCPCS C1886
Hospital Charge Code	270682728
Hospital Revenue Code	278
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$4,125.00
Rate for Payer: Aetna Commercial	$3,135.00
Rate for Payer: Aetna Medicare Advantage	$2,475.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,103.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,650.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,103.75
Rate for Payer: Cigna Commercial	$4,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,996.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,237.50
Rate for Payer: UnitedHealthcare Community & State	$260.70
Rate for Payer: Wellpoint Medicaid Managed Care	$234.30

Know your out-of-pocket cost for care.

All Charges