Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER RED72KIT TUBING

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693923C
Hospital Revenue Code	278
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) NJ Health	$2,795.00
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	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Community & State	$441.61
Rate for Payer: Wellpoint Medicaid Managed Care	$396.89

CATHETER RED72KIT TUBING

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693923C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER REPERFUSION 3MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682973N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATHETER REPERFUSION 3MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682973
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATHETER REPERFUSION 3MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682973
Hospital Revenue Code	278
Min. Negotiated Rate	$211.58
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$235.42
Rate for Payer: Wellpoint Medicaid Managed Care	$211.58

CATHETER REPERFUSION 3MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682973N
Hospital Revenue Code	278
Min. Negotiated Rate	$211.58
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$235.42
Rate for Payer: Wellpoint Medicaid Managed Care	$211.58

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972
Hospital Revenue Code	278
Min. Negotiated Rate	$211.58
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$235.42
Rate for Payer: Wellpoint Medicaid Managed Care	$211.58

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$1,802.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50

CATHETER REPERFUSION 4MAX

Facility

$7,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682972N
Hospital Revenue Code	278
Min. Negotiated Rate	$211.58
Max. Negotiated Rate	$3,725.00
Rate for Payer: Aetna Commercial	$2,831.00
Rate for Payer: Aetna Medicare Advantage	$2,235.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,899.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,490.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,899.75
Rate for Payer: Cigna Commercial	$3,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,802.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,117.50
Rate for Payer: UnitedHealthcare Community & State	$235.42
Rate for Payer: Wellpoint Medicaid Managed Care	$211.58

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971N
Hospital Revenue Code	278
Min. Negotiated Rate	$325.18
Max. Negotiated Rate	$5,725.00
Rate for Payer: Aetna Commercial	$4,351.00
Rate for Payer: Aetna Medicare Advantage	$3,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,919.75
Rate for Payer: Cigna Commercial	$5,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50
Rate for Payer: UnitedHealthcare Community & State	$361.82
Rate for Payer: Wellpoint Medicaid Managed Care	$325.18

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971
Hospital Revenue Code	278
Min. Negotiated Rate	$325.18
Max. Negotiated Rate	$5,725.00
Rate for Payer: Aetna Commercial	$4,351.00
Rate for Payer: Aetna Medicare Advantage	$3,435.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,919.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,919.75
Rate for Payer: Cigna Commercial	$5,725.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50
Rate for Payer: UnitedHealthcare Community & State	$361.82
Rate for Payer: Wellpoint Medicaid Managed Care	$325.18

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.50
Max. Negotiated Rate	$2,770.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50

CATHETER REPERFUSION ACE132

Facility

$11,450.00

Service Code	HCPCS C1725
Hospital Charge Code	270682971
Hospital Revenue Code	278
Min. Negotiated Rate	$1,717.50
Max. Negotiated Rate	$2,770.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,290.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,770.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,717.50

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970N
Hospital Revenue Code	278
Min. Negotiated Rate	$339.38
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$377.62
Rate for Payer: Wellpoint Medicaid Managed Care	$339.38

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION ACE64

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682970
Hospital Revenue Code	278
Min. Negotiated Rate	$339.38
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$377.62
Rate for Payer: Wellpoint Medicaid Managed Care	$339.38

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969N
Hospital Revenue Code	278
Min. Negotiated Rate	$339.38
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$377.62
Rate for Payer: Wellpoint Medicaid Managed Care	$339.38

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969
Hospital Revenue Code	278
Min. Negotiated Rate	$339.38
Max. Negotiated Rate	$5,975.00
Rate for Payer: Aetna Commercial	$4,541.00
Rate for Payer: Aetna Medicare Advantage	$3,585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,047.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,047.25
Rate for Payer: Cigna Commercial	$5,975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50
Rate for Payer: UnitedHealthcare Community & State	$377.62
Rate for Payer: Wellpoint Medicaid Managed Care	$339.38

CATHETER REPERFUSION ACE68

Facility

$11,950.00

Service Code	HCPCS C1725
Hospital Charge Code	270682969
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.50
Max. Negotiated Rate	$2,891.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,390.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,891.90
Rate for Payer: Qualcare PPO/HMO/WC	$1,792.50

CATHETER REPERFUSION RED68

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693922S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

CATHETER REPERFUSION RED68

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693922
Hospital Revenue Code	278
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) NJ Health	$2,795.00
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	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25
Rate for Payer: UnitedHealthcare Community & State	$441.61
Rate for Payer: Wellpoint Medicaid Managed Care	$396.89

CATHETER REPERFUSION RED68

Facility

$13,975.00

Service Code	HCPCS C1757
Hospital Charge Code	270693922
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.25
Max. Negotiated Rate	$3,381.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,381.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,096.25

Know your out-of-pocket cost for care.

All Charges