Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

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

CATHETER REPERF ZOOM 055 137CM

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694792S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.75
Max. Negotiated Rate	$3,006.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,006.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.75

CATHETER REPERF ZOOM 055 137CM

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694792S
Hospital Revenue Code	278
Min. Negotiated Rate	$352.87
Max. Negotiated Rate	$6,212.50
Rate for Payer: Aetna Commercial	$4,721.50
Rate for Payer: Aetna Medicare Advantage	$3,727.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,168.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,168.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,168.38
Rate for Payer: Cigna Commercial	$6,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,006.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.75
Rate for Payer: UnitedHealthcare Community & State	$392.63
Rate for Payer: Wellpoint Medicaid Managed Care	$352.87

CATHETER REPERF ZOOM 071 137CM

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694789S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,863.75
Max. Negotiated Rate	$3,006.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,485.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,006.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.75

CATHETER REPERF ZOOM 071 137CM

Facility

$12,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694789S
Hospital Revenue Code	278
Min. Negotiated Rate	$352.87
Max. Negotiated Rate	$6,212.50
Rate for Payer: Aetna Commercial	$4,721.50
Rate for Payer: Aetna Medicare Advantage	$3,727.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,168.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,168.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,485.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,168.38
Rate for Payer: Cigna Commercial	$6,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,006.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,863.75
Rate for Payer: UnitedHealthcare Community & State	$392.63
Rate for Payer: Wellpoint Medicaid Managed Care	$352.87

CATHETER REPERF ZOOM 35 160CM

Facility

$8,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694791S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,263.75
Max. Negotiated Rate	$2,038.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,685.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,038.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,263.75

CATHETER REPERF ZOOM 35 160CM

Facility

$8,425.00

Service Code	HCPCS C1757
Hospital Charge Code	270694791S
Hospital Revenue Code	278
Min. Negotiated Rate	$239.27
Max. Negotiated Rate	$4,212.50
Rate for Payer: Aetna Commercial	$3,201.50
Rate for Payer: Aetna Medicare Advantage	$2,527.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,148.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,148.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,685.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,148.38
Rate for Payer: Cigna Commercial	$4,212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,038.85
Rate for Payer: Qualcare PPO/HMO/WC	$1,263.75
Rate for Payer: UnitedHealthcare Community & State	$266.23
Rate for Payer: Wellpoint Medicaid Managed Care	$239.27

CATHETER RHINO BLUE CIAGLINA

Facility

$1,800.00

Service Code	HCPCS C1769
Hospital Charge Code	270689139
Hospital Revenue Code	272
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00

CATHETER RHINO BLUE CIAGLINA

Facility

$1,800.00

Service Code	HCPCS C1769
Hospital Charge Code	270689139
Hospital Revenue Code	272
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$900.00
Rate for Payer: Aetna Commercial	$684.00
Rate for Payer: Aetna Medicare Advantage	$540.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$459.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$459.00
Rate for Payer: Cigna Commercial	$900.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$468.00
Rate for Payer: Oxford Commercial	$360.00
Rate for Payer: Qualcare PPO/HMO/WC	$270.00
Rate for Payer: UnitedHealthcare Commercial	$360.00
Rate for Payer: UnitedHealthcare Community & State	$56.88
Rate for Payer: Wellpoint Medicaid Managed Care	$51.12

CATHETER RIGHTSIDE

Facility

$2,200.00

Service Code	HCPCS C1887
Hospital Charge Code	270699656S
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$532.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: Qualcare PPO/HMO/WC	$330.00

CATHETER RIGHTSIDE

Facility

$2,200.00

Service Code	HCPCS C1887
Hospital Charge Code	270699656S
Hospital Revenue Code	278
Min. Negotiated Rate	$62.48
Max. Negotiated Rate	$1,100.00
Rate for Payer: Aetna Commercial	$836.00
Rate for Payer: Aetna Medicare Advantage	$660.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$561.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$440.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$561.00
Rate for Payer: Cigna Commercial	$1,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$532.40
Rate for Payer: Qualcare PPO/HMO/WC	$330.00
Rate for Payer: UnitedHealthcare Community & State	$69.52
Rate for Payer: Wellpoint Medicaid Managed Care	$62.48

CATHETER ROYAL FLUSH 5FR 100cm

Facility

$550.00

Hospital Charge Code	270647398
Hospital Revenue Code	271
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Oxford Commercial	$110.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Commercial	$110.00
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

CATHETER ROYAL FLUSH 5FR 100cm

Facility

$550.00

Hospital Charge Code	270647398
Hospital Revenue Code	271
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

CATHETER RT ANG CHEST TUB 32FR

Facility

$28.90

Hospital Charge Code	270663923
Hospital Revenue Code	270
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.33

CATHETER RT ANG CHEST TUB 32FR

Facility

$28.90

Hospital Charge Code	270663923
Hospital Revenue Code	270
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$14.45
Rate for Payer: Aetna Commercial	$10.98
Rate for Payer: Aetna Medicare Advantage	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.37
Rate for Payer: Cigna Commercial	$14.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Oxford Commercial	$5.78
Rate for Payer: Qualcare PPO/HMO/WC	$4.33
Rate for Payer: UnitedHealthcare Commercial	$5.78
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

CATHETER RT X THORACIC 24FR

Facility

$28.90

Hospital Charge Code	270667143
Hospital Revenue Code	272
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$14.45
Rate for Payer: Aetna Commercial	$10.98
Rate for Payer: Aetna Medicare Advantage	$8.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.37
Rate for Payer: Cigna Commercial	$14.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.51
Rate for Payer: Oxford Commercial	$5.78
Rate for Payer: Qualcare PPO/HMO/WC	$4.33
Rate for Payer: UnitedHealthcare Commercial	$5.78
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$0.82

CATHETER RT X THORACIC 24FR

Facility

$28.90

Hospital Charge Code	270667143
Hospital Revenue Code	272
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$4.33
Rate for Payer: Qualcare PPO/HMO/WC	$4.33

CATHETER RUBICON 4F 135CMx.018

Facility

$775.00

Service Code	HCPCS C1887
Hospital Charge Code	270672778
Hospital Revenue Code	278
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$187.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CATHETER RUBICON 4F 135CMx.018

Facility

$775.00

Service Code	HCPCS C1887
Hospital Charge Code	270672778
Hospital Revenue Code	278
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$155.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$187.55
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$22.01

CATHETER RUBICON 4FR .014 135

Facility

$775.00

Hospital Charge Code	270676380
Hospital Revenue Code	272
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$387.50
Rate for Payer: Aetna Commercial	$294.50
Rate for Payer: Aetna Medicare Advantage	$232.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$197.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$197.62
Rate for Payer: Cigna Commercial	$387.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$201.50
Rate for Payer: Oxford Commercial	$155.00
Rate for Payer: Qualcare PPO/HMO/WC	$116.25
Rate for Payer: UnitedHealthcare Commercial	$155.00
Rate for Payer: UnitedHealthcare Community & State	$24.49
Rate for Payer: Wellpoint Medicaid Managed Care	$22.01

CATHETER RUBICON 4FR .014 135

Facility

$775.00

Hospital Charge Code	270676380
Hospital Revenue Code	272
Min. Negotiated Rate	$116.25
Max. Negotiated Rate	$116.25
Rate for Payer: Qualcare PPO/HMO/WC	$116.25

CATHETER SCHON 14 FR X 20 CM

Facility

$425.00

Service Code	HCPCS C1752
Hospital Charge Code	270680742
Hospital Revenue Code	278
Min. Negotiated Rate	$12.07
Max. Negotiated Rate	$212.50
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare Advantage	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$108.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$108.38
Rate for Payer: Cigna Commercial	$212.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75
Rate for Payer: UnitedHealthcare Community & State	$13.43
Rate for Payer: Wellpoint Medicaid Managed Care	$12.07

CATHETER SCHON 14 FR X 20 CM

Facility

$425.00

Service Code	HCPCS C1752
Hospital Charge Code	270680742
Hospital Revenue Code	278
Min. Negotiated Rate	$63.75
Max. Negotiated Rate	$102.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$85.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$102.85
Rate for Payer: Qualcare PPO/HMO/WC	$63.75

CATHETER SCHON XL SET 15CM

Facility

$475.00

Service Code	HCPCS C1752
Hospital Charge Code	270671344
Hospital Revenue Code	278
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$237.50
Rate for Payer: Aetna Commercial	$180.50
Rate for Payer: Aetna Medicare Advantage	$142.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$121.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$121.12
Rate for Payer: Cigna Commercial	$237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25
Rate for Payer: UnitedHealthcare Community & State	$15.01
Rate for Payer: Wellpoint Medicaid Managed Care	$13.49

CATHETER SCHON XL SET 15CM

Facility

$475.00

Service Code	HCPCS C1752
Hospital Charge Code	270671344
Hospital Revenue Code	278
Min. Negotiated Rate	$71.25
Max. Negotiated Rate	$114.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$95.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$114.95
Rate for Payer: Qualcare PPO/HMO/WC	$71.25

Know your out-of-pocket cost for care.

All Charges