Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATHETER TRAILBLAZER .035X150

Facility

$4,864.00

Service Code	HCPCS C1887
Hospital Charge Code	270683677
Hospital Revenue Code	278
Min. Negotiated Rate	$138.14
Max. Negotiated Rate	$2,432.00
Rate for Payer: Aetna Commercial	$1,848.32
Rate for Payer: Aetna Medicare Advantage	$1,459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.32
Rate for Payer: Cigna Commercial	$2,432.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.09
Rate for Payer: Qualcare PPO/HMO/WC	$729.60
Rate for Payer: UnitedHealthcare Community & State	$153.70
Rate for Payer: Wellpoint Medicaid Managed Care	$138.14

CATHETER TRAILBLAZER .035X90CM

Facility

$4,864.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676
Hospital Revenue Code	278
Min. Negotiated Rate	$729.60
Max. Negotiated Rate	$1,177.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.09
Rate for Payer: Qualcare PPO/HMO/WC	$729.60

CATHETER TRAILBLAZER .035X90CM

Facility

$4,864.00

Service Code	HCPCS C1887
Hospital Charge Code	270683676
Hospital Revenue Code	278
Min. Negotiated Rate	$138.14
Max. Negotiated Rate	$2,432.00
Rate for Payer: Aetna Commercial	$1,848.32
Rate for Payer: Aetna Medicare Advantage	$1,459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.32
Rate for Payer: Cigna Commercial	$2,432.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.09
Rate for Payer: Qualcare PPO/HMO/WC	$729.60
Rate for Payer: UnitedHealthcare Community & State	$153.70
Rate for Payer: Wellpoint Medicaid Managed Care	$138.14

CATHETER TRAILBLAZER .14X150 C

Facility

$4,864.00

Service Code	HCPCS C1887
Hospital Charge Code	270683674
Hospital Revenue Code	278
Min. Negotiated Rate	$138.14
Max. Negotiated Rate	$2,432.00
Rate for Payer: Aetna Commercial	$1,848.32
Rate for Payer: Aetna Medicare Advantage	$1,459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.32
Rate for Payer: Cigna Commercial	$2,432.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.09
Rate for Payer: Qualcare PPO/HMO/WC	$729.60
Rate for Payer: UnitedHealthcare Community & State	$153.70
Rate for Payer: Wellpoint Medicaid Managed Care	$138.14

CATHETER TRAILBLAZER .14X150 C

Facility

$4,864.00

Service Code	HCPCS C1887
Hospital Charge Code	270683674
Hospital Revenue Code	278
Min. Negotiated Rate	$729.60
Max. Negotiated Rate	$1,177.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.09
Rate for Payer: Qualcare PPO/HMO/WC	$729.60

CATHETER TRAILBLAZER.18X150 CM

Facility

$4,864.00

Service Code	HCPCS C1887
Hospital Charge Code	270683675
Hospital Revenue Code	278
Min. Negotiated Rate	$138.14
Max. Negotiated Rate	$2,432.00
Rate for Payer: Aetna Commercial	$1,848.32
Rate for Payer: Aetna Medicare Advantage	$1,459.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,240.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,240.32
Rate for Payer: Cigna Commercial	$2,432.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.09
Rate for Payer: Qualcare PPO/HMO/WC	$729.60
Rate for Payer: UnitedHealthcare Community & State	$153.70
Rate for Payer: Wellpoint Medicaid Managed Care	$138.14

CATHETER TRAILBLAZER.18X150 CM

Facility

$4,864.00

Service Code	HCPCS C1887
Hospital Charge Code	270683675
Hospital Revenue Code	278
Min. Negotiated Rate	$729.60
Max. Negotiated Rate	$1,177.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$972.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,177.09
Rate for Payer: Qualcare PPO/HMO/WC	$729.60

CATHETER TREK CORONARY DILATAT

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645253
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

CATHETER TREK CORONARY DILATAT

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645255S
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATHETER TREK CORONARY DILATAT

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645272
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

CATHETER TREK CORONARY DILATAT

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645272C
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

CATHETER TREK CORONARY DILATAT

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645241S
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

CATHETER TREK CORONARY DILATAT

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645255S
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

CATHETER TREK CORONARY DILATAT

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645241
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

CATHETER TREK CORONARY DILATAT

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645255
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CATHETER TREK CORONARY DILATAT

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645241S
Hospital Revenue Code	278
Min. Negotiated Rate	$24.14
Max. Negotiated Rate	$425.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare Advantage	$255.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$216.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$216.75
Rate for Payer: Cigna Commercial	$425.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50
Rate for Payer: UnitedHealthcare Community & State	$26.86
Rate for Payer: Wellpoint Medicaid Managed Care	$24.14

CATHETER TREK CORONARY DILATAT

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645240
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

CATHETER TREK CORONARY DILATAT

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645240
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CATHETER TREK CORONARY DILATAT

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645255
Hospital Revenue Code	278
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$190.00
Rate for Payer: Aetna Medicare Advantage	$150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$127.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$127.50
Rate for Payer: Cigna Commercial	$250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00
Rate for Payer: UnitedHealthcare Community & State	$15.80
Rate for Payer: Wellpoint Medicaid Managed Care	$14.20

CATHETER TREK CORONARY DILATAT

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645272
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

CATHETER TREK CORONARY DILATAT

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645253S
Hospital Revenue Code	278
Min. Negotiated Rate	$101.25
Max. Negotiated Rate	$163.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25

CATHETER TREK CORONARY DILATAT

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645253S
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

CATHETER TREK CORONARY DILATAT

Facility

$675.00

Service Code	HCPCS C1725
Hospital Charge Code	270645240S
Hospital Revenue Code	278
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Commercial	$256.50
Rate for Payer: Aetna Medicare Advantage	$202.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$172.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$135.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$172.12
Rate for Payer: Cigna Commercial	$337.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$163.35
Rate for Payer: Qualcare PPO/HMO/WC	$101.25
Rate for Payer: UnitedHealthcare Community & State	$21.33
Rate for Payer: Wellpoint Medicaid Managed Care	$19.17

CATHETER TREK CORONARY DILATAT

Facility

$500.00

Service Code	HCPCS C1725
Hospital Charge Code	270645253
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$121.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.00
Rate for Payer: Qualcare PPO/HMO/WC	$75.00

CATHETER TREK CORONARY DILATAT

Facility

$850.00

Service Code	HCPCS C1725
Hospital Charge Code	270645272C
Hospital Revenue Code	278
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$205.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$205.70
Rate for Payer: Qualcare PPO/HMO/WC	$127.50

Know your out-of-pocket cost for care.

All Charges