Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATH SOLID EXCHANG 1.5 360 145

Facility

$12,500.00

Service Code	HCPCS C1724
Hospital Charge Code	270689193
Hospital Revenue Code	272
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$1,875.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00

CATH SOLID EXCHANG 1.5 360 145

Facility

$12,500.00

Service Code	HCPCS C1724
Hospital Charge Code	270689193
Hospital Revenue Code	272
Min. Negotiated Rate	$355.00
Max. Negotiated Rate	$6,250.00
Rate for Payer: Aetna Commercial	$4,750.00
Rate for Payer: Aetna Medicare Advantage	$3,750.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,187.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,187.50
Rate for Payer: Cigna Commercial	$6,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,250.00
Rate for Payer: Oxford Commercial	$2,500.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,875.00
Rate for Payer: UnitedHealthcare Commercial	$2,500.00
Rate for Payer: UnitedHealthcare Community & State	$395.00
Rate for Payer: Wellpoint Medicaid Managed Care	$355.00

CATH SO OM 0 5F 0035X 10720407

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654589
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH SO OM 0 5F 0035X 10720407

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654589
Hospital Revenue Code	278
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CATH SO OM 1 5F 0035X 10720402

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654598
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH SO OM 1 5F 0035X 10720402

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654598
Hospital Revenue Code	278
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CATH SO OM 1 5F 0035X 10720402

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654598S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH SO OM 1 5F 0035X 10720402

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654598S
Hospital Revenue Code	278
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CATH SOS OM 5F 35 80C 10720404

Facility

$90.00

Hospital Charge Code	270624376
Hospital Revenue Code	272
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.40
Rate for Payer: Oxford Commercial	$18.00
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CATH SOS OM 5F 35 80C 10720404

Facility

$90.00

Hospital Charge Code	270624376
Hospital Revenue Code	272
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$13.50
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH SOS OMNI II 5F 0 035

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654600
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH SOS OMNI II 5F 0 035

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654600S
Hospital Revenue Code	278
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CATH SOS OMNI II 5F 0 035

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654600
Hospital Revenue Code	278
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.20
Rate for Payer: Aetna Medicare Advantage	$27.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.95
Rate for Payer: Cigna Commercial	$45.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50
Rate for Payer: UnitedHealthcare Community & State	$2.84
Rate for Payer: Wellpoint Medicaid Managed Care	$2.56

CATH SOS OMNI II 5F 0 035

Facility

$660.00

Service Code	HCPCS C1887
Hospital Charge Code	270654600N
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

CATH SOS OMNI II 5F 0 035

Facility

$90.00

Service Code	HCPCS C1887
Hospital Charge Code	270654600S
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$21.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$21.78
Rate for Payer: Qualcare PPO/HMO/WC	$13.50

CATH SOS OMNI II 5F 0 035

Facility

$660.00

Service Code	HCPCS C1887
Hospital Charge Code	270654600N
Hospital Revenue Code	278
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: Wellpoint Medicaid Managed Care	$18.74

CATH SOS OMNI SEL2 5Fx80CM

Facility

$105.00

Service Code	HCPCS C1887
Hospital Charge Code	270673388
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

CATH SOS OMNI SEL2 5Fx80CM

Facility

$105.00

Service Code	HCPCS C1887
Hospital Charge Code	270673388
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913N
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913N
Hospital Revenue Code	272
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$39.90
Rate for Payer: Aetna Medicare Advantage	$31.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.77
Rate for Payer: Cigna Commercial	$52.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.30
Rate for Payer: Oxford Commercial	$21.00
Rate for Payer: Qualcare PPO/HMO/WC	$15.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Community & State	$3.32
Rate for Payer: Wellpoint Medicaid Managed Care	$2.98

CATH SOS OMNI SEL(3) 5FRx80CM

Facility

$105.00

Hospital Charge Code	270624913
Hospital Revenue Code	272
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$15.75
Rate for Payer: Qualcare PPO/HMO/WC	$15.75

CATH SPY SCOPE DS ACCESS/DELIV

Facility

$13,250.00

Hospital Charge Code	270675498
Hospital Revenue Code	272
Min. Negotiated Rate	$376.30
Max. Negotiated Rate	$6,625.00
Rate for Payer: Aetna Commercial	$5,035.00
Rate for Payer: Aetna Medicare Advantage	$3,975.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,378.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,378.75
Rate for Payer: Cigna Commercial	$6,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,445.00
Rate for Payer: Oxford Commercial	$2,650.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50
Rate for Payer: UnitedHealthcare Commercial	$2,650.00
Rate for Payer: UnitedHealthcare Community & State	$418.70
Rate for Payer: Wellpoint Medicaid Managed Care	$376.30

CATH SPY SCOPE DS ACCESS/DELIV

Facility

$13,250.00

Hospital Charge Code	270675498
Hospital Revenue Code	272
Min. Negotiated Rate	$1,987.50
Max. Negotiated Rate	$1,987.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,987.50

CATH STEALTH 1.25 MICRO 60

Facility

$18,975.00

Hospital Charge Code	270671186
Hospital Revenue Code	278
Min. Negotiated Rate	$2,846.25
Max. Negotiated Rate	$4,591.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,795.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,591.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,846.25

Know your out-of-pocket cost for care.

All Charges