Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

CATH TRAILBLZR 35CM .035

Facility

$4,042.50

Service Code	HCPCS C1887
Hospital Charge Code	270643851N
Hospital Revenue Code	278
Min. Negotiated Rate	$606.38
Max. Negotiated Rate	$978.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.28
Rate for Payer: Qualcare PPO/HMO/WC	$606.38

CATH TRAILBLZR 35CM .035

Facility

$744.80

Service Code	HCPCS C1887
Hospital Charge Code	270643851
Hospital Revenue Code	278
Min. Negotiated Rate	$111.72
Max. Negotiated Rate	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72

CATH TRAILBLZR 35CM .035

Facility

$744.80

Service Code	HCPCS C1887
Hospital Charge Code	270643851
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$372.40
Rate for Payer: Aetna Commercial	$283.02
Rate for Payer: Aetna Medicare Advantage	$223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.92
Rate for Payer: Cigna Commercial	$372.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.15

CATH TRAILBLZR 35CM .035

Facility

$4,042.50

Service Code	HCPCS C1887
Hospital Charge Code	270643851N
Hospital Revenue Code	278
Min. Negotiated Rate	$114.81
Max. Negotiated Rate	$2,021.25
Rate for Payer: Aetna Commercial	$1,536.15
Rate for Payer: Aetna Medicare Advantage	$1,212.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,030.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,030.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$808.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,030.84
Rate for Payer: Cigna Commercial	$2,021.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$978.28
Rate for Payer: Qualcare PPO/HMO/WC	$606.38
Rate for Payer: UnitedHealthcare Community & State	$127.74
Rate for Payer: Wellpoint Medicaid Managed Care	$114.81

CATH TRAILBZ 018 150 SC0181150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643850C
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$372.40
Rate for Payer: Aetna Commercial	$283.02
Rate for Payer: Aetna Medicare Advantage	$223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.92
Rate for Payer: Cigna Commercial	$372.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.15

CATH TRAILBZ 018 150 SC0181150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643850C
Hospital Revenue Code	278
Min. Negotiated Rate	$111.72
Max. Negotiated Rate	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72

CATH TRAILBZ 018 150 SC0181150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643850A
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$372.40
Rate for Payer: Aetna Commercial	$283.02
Rate for Payer: Aetna Medicare Advantage	$223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.92
Rate for Payer: Cigna Commercial	$372.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.15

CATH TRAILBZ 018 150 SC0181150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643850A
Hospital Revenue Code	278
Min. Negotiated Rate	$111.72
Max. Negotiated Rate	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72

CATH TRANSFORM OCCLUS 4X20MM

Facility

$8,323.50

Service Code	HCPCS C2628
Hospital Charge Code	270693898S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.53
Max. Negotiated Rate	$2,014.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,664.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,014.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.53

CATH TRANSFORM OCCLUS 4X20MM

Facility

$8,323.50

Service Code	HCPCS C2628
Hospital Charge Code	270693898S
Hospital Revenue Code	278
Min. Negotiated Rate	$236.39
Max. Negotiated Rate	$4,161.75
Rate for Payer: Aetna Commercial	$3,162.93
Rate for Payer: Aetna Medicare Advantage	$2,497.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,122.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,122.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,664.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,122.49
Rate for Payer: Cigna Commercial	$4,161.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,014.29
Rate for Payer: Qualcare PPO/HMO/WC	$1,248.53
Rate for Payer: UnitedHealthcare Community & State	$263.02
Rate for Payer: Wellpoint Medicaid Managed Care	$236.39

CATH TRAUMA VENTRIC 3.3x1.9MM

Facility

$1,350.00

Service Code	HCPCS C1729
Hospital Charge Code	270695019
Hospital Revenue Code	278
Min. Negotiated Rate	$38.34
Max. Negotiated Rate	$675.00
Rate for Payer: Aetna Commercial	$513.00
Rate for Payer: Aetna Medicare Advantage	$405.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$344.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$270.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.70
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Community & State	$42.66
Rate for Payer: Wellpoint Medicaid Managed Care	$38.34

CATH TRAUMA VENTRIC 3.3x1.9MM

Facility

$1,350.00

Service Code	HCPCS C1729
Hospital Charge Code	270695019
Hospital Revenue Code	278
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$326.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$326.70
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

CATH TRBHWK 8F THS-LS-C

Facility

$16,975.00

Service Code	HCPCS C1885
Hospital Charge Code	270642993C
Hospital Revenue Code	278
Min. Negotiated Rate	$2,546.25
Max. Negotiated Rate	$4,107.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25

CATH TRBHWK 8F THS-LS-C

Facility

$16,975.00

Service Code	HCPCS C1885
Hospital Charge Code	270642993C
Hospital Revenue Code	278
Min. Negotiated Rate	$482.09
Max. Negotiated Rate	$8,487.50
Rate for Payer: Aetna Commercial	$6,450.50
Rate for Payer: Aetna Medicare Advantage	$5,092.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,328.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,395.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,328.62
Rate for Payer: Cigna Commercial	$8,487.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,107.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,546.25
Rate for Payer: UnitedHealthcare Community & State	$536.41
Rate for Payer: Wellpoint Medicaid Managed Care	$482.09

CATHTR BLLN AMPHRN .35X20X130

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270657924
Hospital Revenue Code	278
Min. Negotiated Rate	$19.88
Max. Negotiated Rate	$350.00
Rate for Payer: Aetna Commercial	$266.00
Rate for Payer: Aetna Medicare Advantage	$210.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$178.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$178.50
Rate for Payer: Cigna Commercial	$350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00
Rate for Payer: UnitedHealthcare Community & State	$22.12
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

CATHTR BLLN AMPHRN .35X20X130

Facility

$700.00

Service Code	HCPCS C1725
Hospital Charge Code	270657924
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$169.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$169.40
Rate for Payer: Qualcare PPO/HMO/WC	$105.00

CATHTR BLLN AMPHRN .35X80X130

Facility

$725.00

Service Code	HCPCS C1725
Hospital Charge Code	270657926
Hospital Revenue Code	278
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$362.50
Rate for Payer: Aetna Commercial	$275.50
Rate for Payer: Aetna Medicare Advantage	$217.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.88
Rate for Payer: Cigna Commercial	$362.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75
Rate for Payer: UnitedHealthcare Community & State	$22.91
Rate for Payer: Wellpoint Medicaid Managed Care	$20.59

CATHTR BLLN AMPHRN .35X80X130

Facility

$725.00

Service Code	HCPCS C1725
Hospital Charge Code	270657926
Hospital Revenue Code	278
Min. Negotiated Rate	$108.75
Max. Negotiated Rate	$175.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$145.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.45
Rate for Payer: Qualcare PPO/HMO/WC	$108.75

CATH TRIPLE LM 8 AK-25123-F

Facility

$466.83

Hospital Charge Code	270302229
Hospital Revenue Code	272
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$233.41
Rate for Payer: Aetna Commercial	$177.40
Rate for Payer: Aetna Medicare Advantage	$140.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$119.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$119.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$119.04
Rate for Payer: Cigna Commercial	$233.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$121.38
Rate for Payer: Oxford Commercial	$93.37
Rate for Payer: Qualcare PPO/HMO/WC	$70.02
Rate for Payer: UnitedHealthcare Commercial	$93.37
Rate for Payer: UnitedHealthcare Community & State	$14.75
Rate for Payer: Wellpoint Medicaid Managed Care	$13.26

CATH TRIPLE LM 8 AK-25123-F

Facility

$466.83

Hospital Charge Code	270302229
Hospital Revenue Code	272
Min. Negotiated Rate	$70.02
Max. Negotiated Rate	$70.02
Rate for Payer: Qualcare PPO/HMO/WC	$70.02

CATH TRIPLE LM 8 AK-25123-F

Facility

$739.25

Hospital Charge Code	270606227
Hospital Revenue Code	272
Min. Negotiated Rate	$20.99
Max. Negotiated Rate	$369.62
Rate for Payer: Aetna Commercial	$280.92
Rate for Payer: Aetna Medicare Advantage	$221.78
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$188.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$188.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$188.51
Rate for Payer: Cigna Commercial	$369.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$192.21
Rate for Payer: Oxford Commercial	$147.85
Rate for Payer: Qualcare PPO/HMO/WC	$110.89
Rate for Payer: UnitedHealthcare Commercial	$147.85
Rate for Payer: UnitedHealthcare Community & State	$23.36
Rate for Payer: Wellpoint Medicaid Managed Care	$20.99

CATH TRIPLE LM 8 AK-25123-F

Facility

$739.25

Hospital Charge Code	270606227
Hospital Revenue Code	272
Min. Negotiated Rate	$110.89
Max. Negotiated Rate	$110.89
Rate for Payer: Qualcare PPO/HMO/WC	$110.89

CATH TRLBLZR .014 SC-014-150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643849C
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$372.40
Rate for Payer: Aetna Commercial	$283.02
Rate for Payer: Aetna Medicare Advantage	$223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.92
Rate for Payer: Cigna Commercial	$372.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.15

CATH TRLBLZR .014 SC-014-150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643849A
Hospital Revenue Code	278
Min. Negotiated Rate	$21.15
Max. Negotiated Rate	$372.40
Rate for Payer: Aetna Commercial	$283.02
Rate for Payer: Aetna Medicare Advantage	$223.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$189.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$189.92
Rate for Payer: Cigna Commercial	$372.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72
Rate for Payer: UnitedHealthcare Community & State	$23.54
Rate for Payer: Wellpoint Medicaid Managed Care	$21.15

CATH TRLBLZR .014 SC-014-150

Facility

$744.80

Service Code	HCPCS C1725
Hospital Charge Code	270643849A
Hospital Revenue Code	278
Min. Negotiated Rate	$111.72
Max. Negotiated Rate	$180.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$148.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$180.24
Rate for Payer: Qualcare PPO/HMO/WC	$111.72

Know your out-of-pocket cost for care.

All Charges