Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COIL 400 CPLX SFT 8MMX20CM

Facility

$11,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270695169S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$2,776.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,776.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25

COIL 400 CPLX SFT 8MMX20CM

Facility

$11,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270695169S
Hospital Revenue Code	278
Min. Negotiated Rate	$325.89
Max. Negotiated Rate	$5,737.50
Rate for Payer: Aetna Commercial	$4,360.50
Rate for Payer: Aetna Medicare Advantage	$3,442.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,926.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,926.12
Rate for Payer: Cigna Commercial	$5,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,776.95
Rate for Payer: Qualcare PPO/HMO/WC	$1,721.25
Rate for Payer: UnitedHealthcare Community & State	$362.61
Rate for Payer: Wellpoint Medicaid Managed Care	$325.89

COIL 400 CPLX XSFT 5MMX13CM

Facility

$11,160.00

Service Code	HCPCS C1889
Hospital Charge Code	270695166S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,674.00
Max. Negotiated Rate	$2,700.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00

COIL 400 CPLX XSFT 5MMX13CM

Facility

$11,160.00

Service Code	HCPCS C1889
Hospital Charge Code	270695166S
Hospital Revenue Code	278
Min. Negotiated Rate	$316.94
Max. Negotiated Rate	$5,580.00
Rate for Payer: Aetna Commercial	$4,240.80
Rate for Payer: Aetna Medicare Advantage	$3,348.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,845.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,232.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,845.80
Rate for Payer: Cigna Commercial	$5,580.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,700.72
Rate for Payer: Qualcare PPO/HMO/WC	$1,674.00
Rate for Payer: UnitedHealthcare Community & State	$352.66
Rate for Payer: Wellpoint Medicaid Managed Care	$316.94

COIL 400 CPLX XSFT 6MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695167S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

COIL 400 CPLX XSFT 6MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695167S
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

COIL 400 CPLX XSFT 7MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695168S
Hospital Revenue Code	278
Min. Negotiated Rate	$319.50
Max. Negotiated Rate	$5,625.00
Rate for Payer: Aetna Commercial	$4,275.00
Rate for Payer: Aetna Medicare Advantage	$3,375.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,868.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,868.75
Rate for Payer: Cigna Commercial	$5,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50
Rate for Payer: UnitedHealthcare Community & State	$355.50
Rate for Payer: Wellpoint Medicaid Managed Care	$319.50

COIL 400 CPLX XSFT 7MMX15CM

Facility

$11,250.00

Service Code	HCPCS C1889
Hospital Charge Code	270695168S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$2,722.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,722.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,687.50

COIL 400 CURVE SFT 2MMX4CM

Facility

$9,135.00

Service Code	HCPCS C1889
Hospital Charge Code	270695170S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,370.25
Max. Negotiated Rate	$2,210.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,827.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,210.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,370.25

COIL 400 CURVE SFT 2MMX4CM

Facility

$9,135.00

Service Code	HCPCS C1889
Hospital Charge Code	270695170S
Hospital Revenue Code	278
Min. Negotiated Rate	$259.43
Max. Negotiated Rate	$4,567.50
Rate for Payer: Aetna Commercial	$3,471.30
Rate for Payer: Aetna Medicare Advantage	$2,740.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,329.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,329.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,827.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,329.43
Rate for Payer: Cigna Commercial	$4,567.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,210.67
Rate for Payer: Qualcare PPO/HMO/WC	$1,370.25
Rate for Payer: UnitedHealthcare Community & State	$288.67
Rate for Payer: Wellpoint Medicaid Managed Care	$259.43

COIL CK EMBOLIZATION 251719

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270626429
Hospital Revenue Code	278
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$15.34

COIL CK EMBOLIZATION 251719

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270626429
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

COIL CK EMBOLIZATION 274349

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270627557
Hospital Revenue Code	278
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$130.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

COIL CK EMBOLIZATION 274349

Facility

$540.00

Service Code	HCPCS C1884
Hospital Charge Code	270627557
Hospital Revenue Code	278
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$270.00
Rate for Payer: Aetna Commercial	$205.20
Rate for Payer: Aetna Medicare Advantage	$162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$137.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$108.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$130.68
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Community & State	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$15.34

COIL DET TARGET TETRA1.5MMX3CM

Facility

$10,516.00

Service Code	HCPCS C1889
Hospital Charge Code	270699483S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,577.40
Max. Negotiated Rate	$2,544.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.40

COIL DET TARGET TETRA1.5MMX3CM

Facility

$10,516.00

Service Code	HCPCS C1889
Hospital Charge Code	270699483S
Hospital Revenue Code	278
Min. Negotiated Rate	$298.65
Max. Negotiated Rate	$5,258.00
Rate for Payer: Aetna Commercial	$3,996.08
Rate for Payer: Aetna Medicare Advantage	$3,154.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,681.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,681.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,103.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,681.58
Rate for Payer: Cigna Commercial	$5,258.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,544.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,577.40
Rate for Payer: UnitedHealthcare Community & State	$332.31
Rate for Payer: Wellpoint Medicaid Managed Care	$298.65

COILDETTARGETTETRA 2.5MMX4.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699012S
Hospital Revenue Code	278
Min. Negotiated Rate	$363.09
Max. Negotiated Rate	$6,392.50
Rate for Payer: Aetna Commercial	$4,858.30
Rate for Payer: Aetna Medicare Advantage	$3,835.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,260.18
Rate for Payer: Cigna Commercial	$6,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75
Rate for Payer: UnitedHealthcare Community & State	$404.01
Rate for Payer: Wellpoint Medicaid Managed Care	$363.09

COILDETTARGETTETRA 2.5MMX4.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699012S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,917.75
Max. Negotiated Rate	$3,093.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75

COIL DETTARGET TETRA 2MMX3.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699010S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,917.75
Max. Negotiated Rate	$3,093.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75

COIL DETTARGET TETRA 2MMX3.5CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699010S
Hospital Revenue Code	278
Min. Negotiated Rate	$363.09
Max. Negotiated Rate	$6,392.50
Rate for Payer: Aetna Commercial	$4,858.30
Rate for Payer: Aetna Medicare Advantage	$3,835.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,260.18
Rate for Payer: Cigna Commercial	$6,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75
Rate for Payer: UnitedHealthcare Community & State	$404.01
Rate for Payer: Wellpoint Medicaid Managed Care	$363.09

COILDETTARGET TETRA 3.5MMX10CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699014S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,917.75
Max. Negotiated Rate	$3,093.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75

COILDETTARGET TETRA 3.5MMX10CM

Facility

$12,785.00

Service Code	HCPCS C1889
Hospital Charge Code	270699014S
Hospital Revenue Code	278
Min. Negotiated Rate	$363.09
Max. Negotiated Rate	$6,392.50
Rate for Payer: Aetna Commercial	$4,858.30
Rate for Payer: Aetna Medicare Advantage	$3,835.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,260.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,557.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,260.18
Rate for Payer: Cigna Commercial	$6,392.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,093.97
Rate for Payer: Qualcare PPO/HMO/WC	$1,917.75
Rate for Payer: UnitedHealthcare Community & State	$404.01
Rate for Payer: Wellpoint Medicaid Managed Care	$363.09

COIL EMBO 10/5 12.5 CM

Facility

$480.00

Hospital Charge Code	270626428
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

COIL EMBO 10/5 12.5 CM

Facility

$480.00

Hospital Charge Code	270626428
Hospital Revenue Code	278
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$182.40
Rate for Payer: Aetna Medicare Advantage	$144.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$122.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$122.40
Rate for Payer: Cigna Commercial	$240.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00
Rate for Payer: UnitedHealthcare Community & State	$15.17
Rate for Payer: Wellpoint Medicaid Managed Care	$13.63

COIL EMBO 18S-6/2 7CM

Facility

$480.00

Hospital Charge Code	270669488
Hospital Revenue Code	278
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$116.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$96.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.16
Rate for Payer: Qualcare PPO/HMO/WC	$72.00

Know your out-of-pocket cost for care.

All Charges