Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

COIL EMBOLIZATION HYDRO 3D 3MM

Facility

$14,375.00

Service Code	HCPCS C1889
Hospital Charge Code	270700463S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,156.25
Max. Negotiated Rate	$3,478.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,478.75
Rate for Payer: Qualcare PPO/HMO/WC	$2,156.25

COIL EMBOL OPTIMA 2MMX3CM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698130S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL EMBOL OPTIMA 2MMX3CM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698130S
Hospital Revenue Code	278
Min. Negotiated Rate	$382.69
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$5,120.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25
Rate for Payer: UnitedHealthcare Community & State	$425.81
Rate for Payer: Wellpoint Medicaid Managed Care	$382.69

COIL EMBOL OPTIMA 5CMX2.5MM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698129S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,021.25
Max. Negotiated Rate	$3,260.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25

COIL EMBOL OPTIMA 5CMX2.5MM MX

Facility

$13,475.00

Service Code	HCPCS C1889
Hospital Charge Code	270698129S
Hospital Revenue Code	278
Min. Negotiated Rate	$382.69
Max. Negotiated Rate	$6,737.50
Rate for Payer: Aetna Commercial	$5,120.50
Rate for Payer: Aetna Medicare Advantage	$4,042.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,436.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,695.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,436.12
Rate for Payer: Cigna Commercial	$6,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,260.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,021.25
Rate for Payer: UnitedHealthcare Community & State	$425.81
Rate for Payer: Wellpoint Medicaid Managed Care	$382.69

COIL LP DETACHMENT RLPH1

Facility

$1,190.00

Hospital Charge Code	270696371C
Hospital Revenue Code	272
Min. Negotiated Rate	$33.80
Max. Negotiated Rate	$595.00
Rate for Payer: Aetna Commercial	$452.20
Rate for Payer: Aetna Medicare Advantage	$357.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$303.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$303.45
Rate for Payer: Cigna Commercial	$595.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$309.40
Rate for Payer: Oxford Commercial	$238.00
Rate for Payer: Qualcare PPO/HMO/WC	$178.50
Rate for Payer: UnitedHealthcare Commercial	$238.00
Rate for Payer: UnitedHealthcare Community & State	$37.60
Rate for Payer: Wellpoint Medicaid Managed Care	$33.80

COIL LP DETACHMENT RLPH1

Facility

$1,190.00

Hospital Charge Code	270696371C
Hospital Revenue Code	272
Min. Negotiated Rate	$178.50
Max. Negotiated Rate	$178.50
Rate for Payer: Qualcare PPO/HMO/WC	$178.50

COIL MICRO 3/2 2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270627360N
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 MICRO 3/2 2CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270627360
Hospital Revenue Code	278
Min. Negotiated Rate	$15.64
Max. Negotiated Rate	$275.32
Rate for Payer: Aetna Commercial	$209.25
Rate for Payer: Aetna Medicare Advantage	$165.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.42
Rate for Payer: Cigna Commercial	$275.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: Qualcare PPO/HMO/WC	$82.60
Rate for Payer: UnitedHealthcare Community & State	$17.40
Rate for Payer: Wellpoint Medicaid Managed Care	$15.64

COIL MICRO 3/2 2CM

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270627360N
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 MICRO 3/2 2CM

Facility

$550.65

Service Code	HCPCS C1884
Hospital Charge Code	270627360
Hospital Revenue Code	278
Min. Negotiated Rate	$82.60
Max. Negotiated Rate	$133.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$110.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$133.26
Rate for Payer: Qualcare PPO/HMO/WC	$82.60

COIL MICRONESTER 3MM

Facility

$255.00

Hospital Charge Code	270629637
Hospital Revenue Code	278
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$96.90
Rate for Payer: Aetna Medicare Advantage	$76.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.03
Rate for Payer: Cigna Commercial	$127.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25
Rate for Payer: UnitedHealthcare Community & State	$8.06
Rate for Payer: Wellpoint Medicaid Managed Care	$7.24

COIL MICRONESTER 3MM

Facility

$255.00

Hospital Charge Code	270629637
Hospital Revenue Code	278
Min. Negotiated Rate	$38.25
Max. Negotiated Rate	$61.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$51.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.71
Rate for Payer: Qualcare PPO/HMO/WC	$38.25

COIL MICRONESTER 3MM G26987

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629637C
Hospital Revenue Code	278
Min. Negotiated Rate	$15.01
Max. Negotiated Rate	$264.20
Rate for Payer: Aetna Commercial	$200.79
Rate for Payer: Aetna Medicare Advantage	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.74
Rate for Payer: Cigna Commercial	$264.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26
Rate for Payer: UnitedHealthcare Community & State	$16.70
Rate for Payer: Wellpoint Medicaid Managed Care	$15.01

COIL MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637N
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 MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637V
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 MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637V
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 MICRONESTER 3MM G26987

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629637C
Hospital Revenue Code	278
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$127.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26

COIL MICRONESTER 3MM G26987

Facility

$480.00

Service Code	HCPCS C1884
Hospital Charge Code	270629637N
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 MICRONESTER 4mm

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629638
Hospital Revenue Code	278
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$127.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26

COIL MICRONESTER 4mm

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270629638
Hospital Revenue Code	278
Min. Negotiated Rate	$15.01
Max. Negotiated Rate	$264.20
Rate for Payer: Aetna Commercial	$200.79
Rate for Payer: Aetna Medicare Advantage	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.74
Rate for Payer: Cigna Commercial	$264.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26
Rate for Payer: UnitedHealthcare Community & State	$16.70
Rate for Payer: Wellpoint Medicaid Managed Care	$15.01

COIL NESTER 14CM 10MM

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270627555
Hospital Revenue Code	278
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$127.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26

COIL NESTER 14CM 10MM

Facility

$528.40

Service Code	HCPCS C1884
Hospital Charge Code	270627555
Hospital Revenue Code	278
Min. Negotiated Rate	$15.01
Max. Negotiated Rate	$264.20
Rate for Payer: Aetna Commercial	$200.79
Rate for Payer: Aetna Medicare Advantage	$158.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$134.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$105.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$134.74
Rate for Payer: Cigna Commercial	$264.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$127.87
Rate for Payer: Qualcare PPO/HMO/WC	$79.26
Rate for Payer: UnitedHealthcare Community & State	$16.70
Rate for Payer: Wellpoint Medicaid Managed Care	$15.01

COIL NESTER 14CM 4MM

Facility

$540.00

Hospital Charge Code	270670448
Hospital Revenue Code	272
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) PPO	$137.70
Rate for Payer: Cigna Commercial	$270.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.40
Rate for Payer: Oxford Commercial	$108.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.00
Rate for Payer: UnitedHealthcare Commercial	$108.00
Rate for Payer: UnitedHealthcare Community & State	$17.06
Rate for Payer: Wellpoint Medicaid Managed Care	$15.34

COIL NESTER 14CM 4MM

Facility

$540.00

Hospital Charge Code	270670448
Hospital Revenue Code	272
Min. Negotiated Rate	$81.00
Max. Negotiated Rate	$81.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.00

Know your out-of-pocket cost for care.

All Charges