Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DILATOR 4FR .035

Facility

$27.61

Hospital Charge Code	270630843
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.18
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

DILATOR 4FR .035

Facility

$27.61

Hospital Charge Code	270630843
Hospital Revenue Code	272
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

DILATOR 4FR .035 48-149

Facility

$27.61

Hospital Charge Code	270630843C
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.18
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

DILATOR 4FR .035 48-149

Facility

$27.61

Hospital Charge Code	270630843C
Hospital Revenue Code	272
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

DILATOR 5FR

Facility

$27.61

Hospital Charge Code	270651985
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.18
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

DILATOR 5FR

Facility

$27.61

Hospital Charge Code	270651985
Hospital Revenue Code	272
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

DILATOR 8FR .038

Facility

$27.61

Hospital Charge Code	270630844
Hospital Revenue Code	272
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$4.14
Rate for Payer: Qualcare PPO/HMO/WC	$4.14

DILATOR 8FR .038

Facility

$27.61

Hospital Charge Code	270630844
Hospital Revenue Code	272
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna Commercial	$10.49
Rate for Payer: Aetna Medicare Advantage	$8.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.04
Rate for Payer: Cigna Commercial	$13.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.18
Rate for Payer: Oxford Commercial	$5.52
Rate for Payer: Qualcare PPO/HMO/WC	$4.14
Rate for Payer: UnitedHealthcare Commercial	$5.52
Rate for Payer: UnitedHealthcare Community & State	$0.87
Rate for Payer: Wellpoint Medicaid Managed Care	$0.78

DILATOR BALL.12-13.5-15mm

Facility

$1,125.00

Service Code	HCPCS C1726
Hospital Charge Code	270635747
Hospital Revenue Code	278
Min. Negotiated Rate	$168.75
Max. Negotiated Rate	$272.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75

DILATOR BALL.12-13.5-15mm

Facility

$1,125.00

Service Code	HCPCS C1726
Hospital Charge Code	270635747
Hospital Revenue Code	278
Min. Negotiated Rate	$31.95
Max. Negotiated Rate	$562.50
Rate for Payer: Aetna Commercial	$427.50
Rate for Payer: Aetna Medicare Advantage	$337.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$286.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$286.88
Rate for Payer: Cigna Commercial	$562.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.25
Rate for Payer: Qualcare PPO/HMO/WC	$168.75
Rate for Payer: UnitedHealthcare Community & State	$35.55
Rate for Payer: Wellpoint Medicaid Managed Care	$31.95

DILATOR BALLOON ACHALASIA

Facility

$3,945.00

Hospital Charge Code	270650910
Hospital Revenue Code	272
Min. Negotiated Rate	$591.75
Max. Negotiated Rate	$591.75
Rate for Payer: Qualcare PPO/HMO/WC	$591.75

DILATOR BALLOON ACHALASIA

Facility

$3,945.00

Hospital Charge Code	270650910
Hospital Revenue Code	272
Min. Negotiated Rate	$112.04
Max. Negotiated Rate	$1,972.50
Rate for Payer: Aetna Commercial	$1,499.10
Rate for Payer: Aetna Medicare Advantage	$1,183.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,005.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,005.98
Rate for Payer: Cigna Commercial	$1,972.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,025.70
Rate for Payer: Oxford Commercial	$789.00
Rate for Payer: Qualcare PPO/HMO/WC	$591.75
Rate for Payer: UnitedHealthcare Commercial	$789.00
Rate for Payer: UnitedHealthcare Community & State	$124.66
Rate for Payer: Wellpoint Medicaid Managed Care	$112.04

DILATOR BILE BAKES 3 MM

Facility

$1,991.55

Hospital Charge Code	270689559
Hospital Revenue Code	272
Min. Negotiated Rate	$56.56
Max. Negotiated Rate	$995.77
Rate for Payer: Aetna Commercial	$756.79
Rate for Payer: Aetna Medicare Advantage	$597.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$507.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$507.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$507.85
Rate for Payer: Cigna Commercial	$995.77
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$517.80
Rate for Payer: Oxford Commercial	$398.31
Rate for Payer: Qualcare PPO/HMO/WC	$298.73
Rate for Payer: UnitedHealthcare Commercial	$398.31
Rate for Payer: UnitedHealthcare Community & State	$62.93
Rate for Payer: Wellpoint Medicaid Managed Care	$56.56

DILATOR BILE BAKES 3 MM

Facility

$1,991.55

Hospital Charge Code	270689559
Hospital Revenue Code	272
Min. Negotiated Rate	$298.73
Max. Negotiated Rate	$298.73
Rate for Payer: Qualcare PPO/HMO/WC	$298.73

DILATOR BLUE 18

Facility

$2,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270692307
Hospital Revenue Code	278
Min. Negotiated Rate	$59.21
Max. Negotiated Rate	$1,042.50
Rate for Payer: Aetna Commercial	$792.30
Rate for Payer: Aetna Medicare Advantage	$625.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$531.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$531.67
Rate for Payer: Cigna Commercial	$1,042.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: Qualcare PPO/HMO/WC	$312.75
Rate for Payer: UnitedHealthcare Community & State	$65.89
Rate for Payer: Wellpoint Medicaid Managed Care	$59.21

DILATOR BLUE 18

Facility

$2,085.00

Service Code	HCPCS C1713
Hospital Charge Code	270692307
Hospital Revenue Code	278
Min. Negotiated Rate	$312.75
Max. Negotiated Rate	$504.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$417.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$504.57
Rate for Payer: Qualcare PPO/HMO/WC	$312.75

DILATOR CANNULA USSC VS101005

Facility

$304.20

Hospital Charge Code	270624151
Hospital Revenue Code	272
Min. Negotiated Rate	$45.63
Max. Negotiated Rate	$45.63
Rate for Payer: Qualcare PPO/HMO/WC	$45.63

DILATOR CANNULA USSC VS101005

Facility

$304.20

Hospital Charge Code	270624151
Hospital Revenue Code	272
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$152.10
Rate for Payer: Aetna Commercial	$115.60
Rate for Payer: Aetna Medicare Advantage	$91.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$77.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$77.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$77.57
Rate for Payer: Cigna Commercial	$152.10
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$79.09
Rate for Payer: Oxford Commercial	$60.84
Rate for Payer: Qualcare PPO/HMO/WC	$45.63
Rate for Payer: UnitedHealthcare Commercial	$60.84
Rate for Payer: UnitedHealthcare Community & State	$9.61
Rate for Payer: Wellpoint Medicaid Managed Care	$8.64

DILATOR DISP

Facility

$1,350.00

Hospital Charge Code	270676361
Hospital Revenue Code	272
Min. Negotiated Rate	$202.50
Max. Negotiated Rate	$202.50
Rate for Payer: Qualcare PPO/HMO/WC	$202.50

DILATOR DISP

Facility

$1,350.00

Hospital Charge Code	270676361
Hospital Revenue Code	272
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) PPO	$344.25
Rate for Payer: Cigna Commercial	$675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$351.00
Rate for Payer: Oxford Commercial	$270.00
Rate for Payer: Qualcare PPO/HMO/WC	$202.50
Rate for Payer: UnitedHealthcare Commercial	$270.00
Rate for Payer: UnitedHealthcare Community & State	$42.66
Rate for Payer: Wellpoint Medicaid Managed Care	$38.34

DILATOR ESOPHAGEAL 10-13.5-15

Facility

$1,075.00

Service Code	HCPCS C1726
Hospital Charge Code	270666754
Hospital Revenue Code	278
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$260.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25

DILATOR ESOPHAGEAL 10-13.5-15

Facility

$1,075.00

Service Code	HCPCS C1726
Hospital Charge Code	270666754
Hospital Revenue Code	278
Min. Negotiated Rate	$30.53
Max. Negotiated Rate	$537.50
Rate for Payer: Aetna Commercial	$408.50
Rate for Payer: Aetna Medicare Advantage	$322.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$274.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$215.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$274.12
Rate for Payer: Cigna Commercial	$537.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$260.15
Rate for Payer: Qualcare PPO/HMO/WC	$161.25
Rate for Payer: UnitedHealthcare Community & State	$33.97
Rate for Payer: Wellpoint Medicaid Managed Care	$30.53

DILATOR ESOPHAGEAL 15-16.5-18

Facility

$1,067.35

Hospital Charge Code	270665085
Hospital Revenue Code	272
Min. Negotiated Rate	$160.10
Max. Negotiated Rate	$160.10
Rate for Payer: Qualcare PPO/HMO/WC	$160.10

DILATOR ESOPHAGEAL 15-16.5-18

Facility

$1,067.35

Hospital Charge Code	270665085
Hospital Revenue Code	272
Min. Negotiated Rate	$30.31
Max. Negotiated Rate	$533.67
Rate for Payer: Aetna Commercial	$405.59
Rate for Payer: Aetna Medicare Advantage	$320.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$272.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$272.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$272.17
Rate for Payer: Cigna Commercial	$533.67
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$277.51
Rate for Payer: Oxford Commercial	$213.47
Rate for Payer: Qualcare PPO/HMO/WC	$160.10
Rate for Payer: UnitedHealthcare Commercial	$213.47
Rate for Payer: UnitedHealthcare Community & State	$33.73
Rate for Payer: Wellpoint Medicaid Managed Care	$30.31

DILATOR ESOPHAGEAL 8-9-10

Facility

$1,067.35

Hospital Charge Code	270666753
Hospital Revenue Code	272
Min. Negotiated Rate	$160.10
Max. Negotiated Rate	$160.10
Rate for Payer: Qualcare PPO/HMO/WC	$160.10

Know your out-of-pocket cost for care.

All Charges