Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

DILATOR ESOPHAGEAL 8-9-10

Facility

$1,067.35

Hospital Charge Code	270666753
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 HEAGAR SINGLE 15 MM

Facility

$167.85

Hospital Charge Code	270689048
Hospital Revenue Code	272
Min. Negotiated Rate	$25.18
Max. Negotiated Rate	$25.18
Rate for Payer: Qualcare PPO/HMO/WC	$25.18

DILATOR HEAGAR SINGLE 15 MM

Facility

$167.85

Hospital Charge Code	270689048
Hospital Revenue Code	272
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$83.92
Rate for Payer: Aetna Commercial	$63.78
Rate for Payer: Aetna Medicare Advantage	$50.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.80
Rate for Payer: Cigna Commercial	$83.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.64
Rate for Payer: Oxford Commercial	$33.57
Rate for Payer: Qualcare PPO/HMO/WC	$25.18
Rate for Payer: UnitedHealthcare Commercial	$33.57
Rate for Payer: UnitedHealthcare Community & State	$5.30
Rate for Payer: Wellpoint Medicaid Managed Care	$4.77

DILATOR HEAGAR SINGLE 4 MM

Facility

$70.35

Hospital Charge Code	270689047
Hospital Revenue Code	272
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$35.17
Rate for Payer: Aetna Commercial	$26.73
Rate for Payer: Aetna Medicare Advantage	$21.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.94
Rate for Payer: Cigna Commercial	$35.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.29
Rate for Payer: Oxford Commercial	$14.07
Rate for Payer: Qualcare PPO/HMO/WC	$10.55
Rate for Payer: UnitedHealthcare Commercial	$14.07
Rate for Payer: UnitedHealthcare Community & State	$2.22
Rate for Payer: Wellpoint Medicaid Managed Care	$2.00

DILATOR HEAGAR SINGLE 4 MM

Facility

$70.35

Hospital Charge Code	270689047
Hospital Revenue Code	272
Min. Negotiated Rate	$10.55
Max. Negotiated Rate	$10.55
Rate for Payer: Qualcare PPO/HMO/WC	$10.55

DILATOR HEAGER SINGEL ENDED 18

Facility

$219.15

Hospital Charge Code	270689050
Hospital Revenue Code	272
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$109.58
Rate for Payer: Aetna Commercial	$83.28
Rate for Payer: Aetna Medicare Advantage	$65.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$55.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$55.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$55.88
Rate for Payer: Cigna Commercial	$109.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$56.98
Rate for Payer: Oxford Commercial	$43.83
Rate for Payer: Qualcare PPO/HMO/WC	$32.87
Rate for Payer: UnitedHealthcare Commercial	$43.83
Rate for Payer: UnitedHealthcare Community & State	$6.93
Rate for Payer: Wellpoint Medicaid Managed Care	$6.22

DILATOR HEAGER SINGEL ENDED 18

Facility

$219.15

Hospital Charge Code	270689050
Hospital Revenue Code	272
Min. Negotiated Rate	$32.87
Max. Negotiated Rate	$32.87
Rate for Payer: Qualcare PPO/HMO/WC	$32.87

DILATOR HEAGER SINGLE 16 MM

Facility

$209.15

Hospital Charge Code	270689049
Hospital Revenue Code	272
Min. Negotiated Rate	$31.37
Max. Negotiated Rate	$31.37
Rate for Payer: Qualcare PPO/HMO/WC	$31.37

DILATOR HEAGER SINGLE 16 MM

Facility

$209.15

Hospital Charge Code	270689049
Hospital Revenue Code	272
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$104.58
Rate for Payer: Aetna Commercial	$79.48
Rate for Payer: Aetna Medicare Advantage	$62.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.33
Rate for Payer: Cigna Commercial	$104.58
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.38
Rate for Payer: Oxford Commercial	$41.83
Rate for Payer: Qualcare PPO/HMO/WC	$31.37
Rate for Payer: UnitedHealthcare Commercial	$41.83
Rate for Payer: UnitedHealthcare Community & State	$6.61
Rate for Payer: Wellpoint Medicaid Managed Care	$5.94

DILATOR INSULATD PHANTOM 8-18

Facility

$6,727.50

Hospital Charge Code	270693706
Hospital Revenue Code	272
Min. Negotiated Rate	$1,009.12
Max. Negotiated Rate	$1,009.12
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.12

DILATOR INSULATD PHANTOM 8-18

Facility

$6,727.50

Hospital Charge Code	270693706
Hospital Revenue Code	272
Min. Negotiated Rate	$191.06
Max. Negotiated Rate	$3,363.75
Rate for Payer: Aetna Commercial	$2,556.45
Rate for Payer: Aetna Medicare Advantage	$2,018.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,715.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,715.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,715.51
Rate for Payer: Cigna Commercial	$3,363.75
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,749.15
Rate for Payer: Oxford Commercial	$1,345.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,009.12
Rate for Payer: UnitedHealthcare Commercial	$1,345.50
Rate for Payer: UnitedHealthcare Community & State	$212.59
Rate for Payer: Wellpoint Medicaid Managed Care	$191.06

DILATOR RX BILIARY 10mx4c 4596

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630342
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR RX BILIARY 10mx4c 4596

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630342
Hospital Revenue Code	278
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$38.40
Rate for Payer: Wellpoint Medicaid Managed Care	$34.51

DILATOR RX BILIARY 4mx4c 4590

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630339
Hospital Revenue Code	278
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$38.40
Rate for Payer: Wellpoint Medicaid Managed Care	$34.51

DILATOR RX BILIARY 4mx4c 4590

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630339
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR RX BILIARY 6mx4c 4592

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630340
Hospital Revenue Code	278
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$38.40
Rate for Payer: Wellpoint Medicaid Managed Care	$34.51

DILATOR RX BILIARY 6mx4c 4592

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630340
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR RX BILIARY 8mx4c 4594

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630341
Hospital Revenue Code	278
Min. Negotiated Rate	$182.26
Max. Negotiated Rate	$294.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26

DILATOR RX BILIARY 8mx4c 4594

Facility

$1,215.05

Service Code	HCPCS C1876
Hospital Charge Code	270630341
Hospital Revenue Code	278
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$607.52
Rate for Payer: Aetna Commercial	$461.72
Rate for Payer: Aetna Medicare Advantage	$364.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.84
Rate for Payer: Cigna Commercial	$607.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.04
Rate for Payer: Qualcare PPO/HMO/WC	$182.26
Rate for Payer: UnitedHealthcare Community & State	$38.40
Rate for Payer: Wellpoint Medicaid Managed Care	$34.51

DILATOR SAFEOP STIM OVAL

Facility

$5,850.00

Service Code	HCPCS C1889
Hospital Charge Code	270702574
Hospital Revenue Code	278
Min. Negotiated Rate	$877.50
Max. Negotiated Rate	$1,415.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: Qualcare PPO/HMO/WC	$877.50

DILATOR SAFEOP STIM OVAL

Facility

$5,850.00

Service Code	HCPCS C1889
Hospital Charge Code	270702574
Hospital Revenue Code	278
Min. Negotiated Rate	$166.14
Max. Negotiated Rate	$2,925.00
Rate for Payer: Aetna Commercial	$2,223.00
Rate for Payer: Aetna Medicare Advantage	$1,755.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,491.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,170.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,491.75
Rate for Payer: Cigna Commercial	$2,925.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,415.70
Rate for Payer: Qualcare PPO/HMO/WC	$877.50
Rate for Payer: UnitedHealthcare Community & State	$184.86
Rate for Payer: Wellpoint Medicaid Managed Care	$166.14

DILATOR STD 7FR .035

Facility

$42.45

Hospital Charge Code	270677494
Hospital Revenue Code	279
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$21.23
Rate for Payer: Aetna Commercial	$16.13
Rate for Payer: Aetna Medicare Advantage	$12.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.82
Rate for Payer: Cigna Commercial	$21.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.04
Rate for Payer: Oxford Commercial	$8.49
Rate for Payer: Qualcare PPO/HMO/WC	$6.37
Rate for Payer: UnitedHealthcare Commercial	$8.49
Rate for Payer: UnitedHealthcare Community & State	$1.34
Rate for Payer: Wellpoint Medicaid Managed Care	$1.21

DILATOR STD 7FR .035

Facility

$42.45

Hospital Charge Code	270677494
Hospital Revenue Code	279
Min. Negotiated Rate	$6.37
Max. Negotiated Rate	$6.37
Rate for Payer: Qualcare PPO/HMO/WC	$6.37

DILATOR STD 8FR .035

Facility

$46.35

Hospital Charge Code	270677495
Hospital Revenue Code	272
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$6.95
Rate for Payer: Qualcare PPO/HMO/WC	$6.95

DILATOR STD 8FR .035

Facility

$46.35

Hospital Charge Code	270677495
Hospital Revenue Code	272
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$23.18
Rate for Payer: Aetna Commercial	$17.61
Rate for Payer: Aetna Medicare Advantage	$13.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.82
Rate for Payer: Cigna Commercial	$23.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.05
Rate for Payer: Oxford Commercial	$9.27
Rate for Payer: Qualcare PPO/HMO/WC	$6.95
Rate for Payer: UnitedHealthcare Commercial	$9.27
Rate for Payer: UnitedHealthcare Community & State	$1.46
Rate for Payer: Wellpoint Medicaid Managed Care	$1.32

Know your out-of-pocket cost for care.

All Charges