Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

FILL POLYMER KIT

Facility

$3,750.00

Hospital Charge Code	270678257
Hospital Revenue Code	272
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,425.00
Rate for Payer: Aetna Medicare Advantage	$1,125.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$956.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$956.25
Rate for Payer: Cigna Commercial	$1,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$975.00
Rate for Payer: Oxford Commercial	$750.00
Rate for Payer: Qualcare PPO/HMO/WC	$562.50
Rate for Payer: UnitedHealthcare Commercial	$750.00
Rate for Payer: UnitedHealthcare Community & State	$118.50
Rate for Payer: Wellpoint Medicaid Managed Care	$106.50

FILTER ASSY PRECISION FLOW 02

Facility

$875.00

Hospital Charge Code	270680237
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial	$332.50
Rate for Payer: Aetna Medicare Advantage	$262.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.12
Rate for Payer: Cigna Commercial	$437.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.50
Rate for Payer: Oxford Commercial	$175.00
Rate for Payer: Qualcare PPO/HMO/WC	$131.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Community & State	$27.65
Rate for Payer: Wellpoint Medicaid Managed Care	$24.85

FILTER ASSY PRECISION FLOW 02

Facility

$875.00

Hospital Charge Code	270680237
Hospital Revenue Code	272
Min. Negotiated Rate	$131.25
Max. Negotiated Rate	$131.25
Rate for Payer: Qualcare PPO/HMO/WC	$131.25

FILTER CHARCOAL VAPOR

Facility

$192.65

Hospital Charge Code	270665981
Hospital Revenue Code	270
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$96.33
Rate for Payer: Aetna Commercial	$73.21
Rate for Payer: Aetna Medicare Advantage	$57.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.13
Rate for Payer: Cigna Commercial	$96.33
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$50.09
Rate for Payer: Oxford Commercial	$38.53
Rate for Payer: Qualcare PPO/HMO/WC	$28.90
Rate for Payer: UnitedHealthcare Commercial	$38.53
Rate for Payer: UnitedHealthcare Community & State	$6.09
Rate for Payer: Wellpoint Medicaid Managed Care	$5.47

FILTER CHARCOAL VAPOR

Facility

$192.65

Hospital Charge Code	270665981
Hospital Revenue Code	270
Min. Negotiated Rate	$28.90
Max. Negotiated Rate	$28.90
Rate for Payer: Qualcare PPO/HMO/WC	$28.90

FILTER DENALI IVC FEMORAL

Facility

$6,500.00

Service Code	HCPCS C1880
Hospital Charge Code	270644009
Hospital Revenue Code	278
Min. Negotiated Rate	$975.00
Max. Negotiated Rate	$1,573.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00

FILTER DENALI IVC FEMORAL

Facility

$6,750.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

FILTER DENALI IVC FEMORAL

Facility

$6,500.00

Service Code	HCPCS C1880
Hospital Charge Code	270644009
Hospital Revenue Code	278
Min. Negotiated Rate	$184.60
Max. Negotiated Rate	$3,250.00
Rate for Payer: Aetna Commercial	$2,470.00
Rate for Payer: Aetna Medicare Advantage	$1,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,657.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,657.50
Rate for Payer: Cigna Commercial	$3,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,573.00
Rate for Payer: Qualcare PPO/HMO/WC	$975.00
Rate for Payer: UnitedHealthcare Community & State	$205.40
Rate for Payer: Wellpoint Medicaid Managed Care	$184.60

FILTER DENALI IVC FEMORAL

Facility

$6,750.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

FILTER DENALI IVC FEMORAL

Facility

$6,750.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957S
Hospital Revenue Code	278
Min. Negotiated Rate	$1,012.50
Max. Negotiated Rate	$1,633.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50

FILTER DENALI IVC FEMORAL

Facility

$6,750.00

Service Code	HCPCS C1880
Hospital Charge Code	270646957S
Hospital Revenue Code	278
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$3,375.00
Rate for Payer: Aetna Commercial	$2,565.00
Rate for Payer: Aetna Medicare Advantage	$2,025.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,721.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,350.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,721.25
Rate for Payer: Cigna Commercial	$3,375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,633.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,012.50
Rate for Payer: UnitedHealthcare Community & State	$213.30
Rate for Payer: Wellpoint Medicaid Managed Care	$191.70

FILTER DISPOSABLE FOR MALDEHYD

Facility

$207.80

Hospital Charge Code	270665980
Hospital Revenue Code	270
Min. Negotiated Rate	$31.17
Max. Negotiated Rate	$31.17
Rate for Payer: Qualcare PPO/HMO/WC	$31.17

FILTER DISPOSABLE FOR MALDEHYD

Facility

$207.80

Hospital Charge Code	270665980
Hospital Revenue Code	270
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$103.90
Rate for Payer: Aetna Commercial	$78.96
Rate for Payer: Aetna Medicare Advantage	$62.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$52.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$52.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$52.99
Rate for Payer: Cigna Commercial	$103.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.03
Rate for Payer: Oxford Commercial	$41.56
Rate for Payer: Qualcare PPO/HMO/WC	$31.17
Rate for Payer: UnitedHealthcare Commercial	$41.56
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: Wellpoint Medicaid Managed Care	$5.90

FILTER GREENFIELD FEMORAL

Facility

$4,994.50

Service Code	HCPCS C1880
Hospital Charge Code	270601124
Hospital Revenue Code	278
Min. Negotiated Rate	$141.84
Max. Negotiated Rate	$2,497.25
Rate for Payer: Aetna Commercial	$1,897.91
Rate for Payer: Aetna Medicare Advantage	$1,498.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.60
Rate for Payer: Cigna Commercial	$2,497.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17
Rate for Payer: UnitedHealthcare Community & State	$157.83
Rate for Payer: Wellpoint Medicaid Managed Care	$141.84

FILTER GREENFIELD FEMORAL

Facility

$4,994.50

Service Code	HCPCS C1880
Hospital Charge Code	270601124
Hospital Revenue Code	278
Min. Negotiated Rate	$749.17
Max. Negotiated Rate	$1,208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17

FILTER GREENFIELD JUGULAR 12FR

Facility

$4,994.50

Hospital Charge Code	270601123
Hospital Revenue Code	278
Min. Negotiated Rate	$141.84
Max. Negotiated Rate	$2,497.25
Rate for Payer: Aetna Commercial	$1,897.91
Rate for Payer: Aetna Medicare Advantage	$1,498.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,273.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,273.60
Rate for Payer: Cigna Commercial	$2,497.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17
Rate for Payer: UnitedHealthcare Community & State	$157.83
Rate for Payer: Wellpoint Medicaid Managed Care	$141.84

FILTER GREENFIELD JUGULAR 12FR

Facility

$4,994.50

Hospital Charge Code	270601123
Hospital Revenue Code	278
Min. Negotiated Rate	$749.17
Max. Negotiated Rate	$1,208.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$998.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,208.67
Rate for Payer: Qualcare PPO/HMO/WC	$749.17

FILTER IVC JUGULAR W/ NAVALIGN

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270673332
Hospital Revenue Code	278
Min. Negotiated Rate	$149.10
Max. Negotiated Rate	$2,625.00
Rate for Payer: Aetna Commercial	$1,995.00
Rate for Payer: Aetna Medicare Advantage	$1,575.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,338.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,338.75
Rate for Payer: Cigna Commercial	$2,625.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50
Rate for Payer: UnitedHealthcare Community & State	$165.90
Rate for Payer: Wellpoint Medicaid Managed Care	$149.10

FILTER IVC JUGULAR W/ NAVALIGN

Facility

$5,250.00

Service Code	HCPCS C1880
Hospital Charge Code	270673332
Hospital Revenue Code	278
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,270.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,270.50
Rate for Payer: Qualcare PPO/HMO/WC	$787.50

FILTER LEUKOCYTE RCEZIT

Facility

$180.00

Hospital Charge Code	270626660
Hospital Revenue Code	272
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$27.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00

FILTER LEUKOCYTE RCEZIT

Facility

$180.00

Hospital Charge Code	270626660
Hospital Revenue Code	272
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$68.40
Rate for Payer: Aetna Medicare Advantage	$54.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.90
Rate for Payer: Cigna Commercial	$90.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.80
Rate for Payer: Oxford Commercial	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$27.00
Rate for Payer: UnitedHealthcare Commercial	$36.00
Rate for Payer: UnitedHealthcare Community & State	$5.69
Rate for Payer: Wellpoint Medicaid Managed Care	$5.11

FILTERLINE H SET ADULT/PEDS

Facility

$66.95

Hospital Charge Code	270652784
Hospital Revenue Code	270
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$33.48
Rate for Payer: Aetna Commercial	$25.44
Rate for Payer: Aetna Medicare Advantage	$20.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.07
Rate for Payer: Cigna Commercial	$33.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.41
Rate for Payer: Oxford Commercial	$13.39
Rate for Payer: Qualcare PPO/HMO/WC	$10.04
Rate for Payer: UnitedHealthcare Commercial	$13.39
Rate for Payer: UnitedHealthcare Community & State	$2.12
Rate for Payer: Wellpoint Medicaid Managed Care	$1.90

FILTERLINE H SET ADULT/PEDS

Facility

$66.95

Hospital Charge Code	270652784
Hospital Revenue Code	270
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Qualcare PPO/HMO/WC	$10.04

FILTERLINE W/O2 CONN F/CPAP/

Facility

$63.22

Hospital Charge Code	270674939
Hospital Revenue Code	272
Min. Negotiated Rate	$9.48
Max. Negotiated Rate	$9.48
Rate for Payer: Qualcare PPO/HMO/WC	$9.48

FILTERLINE W/O2 CONN F/CPAP/

Facility

$63.22

Hospital Charge Code	270674939
Hospital Revenue Code	272
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$31.61
Rate for Payer: Aetna Commercial	$24.02
Rate for Payer: Aetna Medicare Advantage	$18.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.12
Rate for Payer: Cigna Commercial	$31.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.44
Rate for Payer: Oxford Commercial	$12.64
Rate for Payer: Qualcare PPO/HMO/WC	$9.48
Rate for Payer: UnitedHealthcare Commercial	$12.64
Rate for Payer: UnitedHealthcare Community & State	$2.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1.80

Know your out-of-pocket cost for care.

All Charges