Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MASK FULL FACE MED DISP VENTED

Facility

$113.73

Hospital Charge Code	270652271
Hospital Revenue Code	270
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$17.06
Rate for Payer: Qualcare PPO/HMO/WC	$17.06

MASK FULL FACE MED DISP VENTED

Facility

$113.73

Hospital Charge Code	270652271
Hospital Revenue Code	270
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$56.87
Rate for Payer: Aetna Commercial	$43.22
Rate for Payer: Aetna Medicare Advantage	$34.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$29.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$29.00
Rate for Payer: Cigna Commercial	$56.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.57
Rate for Payer: Oxford Commercial	$22.75
Rate for Payer: Qualcare PPO/HMO/WC	$17.06
Rate for Payer: UnitedHealthcare Commercial	$22.75
Rate for Payer: UnitedHealthcare Community & State	$3.59
Rate for Payer: Wellpoint Medicaid Managed Care	$3.23

MASK FULL FACE SM DISP VENTED

Facility

$111.66

Hospital Charge Code	270652272
Hospital Revenue Code	270
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$55.83
Rate for Payer: Aetna Commercial	$42.43
Rate for Payer: Aetna Medicare Advantage	$33.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$28.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$28.47
Rate for Payer: Cigna Commercial	$55.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$29.03
Rate for Payer: Oxford Commercial	$22.33
Rate for Payer: Qualcare PPO/HMO/WC	$16.75
Rate for Payer: UnitedHealthcare Commercial	$22.33
Rate for Payer: UnitedHealthcare Community & State	$3.53
Rate for Payer: Wellpoint Medicaid Managed Care	$3.17

MASK FULL FACE SM DISP VENTED

Facility

$111.66

Hospital Charge Code	270652272
Hospital Revenue Code	270
Min. Negotiated Rate	$16.75
Max. Negotiated Rate	$16.75
Rate for Payer: Qualcare PPO/HMO/WC	$16.75

MASK LARYL SFTSL SZ3 100220300

Facility

$56.65

Hospital Charge Code	270634373
Hospital Revenue Code	272
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Qualcare PPO/HMO/WC	$8.50

MASK LARYL SFTSL SZ3 100220300

Facility

$56.65

Hospital Charge Code	270634373
Hospital Revenue Code	272
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$28.32
Rate for Payer: Aetna Commercial	$21.53
Rate for Payer: Aetna Medicare Advantage	$17.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.45
Rate for Payer: Cigna Commercial	$28.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$14.73
Rate for Payer: Oxford Commercial	$11.33
Rate for Payer: Qualcare PPO/HMO/WC	$8.50
Rate for Payer: UnitedHealthcare Commercial	$11.33
Rate for Payer: UnitedHealthcare Community & State	$1.79
Rate for Payer: Wellpoint Medicaid Managed Care	$1.61

MASK LARYN AIRWAY SZ #2 125020

Facility

$33.32

Hospital Charge Code	270642066
Hospital Revenue Code	272
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Qualcare PPO/HMO/WC	$5.00

MASK LARYN AIRWAY SZ #2 125020

Facility

$33.32

Hospital Charge Code	270642066
Hospital Revenue Code	272
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$16.66
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: Aetna Medicare Advantage	$10.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.50
Rate for Payer: Cigna Commercial	$16.66
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.66
Rate for Payer: Oxford Commercial	$6.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.00
Rate for Payer: UnitedHealthcare Commercial	$6.66
Rate for Payer: UnitedHealthcare Community & State	$1.05
Rate for Payer: Wellpoint Medicaid Managed Care	$0.95

MASK LARYNGEAL AIRWAY #3 SILI-

Facility

$210.00

Hospital Charge Code	2706453779
Hospital Revenue Code	272
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$79.80
Rate for Payer: Aetna Medicare Advantage	$63.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.55
Rate for Payer: Cigna Commercial	$105.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.60
Rate for Payer: Oxford Commercial	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.50
Rate for Payer: UnitedHealthcare Commercial	$42.00
Rate for Payer: UnitedHealthcare Community & State	$6.64
Rate for Payer: Wellpoint Medicaid Managed Care	$5.96

MASK LARYNGEAL AIRWAY #3 SILI-

Facility

$210.00

Hospital Charge Code	2706453779
Hospital Revenue Code	272
Min. Negotiated Rate	$31.50
Max. Negotiated Rate	$31.50
Rate for Payer: Qualcare PPO/HMO/WC	$31.50

MASK LARYNGEAL UNIQUE#5 125050

Facility

$33.97

Hospital Charge Code	270643108
Hospital Revenue Code	272
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$16.98
Rate for Payer: Aetna Commercial	$12.91
Rate for Payer: Aetna Medicare Advantage	$10.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.66
Rate for Payer: Cigna Commercial	$16.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.83
Rate for Payer: Oxford Commercial	$6.79
Rate for Payer: Qualcare PPO/HMO/WC	$5.10
Rate for Payer: UnitedHealthcare Commercial	$6.79
Rate for Payer: UnitedHealthcare Community & State	$1.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.96

MASK LARYNGEAL UNIQUE#5 125050

Facility

$33.97

Hospital Charge Code	270643108
Hospital Revenue Code	272
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$5.10
Rate for Payer: Qualcare PPO/HMO/WC	$5.10

MASK LMA #2 DISP

Facility

$29.20

Hospital Charge Code	270677272
Hospital Revenue Code	272
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$14.60
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna Medicare Advantage	$8.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.45
Rate for Payer: Cigna Commercial	$14.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.59
Rate for Payer: Oxford Commercial	$5.84
Rate for Payer: Qualcare PPO/HMO/WC	$4.38
Rate for Payer: UnitedHealthcare Commercial	$5.84
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$0.83

MASK LMA #2 DISP

Facility

$29.20

Hospital Charge Code	270677272
Hospital Revenue Code	272
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$4.38
Rate for Payer: Qualcare PPO/HMO/WC	$4.38

MASK LMA #3 DISP

Facility

$45.00

Hospital Charge Code	270660640
Hospital Revenue Code	272
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$6.75
Rate for Payer: Qualcare PPO/HMO/WC	$6.75

MASK LMA #3 DISP

Facility

$45.00

Hospital Charge Code	270660640
Hospital Revenue Code	272
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$17.10
Rate for Payer: Aetna Medicare Advantage	$13.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.47
Rate for Payer: Cigna Commercial	$22.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.70
Rate for Payer: Oxford Commercial	$9.00
Rate for Payer: Qualcare PPO/HMO/WC	$6.75
Rate for Payer: UnitedHealthcare Commercial	$9.00
Rate for Payer: UnitedHealthcare Community & State	$1.42
Rate for Payer: Wellpoint Medicaid Managed Care	$1.28

MASK LMA #3 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627294
Hospital Revenue Code	272
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$13.03
Rate for Payer: Aetna Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.74
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.92
Rate for Payer: Oxford Commercial	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$6.86
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

MASK LMA #3 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627294
Hospital Revenue Code	272
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

MASK LMA #4 AURA ST

Facility

$40.90

Hospital Charge Code	270660641
Hospital Revenue Code	272
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$20.45
Rate for Payer: Aetna Commercial	$15.54
Rate for Payer: Aetna Medicare Advantage	$12.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.43
Rate for Payer: Cigna Commercial	$20.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.63
Rate for Payer: Oxford Commercial	$8.18
Rate for Payer: Qualcare PPO/HMO/WC	$6.13
Rate for Payer: UnitedHealthcare Commercial	$8.18
Rate for Payer: UnitedHealthcare Community & State	$1.29
Rate for Payer: Wellpoint Medicaid Managed Care	$1.16

MASK LMA #4 AURA ST

Facility

$40.90

Hospital Charge Code	270660641
Hospital Revenue Code	272
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$6.13
Rate for Payer: Qualcare PPO/HMO/WC	$6.13

MASK LMA #4 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627295
Hospital Revenue Code	272
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$13.03
Rate for Payer: Aetna Medicare Advantage	$10.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.74
Rate for Payer: Cigna Commercial	$17.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.92
Rate for Payer: Oxford Commercial	$6.86
Rate for Payer: Qualcare PPO/HMO/WC	$5.14
Rate for Payer: UnitedHealthcare Commercial	$6.86
Rate for Payer: UnitedHealthcare Community & State	$1.08
Rate for Payer: Wellpoint Medicaid Managed Care	$0.97

MASK LMA #4 UNIQUE STD

Facility

$34.29

Hospital Charge Code	270627295
Hospital Revenue Code	272
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$5.14
Rate for Payer: Qualcare PPO/HMO/WC	$5.14

MASK LMA DISPOSIBLE SIZE #5

Facility

$90.80

Hospital Charge Code	270660642
Hospital Revenue Code	272
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$13.62
Rate for Payer: Qualcare PPO/HMO/WC	$13.62

MASK LMA DISPOSIBLE SIZE #5

Facility

$90.80

Hospital Charge Code	270660642
Hospital Revenue Code	272
Min. Negotiated Rate	$2.58
Max. Negotiated Rate	$45.40
Rate for Payer: Aetna Commercial	$34.50
Rate for Payer: Aetna Medicare Advantage	$27.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23.15
Rate for Payer: Cigna Commercial	$45.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.61
Rate for Payer: Oxford Commercial	$18.16
Rate for Payer: Qualcare PPO/HMO/WC	$13.62
Rate for Payer: UnitedHealthcare Commercial	$18.16
Rate for Payer: UnitedHealthcare Community & State	$2.87
Rate for Payer: Wellpoint Medicaid Managed Care	$2.58

MASK LMA SUPREME #3

Facility

$150.00

Hospital Charge Code	270642545
Hospital Revenue Code	272
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$57.00
Rate for Payer: Aetna Medicare Advantage	$45.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$38.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$38.25
Rate for Payer: Cigna Commercial	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.00
Rate for Payer: Oxford Commercial	$30.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.50
Rate for Payer: UnitedHealthcare Commercial	$30.00
Rate for Payer: UnitedHealthcare Community & State	$4.74
Rate for Payer: Wellpoint Medicaid Managed Care	$4.26

Know your out-of-pocket cost for care.

All Charges