Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

MASK LMA SUPREME #3

Facility

$150.00

Hospital Charge Code	270642545
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MASK LMA SUPREME #4

Facility

$150.00

Hospital Charge Code	270642546
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

MASK LMA SUPREME #4

Facility

$150.00

Hospital Charge Code	270642546
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MASK LMA SUPREME #5

Facility

$150.00

Hospital Charge Code	270642547
Hospital Revenue Code	272
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: Qualcare PPO/HMO/WC	$22.50

MASK LMA SUPREME #5

Facility

$150.00

Hospital Charge Code	270642547
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

MASK MULTI LOW CONC - VENTI

Facility

$5.90

Hospital Charge Code	270200155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$2.95
Rate for Payer: Aetna Commercial	$2.24
Rate for Payer: Aetna Medicare Advantage	$1.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.50
Rate for Payer: Cigna Commercial	$2.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.53
Rate for Payer: Oxford Commercial	$1.18
Rate for Payer: Qualcare PPO/HMO/WC	$0.89
Rate for Payer: UnitedHealthcare Commercial	$1.18
Rate for Payer: UnitedHealthcare Community & State	$0.19
Rate for Payer: Wellpoint Medicaid Managed Care	$0.17

MASK MULTI LOW CONC - VENTI

Facility

$5.90

Hospital Charge Code	270200155
Hospital Revenue Code	270
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Qualcare PPO/HMO/WC	$0.89

MASK NIVAIRO FULL FACE SMALL

Facility

$136.63

Hospital Charge Code	270683683
Hospital Revenue Code	272
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$68.31
Rate for Payer: Aetna Commercial	$51.92
Rate for Payer: Aetna Medicare Advantage	$40.99
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.84
Rate for Payer: Cigna Commercial	$68.31
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$35.52
Rate for Payer: Oxford Commercial	$27.33
Rate for Payer: Qualcare PPO/HMO/WC	$20.49
Rate for Payer: UnitedHealthcare Commercial	$27.33
Rate for Payer: UnitedHealthcare Community & State	$4.32
Rate for Payer: Wellpoint Medicaid Managed Care	$3.88

MASK NIVAIRO FULL FACE SMALL

Facility

$136.63

Hospital Charge Code	270683683
Hospital Revenue Code	272
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$20.49
Rate for Payer: Qualcare PPO/HMO/WC	$20.49

MASK NON REBREATHER

Facility

$7.02

Hospital Charge Code	270200135
Hospital Revenue Code	272
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$1.05
Rate for Payer: Qualcare PPO/HMO/WC	$1.05

MASK NON REBREATHER

Facility

$7.02

Hospital Charge Code	270200135
Hospital Revenue Code	272
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare Advantage	$2.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.79
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.79
Rate for Payer: Cigna Commercial	$3.51
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.83
Rate for Payer: Oxford Commercial	$1.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.05
Rate for Payer: UnitedHealthcare Commercial	$1.40
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.20

MASK O2 PEDIATRIC 3 IN1

Facility

$278.65

Hospital Charge Code	270653961
Hospital Revenue Code	270
Min. Negotiated Rate	$7.91
Max. Negotiated Rate	$139.32
Rate for Payer: Aetna Commercial	$105.89
Rate for Payer: Aetna Medicare Advantage	$83.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.06
Rate for Payer: Cigna Commercial	$139.32
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.45
Rate for Payer: Oxford Commercial	$55.73
Rate for Payer: Qualcare PPO/HMO/WC	$41.80
Rate for Payer: UnitedHealthcare Commercial	$55.73
Rate for Payer: UnitedHealthcare Community & State	$8.81
Rate for Payer: Wellpoint Medicaid Managed Care	$7.91

MASK O2 PEDIATRIC 3 IN1

Facility

$278.65

Hospital Charge Code	270653961
Hospital Revenue Code	270
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$41.80
Rate for Payer: Qualcare PPO/HMO/WC	$41.80

MASK OXYGEN NON-REBREATHER

Facility

$11.55

Hospital Charge Code	270654268
Hospital Revenue Code	270
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$5.78
Rate for Payer: Aetna Commercial	$4.39
Rate for Payer: Aetna Medicare Advantage	$3.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.95
Rate for Payer: Cigna Commercial	$5.78
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.00
Rate for Payer: Oxford Commercial	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$1.73
Rate for Payer: UnitedHealthcare Commercial	$2.31
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.33

MASK OXYGEN NON-REBREATHER

Facility

$11.55

Hospital Charge Code	270654268
Hospital Revenue Code	270
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$1.73
Rate for Payer: Qualcare PPO/HMO/WC	$1.73

MASK PEDIATRIC DRAGON

Facility

$170.90

Hospital Charge Code	270630009
Hospital Revenue Code	270
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$85.45
Rate for Payer: Aetna Commercial	$64.94
Rate for Payer: Aetna Medicare Advantage	$51.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.58
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.58
Rate for Payer: Cigna Commercial	$85.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$44.43
Rate for Payer: Oxford Commercial	$34.18
Rate for Payer: Qualcare PPO/HMO/WC	$25.64
Rate for Payer: UnitedHealthcare Commercial	$34.18
Rate for Payer: UnitedHealthcare Community & State	$5.40
Rate for Payer: Wellpoint Medicaid Managed Care	$4.85

MASK PEDIATRIC DRAGON

Facility

$170.90

Hospital Charge Code	270630009
Hospital Revenue Code	270
Min. Negotiated Rate	$25.64
Max. Negotiated Rate	$25.64
Rate for Payer: Qualcare PPO/HMO/WC	$25.64

MASK PED MAN RES CHILD

Facility

$48.03

Hospital Charge Code	270669811
Hospital Revenue Code	270
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$7.20
Rate for Payer: Qualcare PPO/HMO/WC	$7.20

MASK PED MAN RES CHILD

Facility

$48.03

Hospital Charge Code	270669811
Hospital Revenue Code	270
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$24.02
Rate for Payer: Aetna Commercial	$18.25
Rate for Payer: Aetna Medicare Advantage	$14.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.25
Rate for Payer: Cigna Commercial	$24.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.49
Rate for Payer: Oxford Commercial	$9.61
Rate for Payer: Qualcare PPO/HMO/WC	$7.20
Rate for Payer: UnitedHealthcare Commercial	$9.61
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

MASK PERCENT O2 ADULT DISP

Facility

$250.30

Hospital Charge Code	270653960
Hospital Revenue Code	270
Min. Negotiated Rate	$37.55
Max. Negotiated Rate	$37.55
Rate for Payer: Qualcare PPO/HMO/WC	$37.55

MASK PERCENT O2 ADULT DISP

Facility

$250.30

Hospital Charge Code	270653960
Hospital Revenue Code	270
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$125.15
Rate for Payer: Aetna Commercial	$95.11
Rate for Payer: Aetna Medicare Advantage	$75.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.83
Rate for Payer: Cigna Commercial	$125.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.08
Rate for Payer: Oxford Commercial	$50.06
Rate for Payer: Qualcare PPO/HMO/WC	$37.55
Rate for Payer: UnitedHealthcare Commercial	$50.06
Rate for Payer: UnitedHealthcare Community & State	$7.91
Rate for Payer: Wellpoint Medicaid Managed Care	$7.11

MASK RESPIRATOR REGULAR SIZE

Facility

$51.75

Hospital Charge Code	270652718
Hospital Revenue Code	270
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$7.76
Rate for Payer: Qualcare PPO/HMO/WC	$7.76

MASK RESPIRATOR REGULAR SIZE

Facility

$51.75

Hospital Charge Code	270652718
Hospital Revenue Code	270
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$25.88
Rate for Payer: Aetna Commercial	$19.66
Rate for Payer: Aetna Medicare Advantage	$15.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$13.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$13.20
Rate for Payer: Cigna Commercial	$25.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.46
Rate for Payer: Oxford Commercial	$10.35
Rate for Payer: Qualcare PPO/HMO/WC	$7.76
Rate for Payer: UnitedHealthcare Commercial	$10.35
Rate for Payer: UnitedHealthcare Community & State	$1.64
Rate for Payer: Wellpoint Medicaid Managed Care	$1.47

MASK TRACHEOSTOMY ADULT

Facility

$11.25

Hospital Charge Code	270606305
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$1.69
Rate for Payer: Qualcare PPO/HMO/WC	$1.69

MASK TRACHEOSTOMY ADULT

Facility

$11.25

Hospital Charge Code	270606305
Hospital Revenue Code	272
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$5.62
Rate for Payer: Aetna Commercial	$4.28
Rate for Payer: Aetna Medicare Advantage	$3.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.87
Rate for Payer: Cigna Commercial	$5.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Oxford Commercial	$2.25
Rate for Payer: Qualcare PPO/HMO/WC	$1.69
Rate for Payer: UnitedHealthcare Commercial	$2.25
Rate for Payer: UnitedHealthcare Community & State	$0.36
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

Know your out-of-pocket cost for care.

All Charges