Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

TUBE SALEM SUMP 06200046180

Facility

$18.29

Hospital Charge Code	270302275
Hospital Revenue Code	272
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$2.74
Rate for Payer: Qualcare PPO/HMO/WC	$2.74

TUBE SALEM SUMP 12FR 48

Facility

$7.97

Service Code	HCPCS C1729
Hospital Charge Code	270649983
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.07
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

TUBE SALEM SUMP 12FR 48

Facility

$7.97

Service Code	HCPCS C1729
Hospital Charge Code	270649983
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

TUBE SALEM SUMP 14FR

Facility

$8.04

Service Code	HCPCS C1729
Hospital Charge Code	270649982
Hospital Revenue Code	278
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

TUBE SALEM SUMP 14FR

Facility

$8.04

Service Code	HCPCS C1729
Hospital Charge Code	270649982
Hospital Revenue Code	278
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1.61
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.95
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

TUBE SALEM SUMP 16FR

Facility

$8.04

Hospital Charge Code	270649942
Hospital Revenue Code	270
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

TUBE SALEM SUMP 16FR

Facility

$8.04

Hospital Charge Code	270649942
Hospital Revenue Code	270
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.09
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

TUBE SALEM SUMP 16FR 48

Facility

$5.63

Hospital Charge Code	270649981
Hospital Revenue Code	272
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

TUBE SALEM SUMP 16FR 48

Facility

$5.63

Hospital Charge Code	270649981
Hospital Revenue Code	272
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.18
Rate for Payer: Wellpoint Medicaid Managed Care	$0.16

TUBE SALEM SUMP 18FR

Facility

$8.04

Hospital Charge Code	270649939
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna Commercial	$3.06
Rate for Payer: Aetna Medicare Advantage	$2.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.05
Rate for Payer: Cigna Commercial	$4.02
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.09
Rate for Payer: Oxford Commercial	$1.61
Rate for Payer: Qualcare PPO/HMO/WC	$1.21
Rate for Payer: UnitedHealthcare Commercial	$1.61
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

TUBE SALEM SUMP 18FR

Facility

$8.04

Hospital Charge Code	270649939
Hospital Revenue Code	272
Min. Negotiated Rate	$1.21
Max. Negotiated Rate	$1.21
Rate for Payer: Qualcare PPO/HMO/WC	$1.21

TUBE SALEM SUMP 18FR 48

Facility

$7.97

Service Code	HCPCS C1729
Hospital Charge Code	270650091
Hospital Revenue Code	272
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare Advantage	$2.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.03
Rate for Payer: Cigna Commercial	$3.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.07
Rate for Payer: Oxford Commercial	$1.59
Rate for Payer: Qualcare PPO/HMO/WC	$1.20
Rate for Payer: UnitedHealthcare Commercial	$1.59
Rate for Payer: UnitedHealthcare Community & State	$0.25
Rate for Payer: Wellpoint Medicaid Managed Care	$0.23

TUBE SALEM SUMP 18FR 48

Facility

$7.97

Service Code	HCPCS C1729
Hospital Charge Code	270650091
Hospital Revenue Code	272
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.20

TUBE SET SMOKE PNEUMCLEAR

Facility

$165.22

Hospital Charge Code	270686704
Hospital Revenue Code	272
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$82.61
Rate for Payer: Aetna Commercial	$62.78
Rate for Payer: Aetna Medicare Advantage	$49.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$42.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$42.13
Rate for Payer: Cigna Commercial	$82.61
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$42.96
Rate for Payer: Oxford Commercial	$33.04
Rate for Payer: Qualcare PPO/HMO/WC	$24.78
Rate for Payer: UnitedHealthcare Commercial	$33.04
Rate for Payer: UnitedHealthcare Community & State	$5.22
Rate for Payer: Wellpoint Medicaid Managed Care	$4.69

TUBE SET SMOKE PNEUMCLEAR

Facility

$165.22

Hospital Charge Code	270686704
Hospital Revenue Code	272
Min. Negotiated Rate	$24.78
Max. Negotiated Rate	$24.78
Rate for Payer: Qualcare PPO/HMO/WC	$24.78

TUBE SILASTIC .03 X .065 10FT

Facility

$104.00

Hospital Charge Code	270332020
Hospital Revenue Code	272
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.60

TUBE SILASTIC .03 X .065 10FT

Facility

$104.00

Hospital Charge Code	270332020
Hospital Revenue Code	272
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$39.52
Rate for Payer: Aetna Medicare Advantage	$31.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.52
Rate for Payer: Cigna Commercial	$52.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$27.04
Rate for Payer: Oxford Commercial	$20.80
Rate for Payer: Qualcare PPO/HMO/WC	$15.60
Rate for Payer: UnitedHealthcare Commercial	$20.80
Rate for Payer: UnitedHealthcare Community & State	$3.29
Rate for Payer: Wellpoint Medicaid Managed Care	$2.95

TUBE SUCTION KAMVAC STD

Facility

$280.00

Hospital Charge Code	270676729
Hospital Revenue Code	272
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$42.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00

TUBE SUCTION KAMVAC STD

Facility

$280.00

Hospital Charge Code	270676729
Hospital Revenue Code	272
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$106.40
Rate for Payer: Aetna Medicare Advantage	$84.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$71.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$71.40
Rate for Payer: Cigna Commercial	$140.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$72.80
Rate for Payer: Oxford Commercial	$56.00
Rate for Payer: Qualcare PPO/HMO/WC	$42.00
Rate for Payer: UnitedHealthcare Commercial	$56.00
Rate for Payer: UnitedHealthcare Community & State	$8.85
Rate for Payer: Wellpoint Medicaid Managed Care	$7.95

TUBE SUCTION MULTIHOLE

Facility

$240.00

Hospital Charge Code	270667406
Hospital Revenue Code	272
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$36.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00

TUBE SUCTION MULTIHOLE

Facility

$240.00

Hospital Charge Code	270667406
Hospital Revenue Code	272
Min. Negotiated Rate	$6.82
Max. Negotiated Rate	$120.00
Rate for Payer: Aetna Commercial	$91.20
Rate for Payer: Aetna Medicare Advantage	$72.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$61.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$61.20
Rate for Payer: Cigna Commercial	$120.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.40
Rate for Payer: Oxford Commercial	$48.00
Rate for Payer: Qualcare PPO/HMO/WC	$36.00
Rate for Payer: UnitedHealthcare Commercial	$48.00
Rate for Payer: UnitedHealthcare Community & State	$7.58
Rate for Payer: Wellpoint Medicaid Managed Care	$6.82

TUBE SUCTION MULTIHOLE 5FR

Facility

$222.50

Hospital Charge Code	270667408
Hospital Revenue Code	272
Min. Negotiated Rate	$6.32
Max. Negotiated Rate	$111.25
Rate for Payer: Aetna Commercial	$84.55
Rate for Payer: Aetna Medicare Advantage	$66.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.74
Rate for Payer: Cigna Commercial	$111.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$57.85
Rate for Payer: Oxford Commercial	$44.50
Rate for Payer: Qualcare PPO/HMO/WC	$33.38
Rate for Payer: UnitedHealthcare Commercial	$44.50
Rate for Payer: UnitedHealthcare Community & State	$7.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.32

TUBE SUCTION MULTIHOLE 5FR

Facility

$222.50

Hospital Charge Code	270667408
Hospital Revenue Code	272
Min. Negotiated Rate	$33.38
Max. Negotiated Rate	$33.38
Rate for Payer: Qualcare PPO/HMO/WC	$33.38

TUBE T CATTELL DRAIN 14 FR

Facility

$37.82

Hospital Charge Code	270659383
Hospital Revenue Code	270
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$18.91
Rate for Payer: Aetna Commercial	$14.37
Rate for Payer: Aetna Medicare Advantage	$11.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.64
Rate for Payer: Cigna Commercial	$18.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.83
Rate for Payer: Oxford Commercial	$7.56
Rate for Payer: Qualcare PPO/HMO/WC	$5.67
Rate for Payer: UnitedHealthcare Commercial	$7.56
Rate for Payer: UnitedHealthcare Community & State	$1.20
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

TUBE T CATTELL DRAIN 14 FR

Facility

$37.82

Hospital Charge Code	270659383
Hospital Revenue Code	270
Min. Negotiated Rate	$5.67
Max. Negotiated Rate	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$5.67

Know your out-of-pocket cost for care.

All Charges