Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

BREAST SIZER 500CC

Facility

$1,500.00

Hospital Charge Code	270672834
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 500CC

Facility

$1,500.00

Hospital Charge Code	270672834
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 550CC

Facility

$1,500.00

Hospital Charge Code	270672835
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 550CC

Facility

$1,500.00

Hospital Charge Code	270672835
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 600CC

Facility

$1,500.00

Hospital Charge Code	270675851
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 600CC

Facility

$1,500.00

Hospital Charge Code	270675851
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 650CC

Facility

$1,500.00

Hospital Charge Code	270675850
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 650CC

Facility

$1,500.00

Hospital Charge Code	270675850
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 700CC

Facility

$1,500.00

Hospital Charge Code	270674070
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 700CC

Facility

$1,500.00

Hospital Charge Code	270674070
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 750CC

Facility

$1,500.00

Hospital Charge Code	270674071
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREAST SIZER 750CC

Facility

$1,500.00

Hospital Charge Code	270674071
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 800CC

Facility

$1,500.00

Hospital Charge Code	270674072
Hospital Revenue Code	278
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$570.00
Rate for Payer: Aetna Medicare Advantage	$450.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$382.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$382.50
Rate for Payer: Cigna Commercial	$750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00
Rate for Payer: UnitedHealthcare Community & State	$47.40
Rate for Payer: Wellpoint Medicaid Managed Care	$42.60

BREAST SIZER 800CC

Facility

$1,500.00

Hospital Charge Code	270674072
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$363.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$363.00
Rate for Payer: Qualcare PPO/HMO/WC	$225.00

BREATHING CIRCUIT MODIFIED

Facility

$59.00

Hospital Charge Code	270331542
Hospital Revenue Code	272
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

BREATHING CIRCUIT MODIFIED

Facility

$59.00

Hospital Charge Code	270331542
Hospital Revenue Code	272
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$29.50
Rate for Payer: Aetna Commercial	$22.42
Rate for Payer: Aetna Medicare Advantage	$17.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.04
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$11.80
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$11.80
Rate for Payer: UnitedHealthcare Community & State	$1.86
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

BREO ELLIPTA 100 MCG

Facility

$37.72

Service Code	NDC 173085914
Hospital Charge Code	606390199
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$5.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.66

BREO ELLIPTA 100 MCG

Facility

$37.72

Service Code	NDC 173085914
Hospital Charge Code	606390199
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$14.33
Rate for Payer: Aetna Medicare Advantage	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.62
Rate for Payer: Cigna Commercial	$18.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.81
Rate for Payer: Oxford Commercial	$7.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.66
Rate for Payer: UnitedHealthcare Commercial	$7.54
Rate for Payer: UnitedHealthcare Community & State	$1.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

BREO ELLIPTA 200 MCG

Facility

$37.72

Service Code	NDC 173088214
Hospital Charge Code	606390200
Hospital Revenue Code	250
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$5.66
Rate for Payer: Qualcare PPO/HMO/WC	$5.66

BREO ELLIPTA 200 MCG

Facility

$37.72

Service Code	NDC 173088214
Hospital Charge Code	606390200
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$14.33
Rate for Payer: Aetna Medicare Advantage	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.62
Rate for Payer: Cigna Commercial	$18.86
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.81
Rate for Payer: Oxford Commercial	$7.54
Rate for Payer: Qualcare PPO/HMO/WC	$5.66
Rate for Payer: UnitedHealthcare Commercial	$7.54
Rate for Payer: UnitedHealthcare Community & State	$1.19
Rate for Payer: Wellpoint Medicaid Managed Care	$1.07

BRETHINE/5MG/TAB

Facility

$44.56

Service Code	NDC 527131101
Hospital Charge Code	60632578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.68
Max. Negotiated Rate	$6.68
Rate for Payer: Qualcare PPO/HMO/WC	$6.68

BRETHINE/5MG/TAB

Facility

$44.56

Service Code	NDC 527131101
Hospital Charge Code	60632578
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$22.28
Rate for Payer: Aetna Commercial	$16.93
Rate for Payer: Aetna Medicare Advantage	$13.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.36
Rate for Payer: Cigna Commercial	$22.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.59
Rate for Payer: Oxford Commercial	$8.91
Rate for Payer: Qualcare PPO/HMO/WC	$6.68
Rate for Payer: UnitedHealthcare Commercial	$8.91
Rate for Payer: UnitedHealthcare Community & State	$1.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.27

BRG HIP ACT ARTIC E1 28X 42MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270680808
Hospital Revenue Code	278
Min. Negotiated Rate	$498.42
Max. Negotiated Rate	$8,775.00
Rate for Payer: Aetna Commercial	$6,669.00
Rate for Payer: Aetna Medicare Advantage	$5,265.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,475.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,475.25
Rate for Payer: Cigna Commercial	$8,775.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50
Rate for Payer: UnitedHealthcare Community & State	$554.58
Rate for Payer: Wellpoint Medicaid Managed Care	$498.42

BRG HIP ACT ARTIC E1 28X 42MM

Facility

$17,550.00

Service Code	HCPCS C1776
Hospital Charge Code	270680808
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.50
Max. Negotiated Rate	$4,247.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,510.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,247.10
Rate for Payer: Qualcare PPO/HMO/WC	$2,632.50

BRIDGE 12CC (SINGLE)

Facility

$10,383.75

Hospital Charge Code	671263
Hospital Revenue Code	278
Min. Negotiated Rate	$294.90
Max. Negotiated Rate	$5,191.88
Rate for Payer: Aetna Commercial	$3,945.82
Rate for Payer: Aetna Medicare Advantage	$3,115.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,647.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,076.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,647.86
Rate for Payer: Cigna Commercial	$5,191.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,512.87
Rate for Payer: Qualcare PPO/HMO/WC	$1,557.56
Rate for Payer: UnitedHealthcare Community & State	$328.13
Rate for Payer: Wellpoint Medicaid Managed Care	$294.90

Know your out-of-pocket cost for care.

All Charges