Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ECHO POR FMRL FPP NC 13X145MM

Facility

$13,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270694003
Hospital Revenue Code	278
Min. Negotiated Rate	$2,025.00
Max. Negotiated Rate	$3,267.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,267.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,025.00

ECHO POR FMRL FPP NC 14 X 150

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690626
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

ECHO POR FMRL FPP NC 14 X 150

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690626
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

ECHOPOR FMRLLAT FPP NC 16X160M

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697933
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

ECHOPOR FMRLLAT FPP NC 16X160M

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270697933
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

ECHO POR FMRL RPP NC 12 X 140

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691571
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

ECHO POR FMRL RPP NC 12 X 140

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270691571
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

ECHO POR RFMRL RPP NC 13X145MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690808
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.00
Max. Negotiated Rate	$2,541.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00

ECHO POR RFMRL RPP NC 13X145MM

Facility

$10,500.00

Service Code	HCPCS C1776
Hospital Charge Code	270690808
Hospital Revenue Code	278
Min. Negotiated Rate	$298.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: Aetna Commercial	$3,990.00
Rate for Payer: Aetna Medicare Advantage	$3,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,677.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,677.50
Rate for Payer: Cigna Commercial	$5,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,541.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,575.00
Rate for Payer: UnitedHealthcare Community & State	$331.80
Rate for Payer: Wellpoint Medicaid Managed Care	$298.20

ECHO TRANSESOPHAGEAL TEE

Facility

$5,900.00

Service Code	HCPCS 93312
Hospital Charge Code	5300124
Hospital Revenue Code	483
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$2,354.83
Rate for Payer: Aetna Commercial	$1,765.72
Rate for Payer: Aetna Medicare Advantage	$2,103.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,354.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,354.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$649.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$622.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,354.83
Rate for Payer: Cigna Commercial	$1,301.24
Rate for Payer: Cigna Medicare Advantage	$649.16
Rate for Payer: Clover Medicare Advantage	$616.70
Rate for Payer: EmblemHealth Commercial	$1,947.48
Rate for Payer: Humana Medicare Advantage	$668.63
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$649.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,534.00
Rate for Payer: Oxford Commercial	$2,338.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00
Rate for Payer: UnitedHealthcare Commercial	$2,244.00
Rate for Payer: UnitedHealthcare Community & State	$186.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$649.16
Rate for Payer: Wellcare Medicare Advantage	$649.16
Rate for Payer: Wellpoint Medicaid Managed Care	$167.56

ECHO TRANSESOPHAGEAL TEE

Facility

$5,900.00

Service Code	HCPCS 93312
Hospital Charge Code	5300124
Hospital Revenue Code	483
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

ECHOVIRUS AB (4,7,9,11,30 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 I

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038A
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ECHOVIRUS AB (4,7,9,11,30 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038B
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ECHOVIRUS AB (4,7,9,11,30 II

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 III

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038C
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ECHOVIRUS AB (4,7,9,11,30 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS AB (4,7,9,11,30 IV

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038D
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ECHOVIRUS AB (4,7,9,11,30 V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038E
Hospital Revenue Code	302
Min. Negotiated Rate	$11.08
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$148.20
Rate for Payer: Aetna Medicare Advantage	$117.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$99.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$99.45
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$101.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$58.50
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$12.32
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ECHOVIRUS AB (4,7,9,11,30 V

Facility

$390.00

Service Code	HCPCS 8665891
Hospital Charge Code	39990038E
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ECHOVIRUS ANTIBODIES

Facility

$261.00

Service Code	HCPCS 86658
Hospital Charge Code	38476150
Hospital Revenue Code	302
Min. Negotiated Rate	$39.15
Max. Negotiated Rate	$39.15
Rate for Payer: Qualcare PPO/HMO/WC	$39.15

ECHOVIRUS ANTIBODIES

Facility

$261.00

Service Code	HCPCS 86658
Hospital Charge Code	38476150
Hospital Revenue Code	302
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.44
Rate for Payer: Aetna Medicare Advantage	$42.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.27
Rate for Payer: Cigna Commercial	$130.50
Rate for Payer: Cigna Medicare Advantage	$13.03
Rate for Payer: Clover Medicare Advantage	$12.38
Rate for Payer: EmblemHealth Commercial	$39.09
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$67.86
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$39.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.03
Rate for Payer: Wellcare Medicare Advantage	$13.03
Rate for Payer: Wellpoint Medicaid Managed Care	$7.41

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$690,044.28

Service Code	MSDRG 003
Min. Negotiated Rate	$210,109.64
Max. Negotiated Rate	$690,044.28
Rate for Payer: Aetna Medicare Advantage	$690,044.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$590,670.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$590,670.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$221,168.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$590,670.60
Rate for Payer: Cigna Commercial	$473,173.38
Rate for Payer: Cigna Medicare Advantage	$221,168.04
Rate for Payer: Clover Medicare Advantage	$210,109.64
Rate for Payer: EmblemHealth Commercial	$663,504.12
Rate for Payer: Humana Medicare Advantage	$227,803.08
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$221,168.04
Rate for Payer: Oxford Commercial	$373,988.02
Rate for Payer: UnitedHealthcare Commercial	$500,596.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$221,168.04
Rate for Payer: Wellcare Medicare Advantage	$221,168.04

ECNMY ULTRASND GEL 5 LTRE CUBE

Facility

$62.75

Hospital Charge Code	270663149
Hospital Revenue Code	270
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$31.38
Rate for Payer: Aetna Commercial	$23.84
Rate for Payer: Aetna Medicare Advantage	$18.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.00
Rate for Payer: Cigna Commercial	$31.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.32
Rate for Payer: Oxford Commercial	$12.55
Rate for Payer: Qualcare PPO/HMO/WC	$9.41
Rate for Payer: UnitedHealthcare Commercial	$12.55
Rate for Payer: UnitedHealthcare Community & State	$1.98
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

Know your out-of-pocket cost for care.

All Charges