Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ETHAMBUTOL 400 MG TAB

Facility

$11.93

Service Code	NDC 68850001202
Hospital Charge Code	6009435
Hospital Revenue Code	251
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$1.79
Rate for Payer: Qualcare PPO/HMO/WC	$1.79

ETHANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3077073
Hospital Revenue Code	306
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna Medicare Advantage	$200.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$170.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$170.24
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$173.57
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$100.14
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ETHANOL

Facility

$667.59

Service Code	HCPCS 80320
Hospital Charge Code	3077073
Hospital Revenue Code	306
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$100.14
Rate for Payer: Qualcare PPO/HMO/WC	$100.14

ETHANOL 98% INJ

Facility

$953.95

Service Code	NDC 517857510
Hospital Charge Code	60628527
Hospital Revenue Code	250
Min. Negotiated Rate	$27.09
Max. Negotiated Rate	$476.98
Rate for Payer: Aetna Commercial	$362.50
Rate for Payer: Aetna Medicare Advantage	$286.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$243.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$243.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$243.26
Rate for Payer: Cigna Commercial	$476.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$248.03
Rate for Payer: Oxford Commercial	$190.79
Rate for Payer: Qualcare PPO/HMO/WC	$143.09
Rate for Payer: UnitedHealthcare Commercial	$190.79
Rate for Payer: UnitedHealthcare Community & State	$30.14
Rate for Payer: Wellpoint Medicaid Managed Care	$27.09

ETHANOL 98% INJ

Facility

$953.95

Service Code	NDC 517857510
Hospital Charge Code	60628527
Hospital Revenue Code	250
Min. Negotiated Rate	$143.09
Max. Negotiated Rate	$143.09
Rate for Payer: Qualcare PPO/HMO/WC	$143.09

ETHANOLAMINEOLEATE 50MG/ML 2ML

Facility

$1,563.78

Service Code	HCPCS J1430
Hospital Charge Code	60632280
Hospital Revenue Code	636
Min. Negotiated Rate	$234.57
Max. Negotiated Rate	$378.43
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.43
Rate for Payer: Qualcare PPO/HMO/WC	$234.57

ETHANOLAMINEOLEATE 50MG/ML 2ML

Facility

$1,563.78

Service Code	HCPCS J1430
Hospital Charge Code	60632280
Hospital Revenue Code	636
Min. Negotiated Rate	$44.41
Max. Negotiated Rate	$1,881.33
Rate for Payer: Aetna Commercial	$1,410.67
Rate for Payer: Aetna Medicare Advantage	$1,680.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,881.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,881.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$518.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$549.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,881.33
Rate for Payer: Cigna Medicare Advantage	$518.63
Rate for Payer: Clover Medicare Advantage	$492.70
Rate for Payer: EmblemHealth Commercial	$1,555.89
Rate for Payer: Humana Medicare Advantage	$534.19
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$518.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$378.43
Rate for Payer: Qualcare PPO/HMO/WC	$234.57
Rate for Payer: UnitedHealthcare Community & State	$49.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$518.63
Rate for Payer: Wellcare Medicare Advantage	$518.63
Rate for Payer: Wellpoint Medicaid Managed Care	$44.41

ETHICON CAP(384.75)+RETRACTOR

Facility

$707.00

Hospital Charge Code	270335972
Hospital Revenue Code	272
Min. Negotiated Rate	$20.08
Max. Negotiated Rate	$353.50
Rate for Payer: Aetna Commercial	$268.66
Rate for Payer: Aetna Medicare Advantage	$212.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$180.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$180.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$180.28
Rate for Payer: Cigna Commercial	$353.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$183.82
Rate for Payer: Oxford Commercial	$141.40
Rate for Payer: Qualcare PPO/HMO/WC	$106.05
Rate for Payer: UnitedHealthcare Commercial	$141.40
Rate for Payer: UnitedHealthcare Community & State	$22.34
Rate for Payer: Wellpoint Medicaid Managed Care	$20.08

ETHICON CAP(384.75)+RETRACTOR

Facility

$707.00

Hospital Charge Code	270335972
Hospital Revenue Code	272
Min. Negotiated Rate	$106.05
Max. Negotiated Rate	$106.05
Rate for Payer: Qualcare PPO/HMO/WC	$106.05

ETHICON PHYSIOMESH

Facility

$345.00

Hospital Charge Code	270335977
Hospital Revenue Code	278
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$172.50
Rate for Payer: Aetna Commercial	$131.10
Rate for Payer: Aetna Medicare Advantage	$103.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.97
Rate for Payer: Cigna Commercial	$172.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.49
Rate for Payer: Qualcare PPO/HMO/WC	$51.75
Rate for Payer: UnitedHealthcare Community & State	$10.90
Rate for Payer: Wellpoint Medicaid Managed Care	$9.80

ETHICON PHYSIOMESH

Facility

$345.00

Hospital Charge Code	270335977
Hospital Revenue Code	278
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$83.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$69.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$83.49
Rate for Payer: Qualcare PPO/HMO/WC	$51.75

ETHICON P MESH-PHY151V 15X15CM

Facility

$843.00

Hospital Charge Code	270335978
Hospital Revenue Code	278
Min. Negotiated Rate	$126.45
Max. Negotiated Rate	$204.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: Qualcare PPO/HMO/WC	$126.45

ETHICON P MESH-PHY151V 15X15CM

Facility

$843.00

Hospital Charge Code	270335978
Hospital Revenue Code	278
Min. Negotiated Rate	$23.94
Max. Negotiated Rate	$421.50
Rate for Payer: Aetna Commercial	$320.34
Rate for Payer: Aetna Medicare Advantage	$252.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$214.97
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$168.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$214.97
Rate for Payer: Cigna Commercial	$421.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$204.01
Rate for Payer: Qualcare PPO/HMO/WC	$126.45
Rate for Payer: UnitedHealthcare Community & State	$26.64
Rate for Payer: Wellpoint Medicaid Managed Care	$23.94

ETHIC PHY MASH 1520V 15X20 CM

Facility

$1,500.00

Hospital Charge Code	270335979
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

ETHIC PHY MASH 1520V 15X20 CM

Facility

$1,500.00

Hospital Charge Code	270335979
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

ETHIPACK STEEL 3-0 18 STR DS30

Facility

$59.60

Hospital Charge Code	270625531
Hospital Revenue Code	272
Min. Negotiated Rate	$8.94
Max. Negotiated Rate	$8.94
Rate for Payer: Qualcare PPO/HMO/WC	$8.94

ETHIPACK STEEL 3-0 18 STR DS30

Facility

$59.60

Hospital Charge Code	270625531
Hospital Revenue Code	272
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$29.80
Rate for Payer: Aetna Commercial	$22.65
Rate for Payer: Aetna Medicare Advantage	$17.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15.20
Rate for Payer: Cigna Commercial	$29.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.50
Rate for Payer: Oxford Commercial	$11.92
Rate for Payer: Qualcare PPO/HMO/WC	$8.94
Rate for Payer: UnitedHealthcare Commercial	$11.92
Rate for Payer: UnitedHealthcare Community & State	$1.88
Rate for Payer: Wellpoint Medicaid Managed Care	$1.69

ETHI PHY MESH 2025V 20X25CM

Facility

$1,215.00

Hospital Charge Code	270335980
Hospital Revenue Code	278
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$607.50
Rate for Payer: Aetna Commercial	$461.70
Rate for Payer: Aetna Medicare Advantage	$364.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.82
Rate for Payer: Cigna Commercial	$607.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25
Rate for Payer: UnitedHealthcare Community & State	$38.39
Rate for Payer: Wellpoint Medicaid Managed Care	$34.51

ETHI PHY MESH 2025V 20X25CM

Facility

$1,215.00

Hospital Charge Code	270335980
Hospital Revenue Code	278
Min. Negotiated Rate	$182.25
Max. Negotiated Rate	$294.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$243.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$294.03
Rate for Payer: Qualcare PPO/HMO/WC	$182.25

ETHI PHY MESH 2535 V 25X35CM

Facility

$3,500.00

Hospital Charge Code	270335981
Hospital Revenue Code	278
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$1,750.00
Rate for Payer: Aetna Commercial	$1,330.00
Rate for Payer: Aetna Medicare Advantage	$1,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$892.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$892.50
Rate for Payer: Cigna Commercial	$1,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00
Rate for Payer: UnitedHealthcare Community & State	$110.60
Rate for Payer: Wellpoint Medicaid Managed Care	$99.40

ETHI PHY MESH 2535 V 25X35CM

Facility

$3,500.00

Hospital Charge Code	270335981
Hospital Revenue Code	278
Min. Negotiated Rate	$525.00
Max. Negotiated Rate	$847.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$847.00
Rate for Payer: Qualcare PPO/HMO/WC	$525.00

ETHYL ALCOHOL

Facility

$662.29

Service Code	HCPCS 80320
Hospital Charge Code	3000411
Hospital Revenue Code	301
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$331.14
Rate for Payer: Aetna Commercial	$251.67
Rate for Payer: Aetna Medicare Advantage	$198.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.88
Rate for Payer: Cigna Commercial	$331.14
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$172.20
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$99.34
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$18.81

ETHYL ALCOHOL

Facility

$662.29

Service Code	HCPCS 80320
Hospital Charge Code	3000411
Hospital Revenue Code	301
Min. Negotiated Rate	$99.34
Max. Negotiated Rate	$99.34
Rate for Payer: Qualcare PPO/HMO/WC	$99.34

ETHYLENE GLYCOL

Facility

$401.00

Service Code	HCPCS 82693
Hospital Charge Code	38472921
Hospital Revenue Code	301
Min. Negotiated Rate	$11.39
Max. Negotiated Rate	$200.50
Rate for Payer: Aetna Commercial	$40.53
Rate for Payer: Aetna Medicare Advantage	$48.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$14.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$20.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.05
Rate for Payer: Cigna Commercial	$200.50
Rate for Payer: Cigna Medicare Advantage	$14.90
Rate for Payer: Clover Medicare Advantage	$14.15
Rate for Payer: EmblemHealth Commercial	$44.70
Rate for Payer: Humana Medicare Advantage	$15.35
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$14.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$104.26
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$60.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$11.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.90
Rate for Payer: Wellcare Medicare Advantage	$14.90
Rate for Payer: Wellpoint Medicaid Managed Care	$11.39

ETHYLENE GLYCOL

Facility

$401.00

Service Code	HCPCS 82693
Hospital Charge Code	38472921
Hospital Revenue Code	301
Min. Negotiated Rate	$60.15
Max. Negotiated Rate	$60.15
Rate for Payer: Qualcare PPO/HMO/WC	$60.15

Know your out-of-pocket cost for care.

All Charges