Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ET INTUBATION

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	366831500
Hospital Revenue Code	361
Min. Negotiated Rate	$191.72
Max. Negotiated Rate	$191.72
Rate for Payer: Qualcare PPO/HMO/WC	$191.72

ET INTUBATION

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	366831500
Hospital Revenue Code	361
Min. Negotiated Rate	$40.39
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.32
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.72
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$40.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$640.73
Rate for Payer: Wellpoint Medicaid Managed Care	$628.17

ET INTUBATION EMERGENCY PROC

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	7411001
Hospital Revenue Code	361
Min. Negotiated Rate	$191.72
Max. Negotiated Rate	$191.72
Rate for Payer: Qualcare PPO/HMO/WC	$191.72

ET INTUBATION EMERGENCY PROC

Facility

$1,278.15

Service Code	HCPCS 31500
Hospital Charge Code	7411001
Hospital Revenue Code	361
Min. Negotiated Rate	$40.39
Max. Negotiated Rate	$3,536.00
Rate for Payer: Aetna Commercial	$765.35
Rate for Payer: Aetna Medicare Advantage	$911.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,020.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$281.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,020.71
Rate for Payer: Cigna Commercial	$564.04
Rate for Payer: Cigna Medicare Advantage	$281.38
Rate for Payer: Clover Medicare Advantage	$267.31
Rate for Payer: EmblemHealth Commercial	$844.14
Rate for Payer: Humana Medicare Advantage	$289.82
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$281.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$332.32
Rate for Payer: Oxford Commercial	$2,297.00
Rate for Payer: Qualcare PPO/HMO/WC	$191.72
Rate for Payer: UnitedHealthcare Commercial	$2,256.00
Rate for Payer: UnitedHealthcare Community & State	$40.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$281.38
Rate for Payer: Wellcare Medicare Advantage	$281.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$640.73
Rate for Payer: Wellpoint Medicaid Managed Care	$628.17

ETOMIDATE 20 MG/10ML INJ

Facility

$88.84

Service Code	NDC 55390076210
Hospital Charge Code	60628617
Hospital Revenue Code	250
Min. Negotiated Rate	$13.33
Max. Negotiated Rate	$13.33
Rate for Payer: Qualcare PPO/HMO/WC	$13.33

ETOMIDATE 20 MG/10ML INJ

Facility

$88.84

Service Code	NDC 55390076210
Hospital Charge Code	60628617
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$44.42
Rate for Payer: Aetna Commercial	$33.76
Rate for Payer: Aetna Medicare Advantage	$26.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.65
Rate for Payer: Cigna Commercial	$44.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$23.10
Rate for Payer: Oxford Commercial	$17.77
Rate for Payer: Qualcare PPO/HMO/WC	$13.33
Rate for Payer: UnitedHealthcare Commercial	$17.77
Rate for Payer: UnitedHealthcare Community & State	$2.81
Rate for Payer: Wellpoint Medicaid Managed Care	$2.52

EUGLOBULIN LYSIS

Facility

$59.00

Service Code	HCPCS 85360
Hospital Charge Code	38477055
Hospital Revenue Code	305
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$8.85
Rate for Payer: Qualcare PPO/HMO/WC	$8.85

EUGLOBULIN LYSIS

Facility

$59.00

Service Code	HCPCS 85360
Hospital Charge Code	38477055
Hospital Revenue Code	305
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$22.88
Rate for Payer: Aetna Medicare Advantage	$27.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$30.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$30.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$8.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$18.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$30.51
Rate for Payer: Cigna Commercial	$29.50
Rate for Payer: Cigna Medicare Advantage	$8.41
Rate for Payer: Clover Medicare Advantage	$7.99
Rate for Payer: EmblemHealth Commercial	$25.23
Rate for Payer: Humana Medicare Advantage	$8.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$8.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.34
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$8.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$6.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.41
Rate for Payer: Wellcare Medicare Advantage	$8.41
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

EULEXIN/125MG/CAP

Facility

$14.00

Service Code	NDC 591246618
Hospital Charge Code	60632966
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$2.10
Rate for Payer: Qualcare PPO/HMO/WC	$2.10

EULEXIN/125MG/CAP

Facility

$14.00

Service Code	NDC 591246618
Hospital Charge Code	60632966
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$7.00
Rate for Payer: Aetna Commercial	$5.32
Rate for Payer: Aetna Medicare Advantage	$4.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.57
Rate for Payer: Cigna Commercial	$7.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.64
Rate for Payer: Oxford Commercial	$2.80
Rate for Payer: Qualcare PPO/HMO/WC	$2.10
Rate for Payer: UnitedHealthcare Commercial	$2.80
Rate for Payer: UnitedHealthcare Community & State	$0.44
Rate for Payer: Wellpoint Medicaid Managed Care	$0.40

EUROLOGICAL RE-ED ADD 15 MINS

Facility

$314.00

Service Code	HCPCS 97112GO
Hospital Charge Code	74203047
Hospital Revenue Code	430
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$1,060.00
Rate for Payer: Aetna Commercial	$119.32
Rate for Payer: Aetna Medicare Advantage	$94.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$80.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$80.07
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	$80.07
Rate for Payer: Cigna Commercial	$157.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$81.64
Rate for Payer: Oxford Commercial	$933.00
Rate for Payer: Qualcare PPO/HMO/WC	$47.10
Rate for Payer: UnitedHealthcare Commercial	$1,060.00
Rate for Payer: UnitedHealthcare Community & State	$9.92
Rate for Payer: Wellpoint Medicaid Managed Care	$8.92

EUROLOGICAL RE-ED ADD 15 MINS

Facility

$314.00

Service Code	HCPCS 97112GO
Hospital Charge Code	74203047
Hospital Revenue Code	430
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$47.10
Rate for Payer: Qualcare PPO/HMO/WC	$47.10

EV3 PROTEGE RX 8-6X40

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270639883N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

EV3 PROTEGE RX 8-6X40

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270639883
Hospital Revenue Code	278
Min. Negotiated Rate	$291.10
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$323.90
Rate for Payer: Wellpoint Medicaid Managed Care	$291.10

EV3 PROTEGE RX 8-6X40

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270639883
Hospital Revenue Code	278
Min. Negotiated Rate	$1,537.50
Max. Negotiated Rate	$2,480.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50

EV3 PROTEGE RX 8-6X40

Facility

$10,250.00

Service Code	HCPCS C1876
Hospital Charge Code	270639883N
Hospital Revenue Code	278
Min. Negotiated Rate	$291.10
Max. Negotiated Rate	$5,125.00
Rate for Payer: Aetna Commercial	$3,895.00
Rate for Payer: Aetna Medicare Advantage	$3,075.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,613.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$2,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,613.75
Rate for Payer: Cigna Commercial	$5,125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,480.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,537.50
Rate for Payer: UnitedHealthcare Community & State	$323.90
Rate for Payer: Wellpoint Medicaid Managed Care	$291.10

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	2004955
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	321034705
Hospital Revenue Code	361
Min. Negotiated Rate	$2,035.50
Max. Negotiated Rate	$2,035.50
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	2004955
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

EVAC RPR A-BIILIAC NDGFT

Facility

$13,570.00

Service Code	HCPCS 34705
Hospital Charge Code	321034705
Hospital Revenue Code	361
Min. Negotiated Rate	$385.39
Max. Negotiated Rate	$10,269.00
Rate for Payer: Aetna Commercial	$5,156.60
Rate for Payer: Aetna Medicare Advantage	$4,071.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,460.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,536.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,460.35
Rate for Payer: Cigna Commercial	$6,785.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,528.20
Rate for Payer: Oxford Commercial	$9,354.00
Rate for Payer: Qualcare PPO/HMO/WC	$2,035.50
Rate for Payer: UnitedHealthcare Commercial	$10,269.00
Rate for Payer: UnitedHealthcare Community & State	$428.81
Rate for Payer: Wellpoint Medicaid Managed Care	$385.39

EVACUATOR 400CC 3SPRNG 0043610

Facility

$47.74

Hospital Charge Code	270654309
Hospital Revenue Code	272
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$23.87
Rate for Payer: Aetna Commercial	$18.14
Rate for Payer: Aetna Medicare Advantage	$14.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.17
Rate for Payer: Cigna Commercial	$23.87
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$12.41
Rate for Payer: Oxford Commercial	$9.55
Rate for Payer: Qualcare PPO/HMO/WC	$7.16
Rate for Payer: UnitedHealthcare Commercial	$9.55
Rate for Payer: UnitedHealthcare Community & State	$1.51
Rate for Payer: Wellpoint Medicaid Managed Care	$1.36

EVACUATOR 400CC 3SPRNG 0043610

Facility

$47.74

Hospital Charge Code	270654309
Hospital Revenue Code	272
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$7.16
Rate for Payer: Qualcare PPO/HMO/WC	$7.16

EVACUATOR BD BLADDER 000451

Facility

$103.20

Hospital Charge Code	270614999
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$51.60
Rate for Payer: Aetna Commercial	$39.22
Rate for Payer: Aetna Medicare Advantage	$30.96
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.32
Rate for Payer: Cigna Commercial	$51.60
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.83
Rate for Payer: Oxford Commercial	$20.64
Rate for Payer: Qualcare PPO/HMO/WC	$15.48
Rate for Payer: UnitedHealthcare Commercial	$20.64
Rate for Payer: UnitedHealthcare Community & State	$3.26
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

EVACUATOR BD BLADDER 000451

Facility

$103.20

Hospital Charge Code	270614999
Hospital Revenue Code	272
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$15.48
Rate for Payer: Qualcare PPO/HMO/WC	$15.48

EVACUATOR ELLIK BLADDER DISP.

Facility

$103.00

Hospital Charge Code	270331361
Hospital Revenue Code	272
Min. Negotiated Rate	$2.93
Max. Negotiated Rate	$51.50
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare Advantage	$30.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.27
Rate for Payer: Cigna Commercial	$51.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.78
Rate for Payer: Oxford Commercial	$20.60
Rate for Payer: Qualcare PPO/HMO/WC	$15.45
Rate for Payer: UnitedHealthcare Commercial	$20.60
Rate for Payer: UnitedHealthcare Community & State	$3.25
Rate for Payer: Wellpoint Medicaid Managed Care	$2.93

Know your out-of-pocket cost for care.

All Charges