Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EVASC RPR ILIO-ILIAC RPT

Facility

$13,570.00

Service Code	HCPCS 34708
Hospital Charge Code	2004958
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

EVASC RPR ILIO-ILIAC RPT

Facility

$13,570.00

Service Code	HCPCS 34708
Hospital Charge Code	321034708
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

EVASC RPR ILIO-ILIAC RPT

Facility

$13,570.00

Service Code	HCPCS 34708
Hospital Charge Code	2004958
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

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304N
Hospital Revenue Code	278
Min. Negotiated Rate	$208.74
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$2,793.00
Rate for Payer: Aetna Medicare Advantage	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.25
Rate for Payer: Cigna Commercial	$3,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50
Rate for Payer: UnitedHealthcare Community & State	$232.26
Rate for Payer: Wellpoint Medicaid Managed Care	$208.74

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,102.50
Max. Negotiated Rate	$1,778.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50

EVERFLEX PROTEGE 5.0X40

Facility

$7,350.00

Service Code	HCPCS C1876
Hospital Charge Code	270662304
Hospital Revenue Code	278
Min. Negotiated Rate	$208.74
Max. Negotiated Rate	$3,675.00
Rate for Payer: Aetna Commercial	$2,793.00
Rate for Payer: Aetna Medicare Advantage	$2,205.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,874.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,470.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,874.25
Rate for Payer: Cigna Commercial	$3,675.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,778.70
Rate for Payer: Qualcare PPO/HMO/WC	$1,102.50
Rate for Payer: UnitedHealthcare Community & State	$232.26
Rate for Payer: Wellpoint Medicaid Managed Care	$208.74

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302
Hospital Revenue Code	278
Min. Negotiated Rate	$467.89
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$520.61
Rate for Payer: Wellpoint Medicaid Managed Care	$467.89

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302S
Hospital Revenue Code	278
Min. Negotiated Rate	$467.89
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$520.61
Rate for Payer: Wellpoint Medicaid Managed Care	$467.89

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302S
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302N
Hospital Revenue Code	278
Min. Negotiated Rate	$2,471.25
Max. Negotiated Rate	$3,986.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25

EVERFLEX PROTEGE 6.0X200X120

Facility

$16,475.00

Service Code	HCPCS C1876
Hospital Charge Code	270662302N
Hospital Revenue Code	278
Min. Negotiated Rate	$467.89
Max. Negotiated Rate	$8,237.50
Rate for Payer: Aetna Commercial	$6,260.50
Rate for Payer: Aetna Medicare Advantage	$4,942.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4,201.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$3,295.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4,201.12
Rate for Payer: Cigna Commercial	$8,237.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3,986.95
Rate for Payer: Qualcare PPO/HMO/WC	$2,471.25
Rate for Payer: UnitedHealthcare Community & State	$520.61
Rate for Payer: Wellpoint Medicaid Managed Care	$467.89

EVERLAST CROSS LINKED POLY INS

Facility

$24,859.05

Service Code	HCPCS C1713
Hospital Charge Code	270704973
Hospital Revenue Code	278
Min. Negotiated Rate	$3,728.86
Max. Negotiated Rate	$6,015.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,971.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,015.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,728.86

EVERLAST CROSS LINKED POLY INS

Facility

$24,859.05

Service Code	HCPCS C1713
Hospital Charge Code	270704973
Hospital Revenue Code	278
Min. Negotiated Rate	$706.00
Max. Negotiated Rate	$12,429.52
Rate for Payer: Aetna Commercial	$9,446.44
Rate for Payer: Aetna Medicare Advantage	$7,457.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,339.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,339.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,971.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,339.06
Rate for Payer: Cigna Commercial	$12,429.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,015.89
Rate for Payer: Qualcare PPO/HMO/WC	$3,728.86
Rate for Payer: UnitedHealthcare Community & State	$785.55
Rate for Payer: Wellpoint Medicaid Managed Care	$706.00

EVEROLIMUS,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 80169
Hospital Charge Code	401180169
Hospital Revenue Code	301
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

EVEROLIMUS,LC/MS/MS

Facility

$390.00

Service Code	HCPCS 80169
Hospital Charge Code	401180169
Hospital Revenue Code	301
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.35
Rate for Payer: Aetna Medicare Advantage	$44.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.81
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.73
Rate for Payer: Clover Medicare Advantage	$13.04
Rate for Payer: EmblemHealth Commercial	$41.19
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.73
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	$10.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.73
Rate for Payer: Wellcare Medicare Advantage	$13.73
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

EVIVA STEREOTACTC 12MM BRST BX

Facility

$1,161.88

Hospital Charge Code	270675349R
Hospital Revenue Code	272
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$580.94
Rate for Payer: Aetna Commercial	$441.51
Rate for Payer: Aetna Medicare Advantage	$348.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$296.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$296.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$296.28
Rate for Payer: Cigna Commercial	$580.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$302.09
Rate for Payer: Oxford Commercial	$232.38
Rate for Payer: Qualcare PPO/HMO/WC	$174.28
Rate for Payer: UnitedHealthcare Commercial	$232.38
Rate for Payer: UnitedHealthcare Community & State	$36.72
Rate for Payer: Wellpoint Medicaid Managed Care	$33.00

EVIVA STEREOTACTC 12MM BRST BX

Facility

$1,161.88

Hospital Charge Code	270675349R
Hospital Revenue Code	272
Min. Negotiated Rate	$174.28
Max. Negotiated Rate	$174.28
Rate for Payer: Qualcare PPO/HMO/WC	$174.28

EVUSHELD 300MG EUA

Facility

$0.01

Service Code	HCPCS Q0220
Hospital Charge Code	606390480
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
Rate for Payer: Aetna Commercial	$0.00
Rate for Payer: Aetna Medicare Advantage	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.00
Rate for Payer: Cigna Commercial	$0.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00
Rate for Payer: UnitedHealthcare Community & State	$0.00
Rate for Payer: Wellpoint Medicaid Managed Care	$0.00

EVUSHELD 300MG EUA

Facility

$0.01

Service Code	HCPCS Q0220
Hospital Charge Code	606390480
Hospital Revenue Code	636
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.00
Rate for Payer: Qualcare PPO/HMO/WC	$0.00

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3237M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$21.37
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.65
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$23.78
Rate for Payer: Wellpoint Medicaid Managed Care	$21.37

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3048M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3048M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$21.37
Max. Negotiated Rate	$376.25
Rate for Payer: Aetna Commercial	$285.95
Rate for Payer: Aetna Medicare Advantage	$225.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.89
Rate for Payer: Cigna Commercial	$376.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$195.65
Rate for Payer: Oxford Commercial	$140.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.88
Rate for Payer: UnitedHealthcare Commercial	$159.00
Rate for Payer: UnitedHealthcare Community & State	$23.78
Rate for Payer: Wellpoint Medicaid Managed Care	$21.37

EVUSHELD IV INFUS&MONITOR

Facility

$752.50

Service Code	HCPCS M0220
Hospital Charge Code	3237M0220
Hospital Revenue Code	771
Min. Negotiated Rate	$112.88
Max. Negotiated Rate	$112.88
Rate for Payer: Qualcare PPO/HMO/WC	$112.88

Know your out-of-pocket cost for care.

All Charges