Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

EBV EA (D) AB IGG

Facility

$667.59

Service Code	HCPCS 86663
Hospital Charge Code	39900371
Hospital Revenue Code	302
Min. Negotiated Rate	$10.50
Max. Negotiated Rate	$333.80
Rate for Payer: Aetna Commercial	$35.69
Rate for Payer: Aetna Medicare Advantage	$42.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.12
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	$47.59
Rate for Payer: Cigna Commercial	$333.80
Rate for Payer: Cigna Medicare Advantage	$13.12
Rate for Payer: Clover Medicare Advantage	$12.46
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Humana Medicare Advantage	$13.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.12
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	$10.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.12
Rate for Payer: Wellcare Medicare Advantage	$13.12
Rate for Payer: Wellpoint Medicaid Managed Care	$18.96

ECG DURING ECT

Facility

$658.00

Service Code	HCPCS 93005
Hospital Charge Code	84033001
Hospital Revenue Code	730
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$879.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$67.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$171.08
Rate for Payer: Oxford Commercial	$659.00
Rate for Payer: Qualcare PPO/HMO/WC	$98.70
Rate for Payer: UnitedHealthcare Commercial	$879.00
Rate for Payer: UnitedHealthcare Community & State	$20.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$18.69

ECG DURING ECT

Facility

$658.00

Service Code	HCPCS 93005
Hospital Charge Code	84033001
Hospital Revenue Code	730
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$98.70
Rate for Payer: Qualcare PPO/HMO/WC	$98.70

ECG SIGNAL-AVERAGED

Facility

$571.00

Service Code	HCPCS 93278
Hospital Charge Code	5307005
Hospital Revenue Code	731
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$2,460.00
Rate for Payer: Aetna Commercial	$190.62
Rate for Payer: Aetna Medicare Advantage	$227.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$254.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$70.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$130.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$254.22
Rate for Payer: Cigna Commercial	$140.48
Rate for Payer: Cigna Medicare Advantage	$70.08
Rate for Payer: Clover Medicare Advantage	$66.58
Rate for Payer: EmblemHealth Commercial	$210.24
Rate for Payer: Humana Medicare Advantage	$72.18
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$70.08
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$148.46
Rate for Payer: Oxford Commercial	$2,169.00
Rate for Payer: Qualcare PPO/HMO/WC	$85.65
Rate for Payer: UnitedHealthcare Commercial	$2,460.00
Rate for Payer: UnitedHealthcare Community & State	$18.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.08
Rate for Payer: Wellcare Medicare Advantage	$70.08
Rate for Payer: Wellpoint Medicaid Managed Care	$16.22

ECG SIGNAL-AVERAGED

Facility

$571.00

Service Code	HCPCS 93278
Hospital Charge Code	5307005
Hospital Revenue Code	731
Min. Negotiated Rate	$85.65
Max. Negotiated Rate	$85.65
Rate for Payer: Qualcare PPO/HMO/WC	$85.65

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502835
Hospital Revenue Code	730
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502630
Hospital Revenue Code	730
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Qualcare PPO/HMO/WC	$9.75

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502630
Hospital Revenue Code	730
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$879.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.90
Rate for Payer: Oxford Commercial	$659.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$879.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

ECG TRACING FOR IPPE

Facility

$65.00

Service Code	HCPCS G0404
Hospital Charge Code	87502835
Hospital Revenue Code	730
Min. Negotiated Rate	$1.85
Max. Negotiated Rate	$879.00
Rate for Payer: Aetna Commercial	$93.46
Rate for Payer: Aetna Medicare Advantage	$111.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$124.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$34.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$124.64
Rate for Payer: Cigna Commercial	$68.87
Rate for Payer: Cigna Medicare Advantage	$34.36
Rate for Payer: Clover Medicare Advantage	$32.64
Rate for Payer: EmblemHealth Commercial	$103.08
Rate for Payer: Humana Medicare Advantage	$35.39
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$34.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.90
Rate for Payer: Oxford Commercial	$659.00
Rate for Payer: Qualcare PPO/HMO/WC	$9.75
Rate for Payer: UnitedHealthcare Commercial	$879.00
Rate for Payer: UnitedHealthcare Community & State	$2.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.36
Rate for Payer: Wellcare Medicare Advantage	$34.36
Rate for Payer: Wellpoint Medicaid Managed Care	$1.85

E.CHAFFEENSIS AB (IGG,M), I

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033A
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.CHAFFEENSIS AB (IGG,M), I

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033A
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

E.CHAFFEENSIS AB (IGG,M), II

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033B
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

E.CHAFFEENSIS AB (IGG,M), II

Facility

$390.00

Service Code	HCPCS 8660991
Hospital Charge Code	39990033B
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.CHAFFEENSIS AB (IGG,M), III

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033C
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.CHAFFEENSIS AB (IGG,M), III

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033C
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

E.CHAFFEENSIS AB (IGG,M), IV

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033D
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

E.CHAFFEENSIS AB (IGG,M), IV

Facility

$390.00

Service Code	HCPCS 8666691
Hospital Charge Code	39990033D
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

ECHINOC AB EIA REFLEX TO WBLOT

Facility

$236.16

Service Code	HCPCS 86682
Hospital Charge Code	401186682
Hospital Revenue Code	302
Min. Negotiated Rate	$35.42
Max. Negotiated Rate	$35.42
Rate for Payer: Qualcare PPO/HMO/WC	$35.42

ECHINOC AB EIA REFLEX TO WBLOT

Facility

$236.16

Service Code	HCPCS 86682
Hospital Charge Code	401186682
Hospital Revenue Code	302
Min. Negotiated Rate	$6.71
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$35.39
Rate for Payer: Aetna Medicare Advantage	$42.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$47.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$47.19
Rate for Payer: Cigna Commercial	$118.08
Rate for Payer: Cigna Medicare Advantage	$13.01
Rate for Payer: Clover Medicare Advantage	$12.36
Rate for Payer: EmblemHealth Commercial	$39.03
Rate for Payer: Humana Medicare Advantage	$13.40
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.01
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.40
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$35.42
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.01
Rate for Payer: Wellcare Medicare Advantage	$13.01
Rate for Payer: Wellpoint Medicaid Managed Care	$6.71

ECHO 2D LIMITED/FOLLOW UP

Facility

$5,900.00

Service Code	HCPCS 93308
Hospital Charge Code	5300084
Hospital Revenue Code	483
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$496.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
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	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$167.56

ECHO 2D LIMITED/FOLLOW UP

Facility

$5,900.00

Service Code	HCPCS 93308
Hospital Charge Code	5300084
Hospital Revenue Code	483
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

ECHO 2D M MODE

Facility

$5,900.00

Service Code	HCPCS 93307
Hospital Charge Code	5300082
Hospital Revenue Code	483
Min. Negotiated Rate	$885.00
Max. Negotiated Rate	$885.00
Rate for Payer: Qualcare PPO/HMO/WC	$885.00

ECHO 2D M MODE

Facility

$5,900.00

Service Code	HCPCS 93307
Hospital Charge Code	5300082
Hospital Revenue Code	483
Min. Negotiated Rate	$167.56
Max. Negotiated Rate	$2,338.00
Rate for Payer: Aetna Commercial	$771.04
Rate for Payer: Aetna Medicare Advantage	$918.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,028.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$283.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$358.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,028.29
Rate for Payer: Cigna Commercial	$568.20
Rate for Payer: Cigna Medicare Advantage	$283.47
Rate for Payer: Clover Medicare Advantage	$269.30
Rate for Payer: EmblemHealth Commercial	$850.41
Rate for Payer: Humana Medicare Advantage	$291.97
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$283.47
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	$283.47
Rate for Payer: Wellcare Medicare Advantage	$283.47
Rate for Payer: Wellpoint Medicaid Managed Care	$167.56

ECHO B-MTRC FP-SO 14

Facility

$30,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270691145
Hospital Revenue Code	278
Min. Negotiated Rate	$4,621.50
Max. Negotiated Rate	$7,456.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,162.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,456.02
Rate for Payer: Qualcare PPO/HMO/WC	$4,621.50

ECHO B-MTRC FP-SO 14

Facility

$30,810.00

Service Code	HCPCS C1776
Hospital Charge Code	270691145
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$15,405.00
Rate for Payer: Aetna Commercial	$11,707.80
Rate for Payer: Aetna Medicare Advantage	$9,243.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7,856.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7,856.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,162.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7,856.55
Rate for Payer: Cigna Commercial	$15,405.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,456.02
Rate for Payer: Qualcare PPO/HMO/WC	$4,621.50
Rate for Payer: UnitedHealthcare Community & State	$973.60
Rate for Payer: Wellpoint Medicaid Managed Care	$875.00

Know your out-of-pocket cost for care.

All Charges