Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	3039016
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 1/2

Facility

$190.45

Service Code	HCPCS 80335
Hospital Charge Code	3039016
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	3039017
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	38430017
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	39990217
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	39990217
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	38430017
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIDEPRESSANT TRICYCLIC 3-5

Facility

$190.45

Service Code	HCPCS 80336
Hospital Charge Code	3039017
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTI-DNA(DOUBLE STRANDED)ANTIB

Facility

$579.00

Service Code	HCPCS 86225
Hospital Charge Code	38476042
Hospital Revenue Code	302
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$289.50
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.84
Rate for Payer: Cigna Commercial	$289.50
Rate for Payer: Cigna Medicare Advantage	$13.74
Rate for Payer: Clover Medicare Advantage	$13.05
Rate for Payer: EmblemHealth Commercial	$41.22
Rate for Payer: Humana Medicare Advantage	$14.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$150.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$86.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.74
Rate for Payer: Wellcare Medicare Advantage	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$16.44

ANTI-DNA(DOUBLE STRANDED)ANTIB

Facility

$579.00

Service Code	HCPCS 86225
Hospital Charge Code	38476042
Hospital Revenue Code	302
Min. Negotiated Rate	$86.85
Max. Negotiated Rate	$86.85
Rate for Payer: Qualcare PPO/HMO/WC	$86.85

ANTI DNA-DS

Facility

$390.00

Service Code	HCPCS 86225
Hospital Charge Code	39900362
Hospital Revenue Code	302
Min. Negotiated Rate	$10.99
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$37.37
Rate for Payer: Aetna Medicare Advantage	$44.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$49.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$21.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$49.84
Rate for Payer: Cigna Commercial	$195.00
Rate for Payer: Cigna Medicare Advantage	$13.74
Rate for Payer: Clover Medicare Advantage	$13.05
Rate for Payer: EmblemHealth Commercial	$41.22
Rate for Payer: Humana Medicare Advantage	$14.15
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.74
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	$10.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.74
Rate for Payer: Wellcare Medicare Advantage	$13.74
Rate for Payer: Wellpoint Medicaid Managed Care	$11.08

ANTI DNA-DS

Facility

$390.00

Service Code	HCPCS 86225
Hospital Charge Code	39900362
Hospital Revenue Code	302
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

ANTI DNASE B(STREPTOCOCCAL)ANT

Facility

$273.00

Service Code	HCPCS 86215
Hospital Charge Code	38476048
Hospital Revenue Code	302
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Qualcare PPO/HMO/WC	$40.95

ANTI DNASE B(STREPTOCOCCAL)ANT

Facility

$273.00

Service Code	HCPCS 86215
Hospital Charge Code	38476048
Hospital Revenue Code	302
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$36.04
Rate for Payer: Aetna Medicare Advantage	$42.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$13.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$30.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.06
Rate for Payer: Cigna Commercial	$136.50
Rate for Payer: Cigna Medicare Advantage	$13.25
Rate for Payer: Clover Medicare Advantage	$12.59
Rate for Payer: EmblemHealth Commercial	$39.75
Rate for Payer: Humana Medicare Advantage	$13.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$13.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$70.98
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$40.95
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$10.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.25
Rate for Payer: Wellcare Medicare Advantage	$13.25
Rate for Payer: Wellpoint Medicaid Managed Care	$7.75

ANTI-DNA(SINGLE STRANDED)ANTIB

Facility

$542.00

Service Code	HCPCS 86226
Hospital Charge Code	38476045
Hospital Revenue Code	302
Min. Negotiated Rate	$81.30
Max. Negotiated Rate	$81.30
Rate for Payer: Qualcare PPO/HMO/WC	$81.30

ANTI-DNA(SINGLE STRANDED)ANTIB

Facility

$542.00

Service Code	HCPCS 86226
Hospital Charge Code	38476045
Hospital Revenue Code	302
Min. Negotiated Rate	$9.69
Max. Negotiated Rate	$271.00
Rate for Payer: Aetna Commercial	$32.94
Rate for Payer: Aetna Medicare Advantage	$39.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$43.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$12.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$24.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$43.93
Rate for Payer: Cigna Commercial	$271.00
Rate for Payer: Cigna Medicare Advantage	$12.11
Rate for Payer: Clover Medicare Advantage	$11.50
Rate for Payer: EmblemHealth Commercial	$36.33
Rate for Payer: Humana Medicare Advantage	$12.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$12.11
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$140.92
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$81.30
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$9.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.11
Rate for Payer: Wellcare Medicare Advantage	$12.11
Rate for Payer: Wellpoint Medicaid Managed Care	$15.39

ANTI-ENA(SM&SM.RNP) AB

Facility

$179.00

Service Code	HCPCS 86235
Hospital Charge Code	38479092
Hospital Revenue Code	302
Min. Negotiated Rate	$26.85
Max. Negotiated Rate	$26.85
Rate for Payer: Qualcare PPO/HMO/WC	$26.85

ANTI-ENA(SM&SM.RNP) AB

Facility

$179.00

Service Code	HCPCS 86235
Hospital Charge Code	38479092
Hospital Revenue Code	302
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$48.77
Rate for Payer: Aetna Medicare Advantage	$58.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$65.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$17.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$39.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$65.04
Rate for Payer: Cigna Commercial	$89.50
Rate for Payer: Cigna Medicare Advantage	$17.93
Rate for Payer: Clover Medicare Advantage	$17.03
Rate for Payer: EmblemHealth Commercial	$53.79
Rate for Payer: Humana Medicare Advantage	$18.47
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$17.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$46.54
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$26.85
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$14.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.93
Rate for Payer: Wellcare Medicare Advantage	$17.93
Rate for Payer: Wellpoint Medicaid Managed Care	$5.08

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	3039019
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	39990219
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	38430019
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	38430019
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	39990219
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$72.37
Rate for Payer: Aetna Medicare Advantage	$57.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$48.56
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$48.56
Rate for Payer: Cigna Commercial	$95.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$49.52
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$28.57
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$16.66
Rate for Payer: Wellpoint Medicaid Managed Care	$5.41

ANTIEPILEPTICS NOS 1-3

Facility

$190.45

Service Code	HCPCS 80339
Hospital Charge Code	3039019
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

ANTIEPILEPTICS NOS 4-6

Facility

$190.45

Service Code	HCPCS 80340
Hospital Charge Code	3039020
Hospital Revenue Code	301
Min. Negotiated Rate	$28.57
Max. Negotiated Rate	$28.57
Rate for Payer: Qualcare PPO/HMO/WC	$28.57

Know your out-of-pocket cost for care.

All Charges