Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

P2Y12 PLATELET FUNCTION

Facility

$147.65

Service Code	HCPCS 85576
Hospital Charge Code	3038137
Hospital Revenue Code	305
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$67.76
Rate for Payer: Aetna Medicare Advantage	$80.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$90.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$24.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$16.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$90.36
Rate for Payer: Cigna Commercial	$73.83
Rate for Payer: Cigna Medicare Advantage	$24.91
Rate for Payer: Clover Medicare Advantage	$23.66
Rate for Payer: EmblemHealth Commercial	$74.73
Rate for Payer: Humana Medicare Advantage	$25.66
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$24.91
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$38.39
Rate for Payer: Oxford Commercial	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$22.15
Rate for Payer: UnitedHealthcare Commercial	$156.00
Rate for Payer: UnitedHealthcare Community & State	$19.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.91
Rate for Payer: Wellcare Medicare Advantage	$24.91
Rate for Payer: Wellpoint Medicaid Managed Care	$4.19

P2Y12 PLATELET FUNCTION

Facility

$390.00

Service Code	HCPCS 85576
Hospital Charge Code	5100833
Hospital Revenue Code	305
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$58.50
Rate for Payer: Qualcare PPO/HMO/WC	$58.50

P2Y12 PLATELET FUNCTION

Facility

$147.65

Service Code	HCPCS 85576
Hospital Charge Code	3038137
Hospital Revenue Code	305
Min. Negotiated Rate	$22.15
Max. Negotiated Rate	$22.15
Rate for Payer: Qualcare PPO/HMO/WC	$22.15

P50-153-2010

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701870
Hospital Revenue Code	278
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$330.00
Rate for Payer: Aetna Commercial	$250.80
Rate for Payer: Aetna Medicare Advantage	$198.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$168.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$168.30
Rate for Payer: Cigna Commercial	$330.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00
Rate for Payer: UnitedHealthcare Community & State	$20.86
Rate for Payer: Wellpoint Medicaid Managed Care	$18.74

P50-153-2010

Facility

$660.00

Service Code	HCPCS C1713
Hospital Charge Code	270701870
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$159.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$132.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$159.72
Rate for Payer: Qualcare PPO/HMO/WC	$99.00

PACE INTERROGATION W/PROG DUAL

Facility

$208.00

Service Code	HCPCS 93280
Hospital Charge Code	5100279
Hospital Revenue Code	480
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

PACE INTERROGATION W/PROG DUAL

Facility

$208.00

Service Code	HCPCS 93280
Hospital Charge Code	5100279
Hospital Revenue Code	480
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$36.49
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.08
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.91

PACE INTERROGATION W/PROG S

Facility

$208.00

Service Code	HCPCS 93279
Hospital Charge Code	5100278
Hospital Revenue Code	480
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Qualcare PPO/HMO/WC	$31.20

PACE INTERROGATION W/PROG S

Facility

$208.00

Service Code	HCPCS 93279
Hospital Charge Code	5100278
Hospital Revenue Code	480
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$120.60
Rate for Payer: Aetna Medicare Advantage	$143.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$160.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$44.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$31.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$160.84
Rate for Payer: Cigna Commercial	$88.88
Rate for Payer: Cigna Medicare Advantage	$44.34
Rate for Payer: Clover Medicare Advantage	$42.12
Rate for Payer: EmblemHealth Commercial	$133.02
Rate for Payer: Humana Medicare Advantage	$45.67
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$44.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.08
Rate for Payer: Oxford Commercial	$2,441.00
Rate for Payer: Qualcare PPO/HMO/WC	$31.20
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$6.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.34
Rate for Payer: Wellcare Medicare Advantage	$44.34
Rate for Payer: Wellpoint Medicaid Managed Care	$5.91

PACEMAKER ACCENT DR U PR

Facility

$31,920.00

Service Code	HCPCS C1785
Hospital Charge Code	270648446
Hospital Revenue Code	275
Min. Negotiated Rate	$4,788.00
Max. Negotiated Rate	$7,724.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,384.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,724.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,788.00

PACEMAKER ACCENT DR U PR

Facility

$31,920.00

Service Code	HCPCS C1785
Hospital Charge Code	270648446
Hospital Revenue Code	275
Min. Negotiated Rate	$906.53
Max. Negotiated Rate	$15,960.00
Rate for Payer: Aetna Commercial	$12,129.60
Rate for Payer: Aetna Medicare Advantage	$9,576.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,139.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,139.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,384.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,139.60
Rate for Payer: Cigna Commercial	$15,960.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,724.64
Rate for Payer: Qualcare PPO/HMO/WC	$4,788.00
Rate for Payer: UnitedHealthcare Community & State	$1,008.67
Rate for Payer: Wellpoint Medicaid Managed Care	$906.53

PACEMAKER ACCENT SR RFPGD/STER

Facility

$26,435.00

Hospital Charge Code	270660050
Hospital Revenue Code	275
Min. Negotiated Rate	$3,965.25
Max. Negotiated Rate	$6,397.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,287.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,397.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,965.25

PACEMAKER ACCENT SR RFPGD/STER

Facility

$26,435.00

Hospital Charge Code	270660050
Hospital Revenue Code	275
Min. Negotiated Rate	$750.75
Max. Negotiated Rate	$13,217.50
Rate for Payer: Aetna Commercial	$10,045.30
Rate for Payer: Aetna Medicare Advantage	$7,930.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,740.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,740.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$5,287.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,740.93
Rate for Payer: Cigna Commercial	$13,217.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6,397.27
Rate for Payer: Qualcare PPO/HMO/WC	$3,965.25
Rate for Payer: UnitedHealthcare Community & State	$835.35
Rate for Payer: Wellpoint Medicaid Managed Care	$750.75

PACEMAKER ACCOLADE MRI DR

Facility

$40,000.00

Service Code	HCPCS C1785
Hospital Charge Code	270678215
Hospital Revenue Code	275
Min. Negotiated Rate	$1,136.00
Max. Negotiated Rate	$20,000.00
Rate for Payer: Aetna Commercial	$15,200.00
Rate for Payer: Aetna Medicare Advantage	$12,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,200.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,200.00
Rate for Payer: Cigna Commercial	$20,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00
Rate for Payer: UnitedHealthcare Community & State	$1,264.00
Rate for Payer: Wellpoint Medicaid Managed Care	$1,136.00

PACEMAKER ACCOLADE MRI DR

Facility

$40,000.00

Service Code	HCPCS C1785
Hospital Charge Code	270678215
Hospital Revenue Code	275
Min. Negotiated Rate	$6,000.00
Max. Negotiated Rate	$9,680.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,680.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,000.00

PACEMAKER ACCOLADE MRI DR

Facility

$36,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270678215N
Hospital Revenue Code	275
Min. Negotiated Rate	$1,036.60
Max. Negotiated Rate	$18,250.00
Rate for Payer: Aetna Commercial	$13,870.00
Rate for Payer: Aetna Medicare Advantage	$10,950.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,307.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,300.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,307.50
Rate for Payer: Cigna Commercial	$18,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,833.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,475.00
Rate for Payer: UnitedHealthcare Community & State	$1,153.40
Rate for Payer: Wellpoint Medicaid Managed Care	$1,036.60

PACEMAKER ACCOLADE MRI DR

Facility

$36,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270678215N
Hospital Revenue Code	275
Min. Negotiated Rate	$5,475.00
Max. Negotiated Rate	$8,833.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,833.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,475.00

PACEMAKER ACCOLADE MRI DR IS-1

Facility

$38,000.00

Hospital Charge Code	270677287
Hospital Revenue Code	278
Min. Negotiated Rate	$5,700.00
Max. Negotiated Rate	$9,196.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,600.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,196.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,700.00

PACEMAKER ACCOLADE MRI DR IS-1

Facility

$38,000.00

Hospital Charge Code	270677287
Hospital Revenue Code	278
Min. Negotiated Rate	$1,079.20
Max. Negotiated Rate	$19,000.00
Rate for Payer: Aetna Commercial	$14,440.00
Rate for Payer: Aetna Medicare Advantage	$11,400.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9,690.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7,600.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9,690.00
Rate for Payer: Cigna Commercial	$19,000.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,196.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,700.00
Rate for Payer: UnitedHealthcare Community & State	$1,200.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,079.20

PACEMAKER ACCOLADE MRI VR

Facility

$33,500.00

Service Code	HCPCS C1786
Hospital Charge Code	270678188
Hospital Revenue Code	275
Min. Negotiated Rate	$951.40
Max. Negotiated Rate	$16,750.00
Rate for Payer: Aetna Commercial	$12,730.00
Rate for Payer: Aetna Medicare Advantage	$10,050.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,542.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,700.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,542.50
Rate for Payer: Cigna Commercial	$16,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,107.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,025.00
Rate for Payer: UnitedHealthcare Community & State	$1,058.60
Rate for Payer: Wellpoint Medicaid Managed Care	$951.40

PACEMAKER ACCOLADE MRI VR

Facility

$33,500.00

Service Code	HCPCS C1786
Hospital Charge Code	270678188
Hospital Revenue Code	275
Min. Negotiated Rate	$5,025.00
Max. Negotiated Rate	$8,107.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,700.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8,107.00
Rate for Payer: Qualcare PPO/HMO/WC	$5,025.00

PACEMAKER ACOLADE DR

Facility

$40,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270675535
Hospital Revenue Code	275
Min. Negotiated Rate	$1,150.20
Max. Negotiated Rate	$20,250.00
Rate for Payer: Aetna Commercial	$15,390.00
Rate for Payer: Aetna Medicare Advantage	$12,150.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10,327.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,100.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10,327.50
Rate for Payer: Cigna Commercial	$20,250.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,801.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,075.00
Rate for Payer: UnitedHealthcare Community & State	$1,279.80
Rate for Payer: Wellpoint Medicaid Managed Care	$1,150.20

PACEMAKER ACOLADE DR

Facility

$40,500.00

Service Code	HCPCS C1785
Hospital Charge Code	270675535
Hospital Revenue Code	275
Min. Negotiated Rate	$6,075.00
Max. Negotiated Rate	$9,801.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$8,100.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9,801.00
Rate for Payer: Qualcare PPO/HMO/WC	$6,075.00

PACEMAKER ADAPTA DR ADDR01

Facility

$22,020.00

Service Code	HCPCS C1785
Hospital Charge Code	270637950
Hospital Revenue Code	275
Min. Negotiated Rate	$3,303.00
Max. Negotiated Rate	$5,328.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,404.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,328.84
Rate for Payer: Qualcare PPO/HMO/WC	$3,303.00

PACEMAKER ADAPTA DR ADDR01

Facility

$22,020.00

Service Code	HCPCS C1785
Hospital Charge Code	270637950
Hospital Revenue Code	275
Min. Negotiated Rate	$625.37
Max. Negotiated Rate	$11,010.00
Rate for Payer: Aetna Commercial	$8,367.60
Rate for Payer: Aetna Medicare Advantage	$6,606.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,615.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,615.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,404.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,615.10
Rate for Payer: Cigna Commercial	$11,010.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,328.84
Rate for Payer: Qualcare PPO/HMO/WC	$3,303.00
Rate for Payer: UnitedHealthcare Community & State	$695.83
Rate for Payer: Wellpoint Medicaid Managed Care	$625.37

Know your out-of-pocket cost for care.

All Charges