Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4824710
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4509710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4546710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4510710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4502710
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4502710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4517710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4509710
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4822710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4504710
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 10 MINS NEW PAT

Facility

$250.00

Service Code	HCPCS 99201
Hospital Charge Code	4504710
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4515715
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25.68
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4510715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4824715
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25.68
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4504715
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25.68
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4515715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4518715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4504715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4510715
Hospital Revenue Code	913
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$19.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$65.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$7.90
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$25.68
Rate for Payer: Wellpoint Medicaid Managed Care	$7.10

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4824715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4509715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4517715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4546715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4527715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

E&M LEVEL I 5 MINS EST PAT

Facility

$250.00

Service Code	HCPCS 99211
Hospital Charge Code	4832715
Hospital Revenue Code	913
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$37.50
Rate for Payer: Qualcare PPO/HMO/WC	$37.50

Know your out-of-pocket cost for care.

All Charges