Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84509033
Hospital Revenue Code	513
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.85
Rate for Payer: Qualcare PPO/HMO/WC	$72.61
Rate for Payer: UnitedHealthcare Community & State	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

E&M LEVEL III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84509033
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84518033
Hospital Revenue Code	513
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.85
Rate for Payer: Qualcare PPO/HMO/WC	$72.61
Rate for Payer: UnitedHealthcare Community & State	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

E&M LEVEL III 30MINS

Facility

$484.05

Service Code	HCPCS 99203
Hospital Charge Code	84518033
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL III ESTAB. 15 MINS

Facility

$641.45

Service Code	HCPCS 99213
Hospital Charge Code	87504115
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL III ESTAB. 15 MINS

Facility

$641.45

Service Code	HCPCS 99213
Hospital Charge Code	87504115
Hospital Revenue Code	513
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.78
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$20.27
Rate for Payer: Wellpoint Medicaid Managed Care	$18.22

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84509043
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84509043
Hospital Revenue Code	513
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.64
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84517043
Hospital Revenue Code	513
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.64
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84517043
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84518043
Hospital Revenue Code	513
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.64
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

E&M LEVEL III ESTAB.15MINS

Facility

$367.85

Service Code	HCPCS 99213
Hospital Charge Code	84518043
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL IIIESTAB PAT 15MINS

Facility

$367.85

Hospital Charge Code	84504120
Hospital Revenue Code	513
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.64
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

E&M LEVEL IIIESTAB PAT 15MINS

Facility

$367.85

Hospital Charge Code	84504120
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL IIINEW PAT 30MINS

Facility

$484.05

Hospital Charge Code	84504095
Hospital Revenue Code	513
Min. Negotiated Rate	$72.61
Max. Negotiated Rate	$72.61
Rate for Payer: Qualcare PPO/HMO/WC	$72.61

E&M LEVEL IIINEW PAT 30MINS

Facility

$484.05

Hospital Charge Code	84504095
Hospital Revenue Code	513
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$242.03
Rate for Payer: Aetna Commercial	$183.94
Rate for Payer: Aetna Medicare Advantage	$145.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.43
Rate for Payer: Cigna Commercial	$242.03
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$125.85
Rate for Payer: Qualcare PPO/HMO/WC	$72.61
Rate for Payer: UnitedHealthcare Community & State	$15.30
Rate for Payer: Wellpoint Medicaid Managed Care	$13.75

E&M LEVEL II NEW PATIENT20MINS

Facility

$367.85

Hospital Charge Code	84504090
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

E&M LEVEL II NEW PATIENT20MINS

Facility

$367.85

Hospital Charge Code	84504090
Hospital Revenue Code	513
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$183.93
Rate for Payer: Aetna Commercial	$139.78
Rate for Payer: Aetna Medicare Advantage	$110.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$93.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$93.80
Rate for Payer: Cigna Commercial	$183.93
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$95.64
Rate for Payer: Qualcare PPO/HMO/WC	$55.18
Rate for Payer: UnitedHealthcare Community & State	$11.62
Rate for Payer: Wellpoint Medicaid Managed Care	$10.45

E&M LEVEL I NEW PATIENT10 MINS

Facility

$433.40

Hospital Charge Code	84504085
Hospital Revenue Code	513
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$216.70
Rate for Payer: Aetna Commercial	$164.69
Rate for Payer: Aetna Medicare Advantage	$130.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$110.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$110.52
Rate for Payer: Cigna Commercial	$216.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.68
Rate for Payer: Qualcare PPO/HMO/WC	$65.01
Rate for Payer: UnitedHealthcare Community & State	$13.70
Rate for Payer: Wellpoint Medicaid Managed Care	$12.31

E&M LEVEL I NEW PATIENT10 MINS

Facility

$433.40

Hospital Charge Code	84504085
Hospital Revenue Code	513
Min. Negotiated Rate	$65.01
Max. Negotiated Rate	$65.01
Rate for Payer: Qualcare PPO/HMO/WC	$65.01

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84518035
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV 45 MINS

Facility

$800.80

Service Code	HCPCS 99204
Hospital Charge Code	87504095
Hospital Revenue Code	513
Min. Negotiated Rate	$22.74
Max. Negotiated Rate	$400.40
Rate for Payer: Aetna Commercial	$304.30
Rate for Payer: Aetna Medicare Advantage	$240.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$204.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$204.20
Rate for Payer: Cigna Commercial	$400.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$208.21
Rate for Payer: Qualcare PPO/HMO/WC	$120.12
Rate for Payer: UnitedHealthcare Community & State	$25.31
Rate for Payer: Wellpoint Medicaid Managed Care	$22.74

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84518035
Hospital Revenue Code	513
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.78
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$20.27
Rate for Payer: Wellpoint Medicaid Managed Care	$18.22

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84517035
Hospital Revenue Code	513
Min. Negotiated Rate	$96.22
Max. Negotiated Rate	$96.22
Rate for Payer: Qualcare PPO/HMO/WC	$96.22

E&M LEVEL IV 45 MINS

Facility

$641.45

Service Code	HCPCS 99204
Hospital Charge Code	84517035
Hospital Revenue Code	513
Min. Negotiated Rate	$18.22
Max. Negotiated Rate	$320.73
Rate for Payer: Aetna Commercial	$243.75
Rate for Payer: Aetna Medicare Advantage	$192.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$163.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$163.57
Rate for Payer: Cigna Commercial	$320.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$166.78
Rate for Payer: Qualcare PPO/HMO/WC	$96.22
Rate for Payer: UnitedHealthcare Community & State	$20.27
Rate for Payer: Wellpoint Medicaid Managed Care	$18.22

Know your out-of-pocket cost for care.

All Charges