Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84518047
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 V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84518047
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 V ESTAB. 40 MINS

Facility

$641.45

Hospital Charge Code	84310185
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 V ESTAB. 40 MINS

Facility

$641.45

Hospital Charge Code	84310185
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 V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84517047
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 V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84517047
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 V ESTAB. 40 MINS

Facility

$1,048.92

Service Code	HCPCS 99215
Hospital Charge Code	87504125
Hospital Revenue Code	513
Min. Negotiated Rate	$29.79
Max. Negotiated Rate	$524.46
Rate for Payer: Aetna Commercial	$398.59
Rate for Payer: Aetna Medicare Advantage	$314.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$267.47
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$267.47
Rate for Payer: Cigna Commercial	$524.46
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$272.72
Rate for Payer: Qualcare PPO/HMO/WC	$157.34
Rate for Payer: UnitedHealthcare Community & State	$33.15
Rate for Payer: Wellpoint Medicaid Managed Care	$29.79

E&M LEVEL V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84509047
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 V ESTAB. 40 MINS

Facility

$641.45

Service Code	HCPCS 99215
Hospital Charge Code	84509047
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 V ESTAB. 40 MINS

Facility

$1,048.92

Service Code	HCPCS 99215
Hospital Charge Code	87504125
Hospital Revenue Code	513
Min. Negotiated Rate	$157.34
Max. Negotiated Rate	$157.34
Rate for Payer: Qualcare PPO/HMO/WC	$157.34

E&M LEVEL V- ESTAB PAT 40MINS

Facility

$641.45

Hospital Charge Code	84504130
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 V- ESTAB PAT 40MINS

Facility

$641.45

Hospital Charge Code	84504130
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 V- NEW PAT 60 MINS

Facility

$877.65

Hospital Charge Code	84504105
Hospital Revenue Code	513
Min. Negotiated Rate	$24.93
Max. Negotiated Rate	$438.82
Rate for Payer: Aetna Commercial	$333.51
Rate for Payer: Aetna Medicare Advantage	$263.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$223.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$223.80
Rate for Payer: Cigna Commercial	$438.82
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$228.19
Rate for Payer: Qualcare PPO/HMO/WC	$131.65
Rate for Payer: UnitedHealthcare Community & State	$27.73
Rate for Payer: Wellpoint Medicaid Managed Care	$24.93

E&M LEVEL V- NEW PAT 60 MINS

Facility

$877.65

Hospital Charge Code	84504105
Hospital Revenue Code	513
Min. Negotiated Rate	$131.65
Max. Negotiated Rate	$131.65
Rate for Payer: Qualcare PPO/HMO/WC	$131.65

EMR KIT FOR STD GASTROSCOPE

Facility

$1,629.05

Hospital Charge Code	270683729
Hospital Revenue Code	272
Min. Negotiated Rate	$244.36
Max. Negotiated Rate	$244.36
Rate for Payer: Qualcare PPO/HMO/WC	$244.36

EMR KIT FOR STD GASTROSCOPE

Facility

$1,629.05

Hospital Charge Code	270683729
Hospital Revenue Code	272
Min. Negotiated Rate	$46.27
Max. Negotiated Rate	$814.52
Rate for Payer: Aetna Commercial	$619.04
Rate for Payer: Aetna Medicare Advantage	$488.71
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$415.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$415.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$415.41
Rate for Payer: Cigna Commercial	$814.52
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$423.55
Rate for Payer: Oxford Commercial	$325.81
Rate for Payer: Qualcare PPO/HMO/WC	$244.36
Rate for Payer: UnitedHealthcare Commercial	$325.81
Rate for Payer: UnitedHealthcare Community & State	$51.48
Rate for Payer: Wellpoint Medicaid Managed Care	$46.27

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273N
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$1,815.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273C
Hospital Revenue Code	278
Min. Negotiated Rate	$1,162.50
Max. Negotiated Rate	$1,875.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,750.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273C
Hospital Revenue Code	278
Min. Negotiated Rate	$220.10
Max. Negotiated Rate	$3,875.00
Rate for Payer: Aetna Commercial	$2,945.00
Rate for Payer: Aetna Medicare Advantage	$2,325.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,976.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,550.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,976.25
Rate for Payer: Cigna Commercial	$3,875.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,875.50
Rate for Payer: Qualcare PPO/HMO/WC	$1,162.50
Rate for Payer: UnitedHealthcare Community & State	$244.90
Rate for Payer: Wellpoint Medicaid Managed Care	$220.10

EMSHLD NAV6 S 5.0X190 22437-19

Facility

$7,500.00

Service Code	HCPCS C1884
Hospital Charge Code	270643273N
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Aetna Commercial	$2,850.00
Rate for Payer: Aetna Medicare Advantage	$2,250.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,912.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,500.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,912.50
Rate for Payer: Cigna Commercial	$3,750.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1,815.00
Rate for Payer: Qualcare PPO/HMO/WC	$1,125.00
Rate for Payer: UnitedHealthcare Community & State	$237.00
Rate for Payer: Wellpoint Medicaid Managed Care	$213.00

EMTRICITABINE 200MG CAP

Facility

$134.54

Service Code	NDC 61958060101
Hospital Charge Code	60632245
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$20.18
Rate for Payer: Qualcare PPO/HMO/WC	$20.18

EMTRICITABINE 200MG CAP

Facility

$134.54

Service Code	NDC 61958060101
Hospital Charge Code	60632245
Hospital Revenue Code	250
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$67.27
Rate for Payer: Aetna Commercial	$51.13
Rate for Payer: Aetna Medicare Advantage	$40.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$34.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$34.31
Rate for Payer: Cigna Commercial	$67.27
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$34.98
Rate for Payer: Oxford Commercial	$26.91
Rate for Payer: Qualcare PPO/HMO/WC	$20.18
Rate for Payer: UnitedHealthcare Commercial	$26.91
Rate for Payer: UnitedHealthcare Community & State	$4.25
Rate for Payer: Wellpoint Medicaid Managed Care	$3.82

EMTRICITABINE-TENOFOVIR200/300

Facility

$343.91

Service Code	NDC 61958070101
Hospital Charge Code	60629963
Hospital Revenue Code	250
Min. Negotiated Rate	$51.59
Max. Negotiated Rate	$51.59
Rate for Payer: Qualcare PPO/HMO/WC	$51.59

EMTRICITABINE-TENOFOVIR200/300

Facility

$343.91

Service Code	NDC 61958070101
Hospital Charge Code	60629963
Hospital Revenue Code	250
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$171.96
Rate for Payer: Aetna Commercial	$130.69
Rate for Payer: Aetna Medicare Advantage	$103.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$87.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$87.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$87.70
Rate for Payer: Cigna Commercial	$171.96
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$89.42
Rate for Payer: Oxford Commercial	$68.78
Rate for Payer: Qualcare PPO/HMO/WC	$51.59
Rate for Payer: UnitedHealthcare Commercial	$68.78
Rate for Payer: UnitedHealthcare Community & State	$10.87
Rate for Payer: Wellpoint Medicaid Managed Care	$9.77

EMTRIVA ORAL SOLN 10MG/ML

Facility

$5.63

Service Code	NDC 61958060201
Hospital Charge Code	60635533
Hospital Revenue Code	250
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

Know your out-of-pocket cost for care.

All Charges