Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ER-REPAIR BLD VESS UP EXT

Facility

$10,555.00

Service Code	HCPCS 35206
Hospital Charge Code	5790090
Hospital Revenue Code	450
Min. Negotiated Rate	$1,583.25
Max. Negotiated Rate	$1,583.25
Rate for Payer: Qualcare PPO/HMO/WC	$1,583.25

ER REPAIR FOOT TENDON

Facility

$17,434.95

Service Code	HCPCS 28200
Hospital Charge Code	5700824
Hospital Revenue Code	450
Min. Negotiated Rate	$2,615.24
Max. Negotiated Rate	$2,615.24
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.24

ER REPAIR FOOT TENDON

Facility

$17,434.95

Service Code	HCPCS 28200
Hospital Charge Code	5700824
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$14,100.89
Rate for Payer: Aetna Commercial	$10,573.24
Rate for Payer: Aetna Medicare Advantage	$12,594.59
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,100.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$3,887.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$189.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,100.89
Rate for Payer: Cigna Commercial	$7,791.93
Rate for Payer: Cigna Medicare Advantage	$3,887.22
Rate for Payer: Clover Medicare Advantage	$3,692.86
Rate for Payer: EmblemHealth Commercial	$11,661.66
Rate for Payer: Humana Medicare Advantage	$4,003.84
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$3,887.22
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4,533.09
Rate for Payer: Qualcare PPO/HMO/WC	$2,615.24
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,887.22
Rate for Payer: Wellcare Medicare Advantage	$3,887.22
Rate for Payer: Wellpoint Medicaid Managed Care	$495.15

ER REPAIR OF NAIL BED

Facility

$545.00

Service Code	HCPCS 11760
Hospital Charge Code	5700466
Hospital Revenue Code	450
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$81.75
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

ER REPAIR OF NAIL BED

Facility

$545.00

Service Code	HCPCS 11760
Hospital Charge Code	5700466
Hospital Revenue Code	450
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$3,185.09
Rate for Payer: Aetna Commercial	$2,388.27
Rate for Payer: Aetna Medicare Advantage	$2,844.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3,185.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$878.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$76.23
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3,185.09
Rate for Payer: Cigna Commercial	$1,760.02
Rate for Payer: Cigna Medicare Advantage	$878.04
Rate for Payer: Clover Medicare Advantage	$834.14
Rate for Payer: EmblemHealth Commercial	$2,634.12
Rate for Payer: Humana Medicare Advantage	$904.38
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$878.04
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.70
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04
Rate for Payer: Wellcare Medicare Advantage	$878.04
Rate for Payer: Wellpoint Medicaid Managed Care	$15.48

ER REPAIR SUPERFCL WOUND-SUTUR

Facility

$1,248.49

Service Code	HCPCS 12001
Hospital Charge Code	5700280
Hospital Revenue Code	450
Min. Negotiated Rate	$35.46
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$41.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$324.61
Rate for Payer: Qualcare PPO/HMO/WC	$187.27
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$35.46

ER REPAIR SUPERFCL WOUND-SUTUR

Facility

$1,248.49

Service Code	HCPCS 12001
Hospital Charge Code	5700280
Hospital Revenue Code	450
Min. Negotiated Rate	$187.27
Max. Negotiated Rate	$187.27
Rate for Payer: Qualcare PPO/HMO/WC	$187.27

ER REP FING EXT TDN PR/SC EACH

Facility

$8,605.25

Service Code	HCPCS 26418
Hospital Charge Code	5700575
Hospital Revenue Code	450
Min. Negotiated Rate	$1,290.79
Max. Negotiated Rate	$1,290.79
Rate for Payer: Qualcare PPO/HMO/WC	$1,290.79

ER REP FING EXT TDN PR/SC EACH

Facility

$8,605.25

Service Code	HCPCS 26418
Hospital Charge Code	5700575
Hospital Revenue Code	450
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$6,929.76
Rate for Payer: Aetna Commercial	$5,196.12
Rate for Payer: Aetna Medicare Advantage	$6,189.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6,929.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$1,910.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$140.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6,929.76
Rate for Payer: Cigna Commercial	$3,829.26
Rate for Payer: Cigna Medicare Advantage	$1,910.34
Rate for Payer: Clover Medicare Advantage	$1,814.82
Rate for Payer: EmblemHealth Commercial	$5,731.02
Rate for Payer: Humana Medicare Advantage	$1,967.65
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$1,910.34
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2,237.36
Rate for Payer: Qualcare PPO/HMO/WC	$1,290.79
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,910.34
Rate for Payer: Wellcare Medicare Advantage	$1,910.34
Rate for Payer: Wellpoint Medicaid Managed Care	$244.39

ER REP LAC FLR MTH TNG TO 2.5

Facility

$463.00

Service Code	HCPCS 41250
Hospital Charge Code	5700646
Hospital Revenue Code	450
Min. Negotiated Rate	$69.45
Max. Negotiated Rate	$69.45
Rate for Payer: Qualcare PPO/HMO/WC	$69.45

ER REP LAC FLR MTH TNG TO 2.5

Facility

$463.00

Service Code	HCPCS 41250
Hospital Charge Code	5700646
Hospital Revenue Code	450
Min. Negotiated Rate	$13.15
Max. Negotiated Rate	$1,925.19
Rate for Payer: Aetna Commercial	$1,443.56
Rate for Payer: Aetna Medicare Advantage	$1,719.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1,925.19
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$530.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1,925.19
Rate for Payer: Cigna Commercial	$1,063.82
Rate for Payer: Cigna Medicare Advantage	$530.72
Rate for Payer: Clover Medicare Advantage	$504.18
Rate for Payer: EmblemHealth Commercial	$1,592.16
Rate for Payer: Humana Medicare Advantage	$546.64
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$530.72
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$120.38
Rate for Payer: Qualcare PPO/HMO/WC	$69.45
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$530.72
Rate for Payer: Wellcare Medicare Advantage	$530.72
Rate for Payer: Wellpoint Medicaid Managed Care	$13.15

ER REP LIP FULL THK, VERMILION

Facility

$2,371.25

Service Code	HCPCS 40650
Hospital Charge Code	5700645
Hospital Revenue Code	450
Min. Negotiated Rate	$355.69
Max. Negotiated Rate	$355.69
Rate for Payer: Qualcare PPO/HMO/WC	$355.69

ER REP LIP FULL THK, VERMILION

Facility

$2,371.25

Service Code	HCPCS 40650
Hospital Charge Code	5700645
Hospital Revenue Code	450
Min. Negotiated Rate	$67.34
Max. Negotiated Rate	$2,324.28
Rate for Payer: Aetna Commercial	$1,742.81
Rate for Payer: Aetna Medicare Advantage	$2,076.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2,324.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2,324.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$640.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$149.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2,324.28
Rate for Payer: Cigna Commercial	$1,284.36
Rate for Payer: Cigna Medicare Advantage	$640.74
Rate for Payer: Clover Medicare Advantage	$608.70
Rate for Payer: EmblemHealth Commercial	$1,922.22
Rate for Payer: Humana Medicare Advantage	$659.96
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$640.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$616.52
Rate for Payer: Qualcare PPO/HMO/WC	$355.69
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$640.74
Rate for Payer: Wellcare Medicare Advantage	$640.74
Rate for Payer: Wellpoint Medicaid Managed Care	$67.34

ER REP SCA/AR/LEG EA ADDI TO 5

Facility

$1,950.00

Service Code	HCPCS 13122
Hospital Charge Code	5700456
Hospital Revenue Code	450
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$975.00
Rate for Payer: Aetna Commercial	$741.00
Rate for Payer: Aetna Medicare Advantage	$585.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$497.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$44.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$497.25
Rate for Payer: Cigna Commercial	$975.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$507.00
Rate for Payer: Qualcare PPO/HMO/WC	$292.50
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: Wellpoint Medicaid Managed Care	$55.38

ER REP SCA/AR/LEG EA ADDI TO 5

Facility

$1,950.00

Service Code	HCPCS 13122
Hospital Charge Code	5700456
Hospital Revenue Code	450
Min. Negotiated Rate	$292.50
Max. Negotiated Rate	$292.50
Rate for Payer: Qualcare PPO/HMO/WC	$292.50

ER REP SIM NCK TO TRUN7.6-12.5

Facility

$545.00

Service Code	HCPCS 12004
Hospital Charge Code	5700516
Hospital Revenue Code	450
Min. Negotiated Rate	$81.75
Max. Negotiated Rate	$81.75
Rate for Payer: Qualcare PPO/HMO/WC	$81.75

ER REP SIM NCK TO TRUN7.6-12.5

Facility

$545.00

Service Code	HCPCS 12004
Hospital Charge Code	5700516
Hospital Revenue Code	450
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$88.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$141.70
Rate for Payer: Qualcare PPO/HMO/WC	$81.75
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$15.48

ER REP SIM NECK TO TRU 2.6-7.5

Facility

$876.31

Service Code	HCPCS 12002
Hospital Charge Code	5700515
Hospital Revenue Code	450
Min. Negotiated Rate	$24.89
Max. Negotiated Rate	$864.65
Rate for Payer: Aetna Commercial	$648.34
Rate for Payer: Aetna Medicare Advantage	$772.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$864.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$238.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$55.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$864.65
Rate for Payer: Cigna Commercial	$477.79
Rate for Payer: Cigna Medicare Advantage	$238.36
Rate for Payer: Clover Medicare Advantage	$226.44
Rate for Payer: EmblemHealth Commercial	$715.08
Rate for Payer: Humana Medicare Advantage	$245.51
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$238.36
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$227.84
Rate for Payer: Qualcare PPO/HMO/WC	$131.45
Rate for Payer: UnitedHealthcare Community & State	$140.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.36
Rate for Payer: Wellcare Medicare Advantage	$238.36
Rate for Payer: Wellpoint Medicaid Managed Care	$24.89

ER REP SIM NECK TO TRU 2.6-7.5

Facility

$876.31

Service Code	HCPCS 12002
Hospital Charge Code	5700515
Hospital Revenue Code	450
Min. Negotiated Rate	$131.45
Max. Negotiated Rate	$131.45
Rate for Payer: Qualcare PPO/HMO/WC	$131.45

ER SEDATION 1 MD <5 YR - 30MIN

Facility

$449.00

Service Code	HCPCS 99143
Hospital Charge Code	5700813
Hospital Revenue Code	370
Min. Negotiated Rate	$67.35
Max. Negotiated Rate	$67.35
Rate for Payer: Qualcare PPO/HMO/WC	$67.35

ER SEDATION 1 MD <5 YR - 30MIN

Facility

$449.00

Service Code	HCPCS 99143
Hospital Charge Code	5700813
Hospital Revenue Code	370
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$224.50
Rate for Payer: Aetna Commercial	$170.62
Rate for Payer: Aetna Medicare Advantage	$134.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$114.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$114.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$114.50
Rate for Payer: Cigna Commercial	$224.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$116.74
Rate for Payer: Oxford Commercial	$89.80
Rate for Payer: Qualcare PPO/HMO/WC	$67.35
Rate for Payer: UnitedHealthcare Commercial	$89.80
Rate for Payer: UnitedHealthcare Community & State	$14.19
Rate for Payer: Wellpoint Medicaid Managed Care	$12.75

ER SEDATION 1 MD >5YRS - 30MIN

Facility

$1,937.60

Service Code	HCPCS 99144
Hospital Charge Code	5700814
Hospital Revenue Code	370
Min. Negotiated Rate	$55.03
Max. Negotiated Rate	$968.80
Rate for Payer: Aetna Commercial	$736.29
Rate for Payer: Aetna Medicare Advantage	$581.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$494.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$494.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$494.09
Rate for Payer: Cigna Commercial	$968.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$503.78
Rate for Payer: Oxford Commercial	$387.52
Rate for Payer: Qualcare PPO/HMO/WC	$290.64
Rate for Payer: UnitedHealthcare Commercial	$387.52
Rate for Payer: UnitedHealthcare Community & State	$61.23
Rate for Payer: Wellpoint Medicaid Managed Care	$55.03

ER SEDATION 1 MD >5YRS - 30MIN

Facility

$1,937.60

Service Code	HCPCS 99144
Hospital Charge Code	5700814
Hospital Revenue Code	370
Min. Negotiated Rate	$290.64
Max. Negotiated Rate	$290.64
Rate for Payer: Qualcare PPO/HMO/WC	$290.64

ER SEDATION 1 MD EACH ADD 15M

Facility

$184.00

Service Code	HCPCS 99145
Hospital Charge Code	5700815
Hospital Revenue Code	370
Min. Negotiated Rate	$5.23
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna Commercial	$69.92
Rate for Payer: Aetna Medicare Advantage	$55.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.92
Rate for Payer: Cigna Commercial	$92.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$47.84
Rate for Payer: Oxford Commercial	$36.80
Rate for Payer: Qualcare PPO/HMO/WC	$27.60
Rate for Payer: UnitedHealthcare Commercial	$36.80
Rate for Payer: UnitedHealthcare Community & State	$5.81
Rate for Payer: Wellpoint Medicaid Managed Care	$5.23

ER SEDATION 1 MD EACH ADD 15M

Facility

$184.00

Service Code	HCPCS 99145
Hospital Charge Code	5700815
Hospital Revenue Code	370
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$27.60
Rate for Payer: Qualcare PPO/HMO/WC	$27.60

Know your out-of-pocket cost for care.

All Charges