Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	87502230
Hospital Revenue Code	510
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	93950145
Hospital Revenue Code	510
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	485099212
Hospital Revenue Code	510
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	87502230
Hospital Revenue Code	510
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4515716
Hospital Revenue Code	913
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	83652405
Hospital Revenue Code	514
Min. Negotiated Rate	$35.40
Max. Negotiated Rate	$35.40
Rate for Payer: Qualcare PPO/HMO/WC	$35.40

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4509716
Hospital Revenue Code	913
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4502716
Hospital Revenue Code	913
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4509716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4832716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$236.00

Service Code	HCPCS 99212
Hospital Charge Code	83652405
Hospital Revenue Code	514
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$118.00
Rate for Payer: Aetna Commercial	$89.68
Rate for Payer: Aetna Medicare Advantage	$70.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$60.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$60.18
Rate for Payer: Cigna Commercial	$118.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$61.36
Rate for Payer: Qualcare PPO/HMO/WC	$35.40
Rate for Payer: UnitedHealthcare Community & State	$7.46
Rate for Payer: Wellpoint Medicaid Managed Care	$6.70

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	485099212
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4546716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$610.00

Service Code	HCPCS 99212
Hospital Charge Code	421099212
Hospital Revenue Code	510
Min. Negotiated Rate	$91.50
Max. Negotiated Rate	$91.50
Rate for Payer: Qualcare PPO/HMO/WC	$91.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84208270
Hospital Revenue Code	510
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	74308300
Hospital Revenue Code	514
Min. Negotiated Rate	$12.67
Max. Negotiated Rate	$223.00
Rate for Payer: Aetna Commercial	$169.48
Rate for Payer: Aetna Medicare Advantage	$133.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$113.73
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$113.73
Rate for Payer: Cigna Commercial	$223.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$115.96
Rate for Payer: Qualcare PPO/HMO/WC	$66.90
Rate for Payer: UnitedHealthcare Community & State	$14.09
Rate for Payer: Wellpoint Medicaid Managed Care	$12.67

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	84208270
Hospital Revenue Code	510
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	84511041
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

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$446.00

Service Code	HCPCS 99212
Hospital Charge Code	74308300
Hospital Revenue Code	514
Min. Negotiated Rate	$66.90
Max. Negotiated Rate	$66.90
Rate for Payer: Qualcare PPO/HMO/WC	$66.90

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	84511041
Hospital Revenue Code	513
Min. Negotiated Rate	$55.18
Max. Negotiated Rate	$55.18
Rate for Payer: Qualcare PPO/HMO/WC	$55.18

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4504716
Hospital Revenue Code	913
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial	$133.00
Rate for Payer: Aetna Medicare Advantage	$105.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$89.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$58.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$89.25
Rate for Payer: Cigna Commercial	$175.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$91.00
Rate for Payer: Qualcare PPO/HMO/WC	$52.50
Rate for Payer: UnitedHealthcare Community & State	$11.06
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$49.91
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$610.00

Service Code	HCPCS 99212
Hospital Charge Code	421099212
Hospital Revenue Code	510
Min. Negotiated Rate	$17.32
Max. Negotiated Rate	$305.00
Rate for Payer: Aetna Commercial	$231.80
Rate for Payer: Aetna Medicare Advantage	$183.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$155.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$155.55
Rate for Payer: Cigna Commercial	$305.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$158.60
Rate for Payer: Qualcare PPO/HMO/WC	$91.50
Rate for Payer: UnitedHealthcare Community & State	$19.28
Rate for Payer: Wellpoint Medicaid Managed Care	$17.32

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$367.85

Service Code	HCPCS 99212
Hospital Charge Code	87506070
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

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4515716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

ESTAB PATIENT LEV 2 >=10 MINS

Facility

$350.00

Service Code	HCPCS 99212
Hospital Charge Code	4502716
Hospital Revenue Code	913
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$52.50
Rate for Payer: Qualcare PPO/HMO/WC	$52.50

Know your out-of-pocket cost for care.

All Charges