Hoboken University Hospital

All Charges

Charge

Type

Setting

Price

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	84208280
Hospital Revenue Code	510
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	74308310
Hospital Revenue Code	514
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4517718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4509718
Hospital Revenue Code	913
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$678.40

Service Code	HCPCS 99214
Hospital Charge Code	84511045
Hospital Revenue Code	513
Min. Negotiated Rate	$101.76
Max. Negotiated Rate	$101.76
Rate for Payer: Qualcare PPO/HMO/WC	$101.76

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4509718
Hospital Revenue Code	913
Min. Negotiated Rate	$82.50
Max. Negotiated Rate	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$82.50

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	9800385
Hospital Revenue Code	510
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$414.40
Rate for Payer: Aetna Commercial	$314.94
Rate for Payer: Aetna Medicare Advantage	$248.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$211.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$211.34
Rate for Payer: Cigna Commercial	$414.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$215.49
Rate for Payer: Qualcare PPO/HMO/WC	$124.32
Rate for Payer: UnitedHealthcare Community & State	$26.19
Rate for Payer: Wellpoint Medicaid Managed Care	$23.54

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$550.00

Service Code	HCPCS 99214
Hospital Charge Code	4546718
Hospital Revenue Code	913
Min. Negotiated Rate	$15.62
Max. Negotiated Rate	$275.00
Rate for Payer: Aetna Commercial	$209.00
Rate for Payer: Aetna Medicare Advantage	$165.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$140.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$143.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$140.25
Rate for Payer: Cigna Commercial	$275.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$143.00
Rate for Payer: Qualcare PPO/HMO/WC	$82.50
Rate for Payer: UnitedHealthcare Community & State	$17.38
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$118.08
Rate for Payer: Wellpoint Medicaid Managed Care	$15.62

ESTAB PATIENT LEV 4 >=30 MINS

Facility

$828.80

Service Code	HCPCS 99214
Hospital Charge Code	9800385
Hospital Revenue Code	510
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$124.32
Rate for Payer: Qualcare PPO/HMO/WC	$124.32

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	9800395
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4546719
Hospital Revenue Code	913
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$158.24
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4504719
Hospital Revenue Code	913
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$158.24
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4515719
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4824719
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	421599215
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	485599215
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	485599215
Hospital Revenue Code	510
Min. Negotiated Rate	$182.07
Max. Negotiated Rate	$182.07
Rate for Payer: Qualcare PPO/HMO/WC	$182.07

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4818719
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	421099215
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4822719
Hospital Revenue Code	913
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$158.24
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	485099215
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	87502245
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4515719
Hospital Revenue Code	913
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$228.00
Rate for Payer: Aetna Medicare Advantage	$180.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$153.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$193.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$153.00
Rate for Payer: Cigna Commercial	$300.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$156.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00
Rate for Payer: UnitedHealthcare Community & State	$18.96
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$158.24
Rate for Payer: Wellpoint Medicaid Managed Care	$17.04

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$1,213.80

Service Code	HCPCS 99215
Hospital Charge Code	84208285
Hospital Revenue Code	510
Min. Negotiated Rate	$34.47
Max. Negotiated Rate	$606.90
Rate for Payer: Aetna Commercial	$461.24
Rate for Payer: Aetna Medicare Advantage	$364.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$309.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$309.52
Rate for Payer: Cigna Commercial	$606.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$315.59
Rate for Payer: Qualcare PPO/HMO/WC	$182.07
Rate for Payer: UnitedHealthcare Community & State	$38.36
Rate for Payer: Wellpoint Medicaid Managed Care	$34.47

ESTAB PATIENT LEV 5 >=40 MINS

Facility

$600.00

Service Code	HCPCS 99215
Hospital Charge Code	4832719
Hospital Revenue Code	913
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Qualcare PPO/HMO/WC	$90.00

Know your out-of-pocket cost for care.

All Charges